Here’s the transcript of my Thursday chat with columnist-to-the-world Mark Steyn, which includes a comparison of Canadian, British and Bulgarian health care.
And here is the transcript and here the podcast of the first hour of my two hour conversation with Meg Whitman, candidate for governor in California and former CEO of eBay. The second hour will air later this week as I continue the “100 Days of Obama Tour” with some combination of Bill Bennett, Mike Gallagher, Michael Medved and Dennis Prager.
My next Townhall.com column will be on Whitman, but California voters especially ought to read the entire interview.
Every American ought to read a few times Steyn’s caution on why the Dems are so hot to impose rationing via a “government option” on health care. I asked Mark why –when it has failed everywhere it has been tried– the left is still so fond of single payer. His response:
HH: Well now, this all is a roundabout way of coming, because I’m trying to figure this out, I’m spending the month of May on American medicine, asking doctors, posting their e-mails at Hughhewitt.com, why do the Democrats want to do this? We have no evidence that it works anywhere. They call it a government option, but it’s really single payer, and it really means rationing. Everywhere you try it, you just mentioned Bulgaria, Great Britain and Canada, it is a disaster. Why do they want to do it?
MS: Well, what is does is, if you’re a Democrat, what it does is it changes the relationship between the citizen and the state. It alters the equation. If you provide government health care, then suddenly all the elections, they’re not thought about war and foreign policy, or even big economic questions. They’re suddenly fought about government services, and the level of government services, and that’s all they’re about, because once you get government health care, the citizens’ dependency on government as provider is so fundamentally changed that in effect, every election is fought on left wing terms. And for the Democratic Party, that is a huge, transformative advantage.
HH: Oh, that’s very interesting. Now in Canada, though, don’t people get mad at their quality of health care? Don’t they throw the bums out and perhaps urge a return to American style medicine?
MS: No, because the strange thing is that when people, even when people have really bad experiences, you see this in the British press all the time whenever they have one of these horror stories about someone who goes in because they’ve got a bad case of, they’ve got a case of pneumonia, and they wake up and find their left leg’s been amputated because the wrong memo went around. All those horror stories are always followed two days later by someone writing a fawningly, groveling letter about having received mediocre, third world care, but being eternally grateful for it. It really does, government health care is really the ditch you want to fight in, because once you surrender that, I think it’s very difficult to have genuine self-reliant citizenry every again. It really fundamentally changes the equation.
HH: Then where’s the AMA? Where is business? Why hasn’t this battle been joined even as the ink is getting very dry on the big Obama rewrite of American medicine?
MS: Well, because I think most of the spokesmen for the conservative argument in Washington do not make the case. And they don’t understand that once you’ve got a government system, it becomes like any other government program. On Friday, you have to pay the doctor, you have to pay the nurse, you have to pay the janitor. So your only way of controlling the cost is to restrict access to the patient, to the customer. And that’s why once you’ve got a government health care system, everything is about waiting lists and waiting time. It’s about waiting two years for a hip operation. It’s about waiting 9 months for an MRI. It’s about waiting, waiting, waiting.
“Stop ObamaCare” by James C. Capretta and Yuval Levin in the new Weekly Standard is a first sign of serious resistance to the Obama/Pelosi/Reid rationing plan due for its public debut in the next few weeks. The key insight:
[T]he Obama plan would involve a profound displacement of currently insured Americans, who for the most part are happy with their coverage and will not appreciate being dumped into a program that could end up resembling Medicaid. A recent study by the Lewin Group estimates that almost 120 million Americans could be forced from employer-based coverage into government-run insurance by the kind of two-step strategy the Democrats envision. Americans with stable job-based insurance do not know this is what Democrats have in store for them, and they will not be happy about it.
There are numerous, other killer flaws in the plan, chief among them the certain and disastrous impact on care for the elderly who will be the first to feel the impact of government imposed limits on their health care choices. AARP may have sold out to the new Democratic majorities, but AARP doesn’t represent the nation’s senior citizens when it comes to rationing, and the seniors will be heard on the Hill and will vote in 2010.
Below are a couple more of the e-mails from doctors which continue to arrive on the subject of what single-payer means. The GOP has got to begin now to demand details and open hearings on the radical attempt to end American medicine as it exists and replace it with a bad version of Canadian rationing.
