Sometimes the voting behavior of certain members of “the world’s greatest deliberative body” is so far beneath contempt that it can be likened to a demented limbo dance, in which the bar is set so low that only the most reptilian of U.S. Senators dare try to slither under it. Sue Sturgis of Facing South may have found a new measure for such low-lifery in the U.S. Senate in her report “The 10 Senators who vetoed insurance protection for domestic violence survivors.” As Sturgis explains:

…Health insurance companies in a number of states and the District of Columbia are allowed by law to treat domestic violence as a pre-existing condition for which they can deny individual coverage…The story was met with outrage, but it gets even worse.
The blog of the Service Employees International Union, which is pressing for health insurance reform, reports that in 2006 a Senate committee considered an amendment to the Health Insurance Marketplace Modernization and Affordability Act that would have required insurers to stop ignoring state laws that make it illegal for them to deny coverage to domestic violence survivors — and 10 Senators, all Republicans, voted against it. They were:
* Lamar Alexander (R-Tenn.)
* Richard Burr (R-N.C.)
* John Ensign (R-Nev.)
* Mike Enzi (R-Wy.)
* Bill Frist (R-Tenn.)
* Judd Gregg (R-N.H.)
* Orrin Hatch (R-Utah)
* Johnny Isakson (R-Ga.)
* Pat Roberts (R-Kan.)
* Jeff Sessions (R-Ala.)

Yes, that’s right. These ten Republican Senators reportedly voted to protect the right of health insurers to deny coverage to women who have been beaten by their spouses. As Sturgis notes, Frist, a physician no less, is thankfully out of the picture. But the others are still railing away, doing what they can to stop the Democratic reform plan. If they think it’s OK for insurance companies to penalize battered women, it’s hard to imagine what kind of “reform” they would support.

President Obama’s TV blitz amounts to a declaration of all-out media war against the GOP’s efforts to obstruct health care reform with lies and distortions. Katharine Q. Seelye reports in the New York Times on the President’s historic media initiative:

For the first time ever, a president is appearing on five talk shows on a single Sunday, in quick succession — on ABC, CBS, NBC, CNN and Univision. (To be clear: He is taping them Friday night at the White House, not sprinting from set to set on Sunday)… Collectively, those five shows reach almost 12 million people, according to Nielsen…The president is leaving no channel unchurned in his quest to convince Congress to pass a health care overhaul.

Seelye points out that Obama’s blitz “raises the ante” and “suggests he knows he needs to do something dramatic to alter the course of debate.” The risk is that the President will expose himself to tricky “gotcha” questions, which are difficult to anticipate. In addition, Obama’s strongest messaging weapon is the speech, not the television interview, in which his skills are about average among leading Democrats. Still, time is short, and he has few alternatives to using as many major TV programs as he can to help educate voters and persuade undecided Senators and House reps.
Ads, with Obama in particular, provide an edge over interviews in that they can be edited and tweaked for maximum effect. The downside is that they are expensive, while interviews cost nothing but time. Hopefully, the DNC and health reform groups are re-packaging bits of his well-received health care address to congress into TV ads, which also depict the outrageous injustices practiced by health insurance companies. Not doing so would be the equivalent of the DNC’s failure to re-package Al Gore’s excellent acceptance address at the 2000 convention, which soon disappeared unused into the ether, while his campaign ran mediocre ads. We can be certain that the health insurance industry is now preparing an ad blitz of unprecedented scale. If Dems and their supporting organizations get buried by a tidal wave of insurance industry TV ads and respond weakly, we will have only ourselves to blame.
The optimistic scenario is that Obama handles the interviews exceptionally-well, which is certainly possible and Democrats and health reform groups run a great ad blitz that more than offsets the insurance industry effort. If these two challenges are met, it could help make the difference between victory and defeat on health care reform.
It’s probably too much to hope that a good YouTube health care reform video will go viral as did the “Yes We Can” clip, although there are some good ones available. Seelye also reports that a coalition group, Health Care for America now has budgeted $1.2 million to run an ad on nation-wide cable TV and Washington, D.C.-area television (It’s a pretty tough, but very short ad. see it here), as well as print ad in political publications. For those who like longer (about 11 minutes), tougher fare, in this video clip Keith Olbermann gets seriously medieval on specific members of congress who oppose/obstruct health reform while taking big money from the health insurance companies. Also, YouTube has dozens of video clips from Michael Moore’s “Sicko.”
The great advantage of videos and documentaries is that they can show the need for health care reform as opposed to just talking about it. The networks could do a tremendous public service that could save the lives of many simply by showing some of the better videos and documentaries about health care and the need for reform in the days ahead. It’s unlikely that network programming execs will ever have a better opportunity to do something great for their country and its people.