From the MDs.
Dr. R. in CO:
My background, inspired by my sister’s new husband, a great cardiac surgeon, I decided to become a physician around age 12. Ironically, money had nothing to do with it, but now that I am close to retirement, I am sure glad I that made some. Physician’s pay is about to plummet.The type of person who will be applying to medical school in the future will be a lot different than me and my classmates. I spent part of my 4th year of medical school in London and saw the future. Students there knew they were going to be low paid but secure drones and didn’t work very hard. I knew that I had unlimited possibilities if I worked hard. I did work very hard, both in training and in practice, and I view myself as a great success. As a student in London, I was in the library reading journals every spare moment. The only English student I ever saw there ( in the library) was planning on going to the States after graduation to do a residency in neurosurgery. None were available in England (topic for another day). All the other students were going to be primary care doctors. They had no other choice. They did no extra studying, just got through the program. They were going to be sent to the equivalent of Appalacia to do primary care for quite a few years to achieve payback for their education.One of my fellow physicians is a refugee from Canada. He say that it took about two years to implement fully the one-payer system there. Then, healthcare providers got paid under the system just great for the next two years. Then, they ran out of money. Payments were slashed, waiting lists established, and denial of care ( a more realistic term than rationing) was under way. I believe that last year the Supreme Court in Canada ruled that access to a waiting list does not constitute medical care. This came after a man was told to wait months to get an MR scan to find his brain tumor. He didn’t wait, but came to the States and had his brain tumor detected in a matter of days. He returned to Canada to be told that it would take months for him to get in to see a neurosurgeon and some time after that to actually have an operation in a hospital. He went South again and once more had appropriate treatment in a matter of days. The Canadian system declined to pay for the US care and the lawsuit followed. Where are we going to go when we are denied care here? Mexico?, Thailand?, Singapore?, Costa Rica?Finally, a word about the “uninsured”. These folks, estimated to number ~46 million, are one of the big drivers pushing the nation to a one-payer system. Study after study has shown that most of these patients are 1) eligible for gov’t programs already,2) transiently uninsured because of job change, 3) making good money but have elected not to buy insurance, 4) illegal aliens. The hardcore long-term uninsured only number 10 to 15 million. In a nation of 300 million, this really should not be a big problem. Providing some level of care for the 3-5% that are truly uninsurable should not be a justification for screwing things up for everybody else.
I have been a practicing orthopedic surgeon in Honolulu for 17 years. I cannot state strongly enough how concerned I am over impending “universal/rationed” healthcare in this great country of ours.It is my opinion that the AMA has “sold out” on Capitol Hill. The “11,000 Doctors for Obama” is a fabrication…….even if it was real, it would represent less than 2% of America’s doctors. Virtually every physician I know is strongly against nationalization of healthcare—it will create rationing and restrict American citizens’ access to timely and quality healthcare.For the past 40 years, Medicare has set physician reimbursements, and then steadily decreased them, accelerated especially in the past 15 years. In Hawaii, the private insurers have taken their cues from Medicare and currently reimburse physicians 10-20% above Medicare rates. Over the past 25 years, a study presented by the American Association of Hip and Knee Surgeons has shown that the reimbursement to a surgeon for a hip or knee replacement has DECREASED by over 80%. It doesn’t make any difference how skilled or how highly-trained the surgeon is—-Medicare pays the same low rate to all surgeons. Patients are uniformly appalled at how little we get paid once they receive their bills! It is a federal offense to charge/collect more than the Medicare set fee, and the doctor MUST collect the patient’s 20% co-pay under the same law. Thus, it becomes impossible to perform “charity work”! To “make up” for this ever-decreasing reimbursement, doctors are having to see more and more volume of patients each day just to “keep the lights on.” This results, in and of itself, in a lessening of quality of care for each patient.Hawaii has been losing it’s physicians to the mainland due to the high cost of living and the high cost of doing business in our State. No doctors can afford to come in to replace these physicians. Now, the mainland is feeling the same pressures.New Medicare patients moving to Hawaii are increasingly told by primary-care doctors that they are “no longer taking” new Medicare patients because their practices are overflowing—-now THAT is restriction of access to care.In 1994 Hillary Clinton held up the State of Hawaii as the “model” for her proposed healthcare reform system (“Everybody in Hawaii is covered by insurance.”). Now, that very State is becoming the first to crumble under the CURRENT system—–and that’s BEFORE the Nation adopts “universal healthcare.”I have contacted our Federal and State representatives and met with the insurance companies, pleading our case to no avail.Thus, I have taken my own personal step to attempt to preserve the sacred doctor/patient relationship: I dropped out of Medicare and no longer accept private insurance. Thus, I can set my fees according to complexity of each case, and on patient’s ability to pay….. without fear of governmental retribution. Some patients are upset with this, but the vast majority are very understanding and supportive once the situation is explained to them by my staff and me. Patients really have NO IDEA how their current healthcare delivery system works (nor do many physicians!).Most doctors became doctors to HELP PEOPLE….not to get rich. The institution of so-called “universal healthcare” in the U.S. will no longer allow doctors to help the very people who need help.