Those old enough to remember what the McCarthy Era felt like will recognize the re-emergence of an ugly meme in American politics: branding reforms and individuals as “Socialist.” Of course, red-baiting never really went completely away. But now it’s back in a big way. The idea here is to demonize their liberal adversaries as authoritarian, even those who are advocating the most moderately liberal of reforms.
Effective branding, as every experienced business person knows, requires repetition. And so here we go with conservative ideologues repeated demonizing of liberal supporters of health care reform as “Socialists.” Presumably the term “Communist” has been judged a little too harsh for modern meme-propagation, at least at this juncture. But the same twisted, fear-mongering psychology is at work, and if unchallenged, it could get worse.
I suspect that many, if not most of the latter-day red-baiters have no clue that there are many stable governments that have free speech, free elections and embrace what can be described as ‘Socialist’ policies. They merely parrot memes they have heard on Fox Network, Freedomworks or WorldnetDaily.Com, encouraged by GOP opinion leaders who know better.
The New York Times ‘Room for Debate’ blog is running a mini-forum on “What is Socialism 2009?,” with contributions by academics and journalists. A couple of their short essays, followed by some perceptive reader comments, illuminate the psychology behind latest round of neo-Mcarthyist Socialist-bashing.
In his essay, Andrew Hartman an assistant professor of history at Illinois State University, observes:

…The degree to which conservatives invoke the specter of socialism has always been more calibrated to domestic anxieties than to foreign threats…For many, the label serves as an effective, if cynical sledgehammer. In a nation with a long history of anti-socialist sentiments, if health care reform can be associated with “socialism,” that’s good strategy.

In her contribution, The Nation Editor Katrina Vanden Heuval explains:

America’s Glenn Beck-inspired mobs would consider social democracy one and the same as socialism or communism. But there is a difference; and it is one which our history textbooks and our media have for the most part failed to fill us in on. So, now we are in a vacuum, and misinformation and mendacity fills it. At our peril. Isn’t social democracy — or call it socialism with a human face — all about a healthy and thriving public sphere in education, health care, transportation, libraries, parks, childcare? Isn’t it about government programs that improve the conditions of people’s lives? If that is socialism, then Medicare is our America variant of socialism.
We are poorer today for the divisions unleashed by those who would lash the label “socialism” around the neck of a moderately liberal president in order to cripple efforts by government to play a smart and humane role.

A commenter, Bill Hoagland adds:

When a reactionary political party has nothing positive to offer, and they desire to maintain the status quo– they can only resort to negativity. Calling someone a “Liberal” doesn’t quite have the negative connotation that they were once able to attach to it. So they label someone a “Socialist” and attack the person, or the plan. But it is nothing except ‘name calling’…

But a few Republican leaders are getting a bit worried. Former Bush speechwriter David Frum, quoted in Peter Wallsten’s L.A. Times article “Some fear GOP is being carried to the extreme,” has expressed concern about “wild accusations and the paranoid delusions coming from the fever swamps…you have to be aware that there’s a line where legitimate concerns begin to collapse into paranoid fantasy.”
When the problem is ignorance, as always, the best approach is education. In her CNNPolitics.com commentary, Yale professor Jennifer Klein describes one couple’s stated fears of “a socialist takeover of their health care” voiced at one of the recent town hall meetings. Klein, co-author, with Eilene Boris of “For All These Rights: Business, Labor, and the Shaping of America’s Public-Private Welfare State,” explains in interesting historical detail how the couple’s health care with the United Mineworkers’ union, has been government-subsidized from the outset.
But Klein concludes on a cautionary note and observes,

Health care reform will derail once more if we can’t learn to talk honestly about public benefits and public goods — how they protect us from the insecurities and inequities of the market and promote genuine economic security in the face of real imbalances of economic power and resources…The only moments when health security has been achieved in America are those founded on a partnership between empowered citizens and the federal government…It’s been the American way all along.

The “Socialist” accusation is being responded to across the country by progressives favoring an expanded role for government in health care reform. Although the climate of fear is not as intense as it was during the McCarthy era, Democrats should expect the attacks for a while longer, until even lazy reporters who can’t analyze policy get tired of writing about it. The thing is to be ready for it, to have some good soundbites and brief responses that put the accusations in proper perspective, such as:

“I think real socialists would laugh at the notion that the President’s plan is anything but a modest adjustment to capitalist health care.”

or,

“Name-calling is the signature of a failed argument. They are accusing us of being “Socialist” to distract people from the weakness of their position.”

or,

“If the President’s plan is so ‘Socialist”, why are physicians organizations and pharmaceutical companies supporting it?”

After that is accomplished, we can steer the discusssion away from name-calling and back toward the impressive benefits of health reforms being proposed by Democrats.

Although Reagan and Gingrich have long been out of power, there is a sense in which the Reagan-Gingrich era of government-bashing still rules America. Their accomplishment, begun by Reagan and hammered into place by Gingrich, is quite remarkable. The “government is bad” meme has been floating around in GOP circles for nearly a century. What they suceeded in doing, however, is implanting it as the knee-jerk, default belief, not only among conservative ideologues, but among millions of low-information voters, including Independents and not a few Democrats.
I’m not saying subscribers to the meme are a majority at the moment. They are not. A CBS News/New York Times Poll conducted 7/24-28, for example, found that 53 percent of respondents were “not willing” “for the government to provide fewer services” in key areas to reduce the federal budget deficit, with 31 percent saying they were willing. But 31 percent suggests there is a sizable minority, large enough to obstruct and often prevent the enactment of needed reform legislation.
There is a temptation, maybe it’s the common wisdom, to attribute the phenomenon to Reagan’s charisma and Newt’s shrewd manipulation of the media — both undeniable factors. But I would argue that the single most potent factor that fuels the meme is the acquiescence of Democrats and progressives. Yes, I know, many Dems and progressives scream loud and long in defense of government programs. But usually we are preaching to the choir. What we rarely do is reach out and target persuadable voters with educational campaigns about the virtues of government.
Even when Democrats control the reins of government, like, ahem, now, we fail to trumpet its formidable virtues. Sure, every government agency has brochures and web pages pointing out its accomplishments. But hearts and minds are not won by brochures or even, gasp, web pages. They are won by television.

Read more…

I watched the President’s address on a jumbotron screen at a rally in the MLK National Historic Site in Atlanta. The rally and viewing, which were put together by Organizing for America, featured some of the better local agitators, including the state AFL-CIO president, the pastor of King’s church, a firebrand state senator, a couple of people who had been badly burned by insurance companies and OFA leaders, all of whom stoked the crowd leading up to the President’s address.
About 300-350 people attended, maybe 75-80 percent African Americans, plus a subtantial number of people with disabilities of all races. These were not just Obamaphiles, but people who felt strongly about health reform, and, moving around in the crowd, I heard pieces of quite a few health care horror stories. The event seems to have been designed mostly for the local TV cameras, which is understandible, since the tube still rules in the battle for hearts and minds.
Predictably enough, the crowd cheered the President’s stronger statements, and booed lustiily when the camera panned to Rep. Boehner and other GOP stiffs. I imagine the scene was replicated in cities across the country. I wondered what political moderates viewing the speech thought about the stolid Republicans, who have offered no reform proposals of their own thus far. I especially like how Robert Creamer puts it in his HuffPo post, that the heckling S.C. Rep. Joe Wilson is “the poster child for the new Republican Party.”
As for President Obama’s address (transcript here) , I thought he scored key points with impressive brevity. Never did I feel, “this is too wonky,” which has been an issue with other health care reform advocates. I liked the way he directly addressed the lies and distortions foisted by Republican fear-mongers. His tone was a little sharp. But there is really no way to make nice when debunking some of the nastier allegations they have smeared on his reform proposals. He unsheathed a few good zingers, such as the reference to the monstrous deficit he inherited, but wisely kept them to a minimum. Better to let the glowering Republicans marinate in bitterness on national TV, and they obliged.
President Obama endorsed the public option, but he kept an escape hatch open, saying he would consider alternatives. There was only a vague reference to what has elsewhere been called the “trigger mechanism” that would make the public option available. Even less was said about the possibility of taxing health care benefits. Those who were looking for heightened clarity on these controversial issues in the Presidents’ speech were probably disappointed. He tossed out a bit of an olive branch to the Republicans, in the form of a hint that some kind of tort reform should be part of the enacted legislation, which may be small comfort to them, but it’s more conciliatory than anything they have offered.
I expect that the President’s approval ratings will improve, as they generally do after a televised address. But I do think he needs to do more, perhaps in a warmer format, such as a series of televised “fireside chats,” as has been suggested. The President’s address was a pretty good beginning, especially if he will follow it with more visible, assertive leadership.
Among progressives, the reaction has been more favorable than not. Open Left‘s David Sirota and Mike Lux heard different speeches, with Lux giving Obama’s address a rave review and Sirota a pan. E. J. Dionne, Jr. noted a positive transformation in his WaPo column:

It seemed as if a politician who had been channeling the detached and cerebral Adlai Stevenson had discovered a new role model in the fighting Harry Truman. For the cause of health-care reform, it was about time.