If you are a doctor with an opinion on Obama/Pelosi/Reid rationing, send it to me via firstname.lastname@example.org.
Dr. John Mark Reynolds is a Professor of Philosophy at Biola University where he also leads the Torrey Honors Institute, a source of an extraordinary number of gifted young conservative intellectuals (and at least one young USMC Lieutenant.) I asked him recently for his thoughts on how to go about creating young conservatives as he has been so successful in doing so for so many years. His essay follows. Send it to every elected conservative you know.
On Creating Young Conservatives
by Dr. John Mark Reynolds
Losing an aging Arlen Specter will do little harm to a movement long term. Losing the youth vote year after year is a sign of approaching party senility.
Obama won the youth vote overwhelmingly. Some conservatives believe that he won because of his acknowledged personal qualities and awesome campaign skills. A recent Rasmussen Report analysis of polling data suggests that while being a super hero campaigner never hurts, Obama won because of his ideas. He won the youth vote, because young voters are more liberal than previous generations.
That has to change for the good of the nation. Sadly for the good of the nation, Obama will fail as president, but the nation may not perceive this failure. He will fail, because the actions he has already taken will limit our liberty. Our liberty may be impaired, but people may become accustomed to it.
The good news for conservatives is there is no reason to split our economic and social conservative base. The bad news is that this is because Obama’s young voters reject both wings of the party. They are not social conservatives and they are not economic libertarians.
Not all youthful voters can be reached. Many have decided on their political philosophy and will not change their minds. We cannot persuade them if they will not listen and many have closed their minds to conservatives.
Partly this is a natural reaction of youth to their parents who are one of the most conservative generations in US history. Patient citizens will see the Obama generation raise a conservative cohort in thirty years, but sadly too much damage can be done to the Republic in the meantime to wait.
My experience shows a sizeable minority of Obama voters can be reached by good conservative arguments. Conservatives need only persuade a portion of Obama’s voters to change their minds, but not by alienating that third of the young who already vote for conservative candidates.[# More #]
The Long Road Back Begins with Education
You cannot win by subtracting and conservatives need not immediately win the youth vote, just reduce the size of the defeat. This should begin with groups that are less conservative than one would anticipate. The core youth vote for conservatives is traditionally Christian and there is room for growth. Conservatives are underachieving in what should be their core constituency.
Partly this is because too many conservative educational institutions are either too sectarian or mostly secular. Those that claim to be broad based often ignore important classes of potential conservative voters.
There are major conservative organizations having few if any young Evangelical Christian voices. This is embarrassing given the clout such voters have in the conservative movement. Conservatives who are Evangelical often end up in their own organizations and seemingly “appear” every few years in primaries like Iowa. Conservatives don’t talk to each other enough.
Evangelicals should learn to listen to atheists, but atheist conservatives should listen to young, bright Evangelicals who disagree with some of their views. This should happen in one place where possible!
Winning voters who think they disagree with conservatism need not begin by becoming less conservative. What would be the point of this? If after close examination of our own views, we still think the conservative philosophy correct, we need to begin the long slow process of educating persuadable voters.
This begins by listening and not attacking. Rousing the base has its place, but when one is in the minority it is of limited use. Humility, time, and discussion are the best approaches to those who disagree with us, but could be persuaded.