And that’s all to the good.

Bill Moyers, in his Journal, offers an interesting suggestion (Alternet transcript here) for President Obama for his big health care reform speech on Wednesday:

Here’s a suggestion, Mr. President: ask Josh Marshall to draft your speech. Josh is the founder of the website talkingpointsmemo.com. He’s a journalist and historian, not a politician. He doesn’t split things down the middle and call it a victory for the masses. He’s offered the simplest and most accurate description yet of a public insurance plan — one that essentially asks people: would you like the option — the voluntary option — of buying into Medicare before you’re 65? Check it out, Mr. President.

Moyers’ suggestion, made on Friday, will probably not be followed, since the President knows he has a great speechwriter in Jon Favreau. But there is something to be said for Moyers’ comment about there being value in the “simplest and most acurate description yet” of a credible public option. Moyers links to Marshall’s TPM post on the topic, in which he wonders:

…why the advocates of a public option and just reform in general have not simply explained this as allowing people to buy into Medicare at any age. Because, essentially, that’s what it is. And I think I could pretty much guarantee you that if the question in the public mind was “Would you like the option of buying into Medicare before you turn 65?” the opposition would be vastly diminished.
This isn’t just rhetoric. This is the most accurate and graspable explanation of what’s being proposed. Indeed, the big secret not many people are discussing is that in the current iterations of the ‘public option’ in most of the bills in committee that ‘option’ isn’t given as an option to many people. Most people aren’t allowed to access it. And it’s designed that way in order to put a crimp on any competition it might provide to private sector insurers.

Read more…

Buzz is building around the so-called “trigger mechanism” as a compromise provision to make the public option palatable to centrist Senators. Marc Armbinder reports from The Atlantic‘s ‘Politics’ blog that White House Chief of Staff Rahm Emanuel is “pushing the idea of a “trigger” internally,” and he and Senator Olympia Snowe “regularly trade legislative and political intelligence.” In their New York Times article, “Health Care Idea Has Public Plan Only as Backup,” Robert Pear and Jackie Calmes report that,

The idea of such a backup plan or “trigger mechanism” has emerged in negotiations between the White House and the one Republican willing to engage with them on the issue, Senator Olympia J. Snowe of Maine, on whom the White House rests its hopes of finding a middle ground…Despite Mr. Obama’s impressive victory last November, the White House finds itself trying to satisfy Ms. Snowe for several reasons: other Republican senators have turned against Mr. Obama’s approach, the White House cannot count on the support of moderate-to-conservative Democratic senators, and efforts to forge a bipartisan bill in the Senate Finance Committee have bogged down.

Senator Snowe’s ‘trigger mechanism’ is, well, complicated, as the authors explain:

Under Ms. Snowe’s proposal, a new government corporation would offer health insurance in any states where affordable coverage was not readily and widely available from private insurers. The corporation would not be part of the Department of Health and Human Services, although federal officials would serve on its board.
The public insurance plan would be offered in any state where fewer than 95 percent of the residents had access to affordable coverage…Congress would define “affordable” with a sliding scale based on income. Under a proposal being considered by the Finance Committee, Medicaid would be extended to anyone with income less than 133 percent of the poverty level ($29,327 for a family of four).
For people with incomes just above that level, insurance would be considered affordable if they could find a policy with premiums equal to no more than, say, 3 percent or 4 percent of their income. For people with incomes exceeding three times the poverty level ($66,150 for a family of four), insurance might be deemed unaffordable if the premiums were more than, say, 12.5 percent to 15 percent of their income.