It is hard for me to name institutions that are set up to persuade those on the left. Such institutions may not excite the base, but they will expand it. Conservatism needs media (old and new) that does not require total “buy in.” Gradual exposure to conservative positions will slowly move the thoughtful voter toward mainline conservative media.
In a different generation voices like Paul Harvey served as a “first-contact” for many Americans to the conservative mainstream. They were media figures first in the public mind, conservatives second. Paul Harvey made minds receptive to conservative ideas. Such people and institutions should be conservative without announcing it at every turn. A young-sort-of-liberal vegan would find a Hannity too much red meat and needs a gentler diet first!
It is sad that young voters have the views they have. There are probably social institutions such as the major media and schools that share some of the blame for this situation, but conservative whining should end. Major change is not coming soon and so we need to embrace our role of underdogs and begin to infiltrate liberal institutions while strengthening those that are still conservative.
Most youth voters I meet, even from conservative families, have never heard an intellectual case for conservative economics or social policy that is also sensitive to the poor and to the environment. This does not require so much a new conservatism as new educational approach. The initial success of Mike Huckabee shows that young voters, and he did very well with Republican young voters, are waiting for someone who can explain our views.
Too often conservatives have looked for quick fix solutions that ignore the years of educational effort that will be required to solve this problem. This will begin by strengthening conservative schools and media institutions we already have. Why don’t conservative donors endow chairs in conservatism at more schools? Many middle-sized Christian colleges and universities, while non-partisan, are sensitive enough to their overwhelmingly conservative constituencies to accept such gifts.
Imagine scores of conservative scholars freed to educate and mentor the next generation of conservative leaders. One student once said to me, “I wish conservative leaders did not keep embarrassing me.” The student was no coward, but leaders, particularly on the religious right, were not helping but harming him.
Don’t Embarrass Me: Creating a Middlebrow Conservatism
I believe there are many young conservative voters, often religious, looking for a party that will not embarrass them. It is already hard when you are young to stand against the majority and conservatives should want to make it easier, not harder. We cannot win the youth vote with candidates who make conservatives hold their breath in debates lest they say something stupid.
We need candidates who can explain our pro-life views by making arguments, not just repeating talking points. This is one of the strengths of the left and of Obama. The entire left does not take a high tone. There is a left-wing noise machine-and such populist style will always exist in a republic. Conservatives can generally match the left at this level of discourse, but control of schools, “middle-brow” cultural institutions, and media have given the left an overwhelming advantage at “middle-brow” discussions.
It is not conservatism when big business and big government corrupt each other. We don’t need a new conservatism to say this, I have never met a serious conservative who favors graft or lets Wall Street plutocrats off the hook for their part in the corruption of our national affairs, but we do need to say it more loudly. Most of my students, the majority from households that consume huge amounts of conservative media, have never heard it.
Conservatives need strong apologetics, a defense of their point of view. Strong defense requires a charitable understanding of the other side. Nobody will be persuaded if the liberalism being attacked bears no resemblance to the liberalism they have (weakly!) embraced.
Our approach must be dialectic, centered in listening and discussion, rather than preaching. Persuadable Obama voters have rejected what they believe is conservatism and one thing they think they know about conservatism is that it is narrow minded and intolerant. Discussion with thinkers on both sides of the aisle is the key to ending this perception. Some communicators like Hewitt and Medved do this, but
many do not.
Conservatives have thinkers, living and historic. Conservatism has good populist roots in the United States. Yet these days conservatives lack a way of appealing to the influential intellectual middle. National Review is a good start, but is not enough.
We either need to be part of or fund the equivalent of middlebrow institutions such NPR and public television to discuss the entire culture from a conservative point of view. A political movement in a republic cannot be healthy if it loses the class of people who are not professional intellectuals, but who care deeply about the life of the mind. Such folk will produce much of the popular entertainments consumed by the rest of us.
At present, middlebrow media is overwhelmingly leftist.
My personal experience suggests that young voters can be persuaded to consider conservative ideas and solutions. The total dominance in Washington of liberalism gives us prized “outsider status.” This is a good moment to begin the long process of educating the next generation of voters so that generation Obama gives way to generation Conservative.