However, Chris Good of The Atlantic ‘Politics’ blog, reports that Reps. Lyn Woolsey (D-CA) and Raul Grijalva (D-AZ), co-chairs of the House Progressive Caucus, who spoke with thge President on a Friday conference call, have expressed their strong opposition to a ‘trigger mechanism.’ Woolsey said she was “skeptical that such a trigger would ever get pulled,” according to Good.
In their L. A. Times article “Democrats Consider Setting ‘Trigger’ for Government Health Care,” Peter Nicholas and Christi Parsons report:

The plan might win over moderate Republican and wavering Democratic senators, who do not want to give the government blanket authorization to enter the insurance market and compete with private companies. At the same time, President Obama could make the argument that he has not abandoned the prospect of a government-run plan, also called a “public option,” which liberals contend is needed to inject competition into the insurance industry…”This is the best shot we’ve got for getting a public option,” said one House Democratic advisor, who requested anonymity because he was not authorized to speak publicly. “It’s better than nothing.”

Parsons and Nicholas report that the views of key Democratic leaders on the “trigger mechanism” are skeptical:

“I will support nothing short of a robust public health insurance plan upon implementation — no triggers,” said Rep. Jan Schakowsky (D-Ill.). “I believe Congress will pass and the president will sign such a bill this fall.”
In an interview Thursday, Sen. Barbara Boxer (D-Calif.) cited the high salaries of health insurance executives and rising premiums as reasons for adopting a public plan without delay. Giving insurers a chance to prove themselves anew is a waste of time, she said…”I support a public-interest option now because we already know the problem,” Boxer said….She added: “We don’t need to test out the insurance companies. We’ve tested them out for years.”
…One Democratic senator, speaking on condition of anonymity because negotiations were ongoing, said that there were no guarantees that a trigger would create a 60-vote, filibuster-proof majority in the Senate…”We don’t even know what this buys us,” the senator said. “Does it get us to 58 votes? And if that’s all it does for us, why do we want to go down this route?”

I looked in vain for articles that said positive things about the “trigger mechanism.” Logic suggests there could be a point at which a “trigger” produces broad coverage for everyone. But the main benefit of the idea seems to be to get Sens. Snowe, Collins and perhaps one other Republican to support the Democratic plan. Still, the distrust of a trigger among progressive legislators seems broad and deep — a tough sell

Two of the leading strategists of the progressive wing of the Democratic Party, Mike Lux and Robert Creamer have posts expressing optimism for the enactment of health care reform. At Open Left, Mike Lux discusses and dismisses rumours that President Obama will cave to his right flank in his September 9 speech, and then Lux says:

I have always believed, and continue to, that at the end of the day, the House will pass a fairly strong bill with a good public option, and the Senate will pass a mushed-up compromise with less coverage and a trigger or co-op or some other unworkable thing. After that, the final question will be determined by who blinks in conference committee and takes a fig leaf compromise, and who stays resolute until the end. One side will walk away with some phony rhetorical nod that will allow them to go to the media and say they forced a compromise, and one side will win the policy fight. I still believe it could be the good guys.
I’m guessing Obama understands the dynamic…I think he will give a strong speech about the need to go forward on health care, while continuing to keep his options and the negotiations process moving ahead. I believe this not because I have blind faith and trust in the President, but because I think it’s the only path open to him that actually makes political sense right now.

Robert Creamer argues at HuffPo that “…The odds are very good that President Obama will succeed in passing landmark health insurance reform legislation this fall – with a robust public health insurance option. The reason is simple: it’s the high political ground.”
Creamer cites four major reasons why Obama and the Dems can claim the high ground, including — Hallelujah somebody finally said it plain — the fact that most Americans “can’t stand the health insurance industry,” and he provides some convincing statistics to back it up (e.g. – CEO’s of the 10 largest insurers had average compensation of $4,100 per hour and Cigna’s CEO retiring with a $73 mill golden parachute this fall). Creamer is also confident that Obama will bring his ‘A’ Game on September 9th, which we have seen is pretty impressive, and Dem centrists will bend, when confronted with the grim reality of being responsible for obstructing reform and owning the consequences. Finally, Creamer believes that the progressive base is energized in a big way:

…Hundreds of thousands of Progressives have been mobilized to counter the Right. They swamped the Right at town meetings at the end of August and are now conducting a week of 2000 “Let’s Get It Done” events in the lead-up to Congress’ return…There is no longer any lack of progressive intensity. The right wing assault awakened progressive passion that has spread like the Los Angeles wildfires…As Members of Congress reconvene on the battleground for this fall’s decisive engagement over health insurance reform, they will look up the political ridge and see that the cavalry has arrived.

Creamer’s and Lux’s optimistic prognosis is a welcome antidote to the toxic speculations of chicken-little pundits of the left and fear-mongers of the right. A proverb favored by MLK comes to mind: “Fear knocked at the door. Faith answered. There was no one there.”

As President Obama prepares to address to a joint session of Congress on health care reform a week from today, a couple of veteran bloggers see cause for optimism. Writing in Mother Jones, Kevin Drum reasons it out thusly in his post, “Optimistic About Health Care“:

…Republicans have been given every chance and have obviously decided to obstruct rather then work on a bipartisan compromise. So the Blue Dogs and centrist Dems feel like they’re covered on that angle. What’s more, the townhalls have shown them what they’re up against: if they don’t pass a bill — if they cave in to the loons and demonstrate that their convictions were weak all along — they’re probably doomed next year. Their only hope is to pass a bill and look like winners who get things done.
When you’re up against a wall, you do what you have to do. Politically, Dems have to succeed, and at this point they’ve all had their noses rubbed in the fact that the only way to succeed is to stick together. What’s more, Barack Obama has a pretty good knack for coming in after everyone else has talked themselves out and cutting through the haze to remind people of what’s fundamentally at stake. If he can do that again, and if he has the entire Democratic caucus supporting him, they can win this battle.
Nearly every Democrat now has a stake in seeing healthcare reform pass. The devil, of course, is in the word “nearly,” but at this point even Ben Nelson probably doesn’t want to be the guy to sink a deal if he’s literally the 60th vote to get something done. It’s usually possible to pass a bill when everyone’s incentives are aligned, and right now they’re about as aligned as they can be. That’s why, on most days, I remain optimistic.

And if the Dems have to skirt the cloture route, the reconciliation process is unlikely to draw prolonged criticism, according to Jonathan Singer’s MyDD post, “GOP for Reconciliation Before it Was Against It.” Singer nails the Republicans for their hypocricy in whining about Democrats using reconciliation, noting that they, lead by Sen Gregg no less, used it to try and open the Alaska National Wildlife Refuge to oil drilling and to pass Bush’s massive tax cuts. Then Singer adds:

This is one of those fake controversies by the Beltway, of the Beltway and for the Beltway… The American people simply do not care as much about these process debates as do those in the establishment media. If healthcare reform gets passed, voters aren’t going to harp on exactly how many votes it took — a 60-vote supermajority or a 51-vote regular majority — they are going to focus on what the new legislation means to them and to their country.

Singer is exactly right. It’s hard to imagine many voters saying “Those dirty Democrats passed reform with a majority vote. That’s outrageous.” The cautious optimism of Singer and Drum seems warranted — especially if the President can cut through the fear and gloom with a bold message based on hope and reason.

Thomas Frank has a good opinion piece, “Why Democrats Are Losing on Health Care” in the Wall St. Journal. The first part of Frank’s article is reflected in its subtitle “They Won’t Debate the Proper Role of Government,” in which he argues that Democrats should be making the health care debate in terms of “fundamental principles,” specifically “the size and role of government.” He doesn’t really address the size of government here, nor should Democrats. Ideologues already have strong opinions on the topic, and most Americans are less concerned about size than making government more effective in helping to provide affordable health security.
But the best part of Frank’s article provides a nicely-stated response to the frequently-heard protest, “Why should I have to pay for your health care?” First the set-up”

Consider the assertion, repeated often in different forms, that health insurance is a form of property, a matter of pure personal responsibility. Those who have insurance, the argument goes, have it because they’ve played by the rules. Sure, insurance is expensive, but being prudent people, they recognized that they needed it, and so they worked hard, chose good employers, and got insurance privately, the way you’re supposed to.
Those who don’t have what they need, on the other hand, should have thought of that before they chose a toxic life of fast food and fast morals. Healthiness is, in this sense, how the market tests your compliance with its rules, and the idea of having to bail out those who failed the test—why, the suggestion itself is offensive. We have all heard some version of the concluding line, usually delivered in the key of fury: By what right do you ask me to pay for someone else’s health care?

Then the response:

This image of sturdy loners carving their way through a tough world is an attractive one. But there is no aspect of life where it makes less sense than health care.
To begin with, we already pay for other people’s health care; that’s how insurance works, with customers guarding collectively against risks that none of them can afford to face individually. Our health-care dollars are well mingled already, with some of us paying in more than we consume while others use our money to secure medical services for themselves alone.
The only truly individualistic health-care choice—where you receive care that is unpolluted by anyone else’s funds—is to forgo insurance altogether, paying out-of-pocket for health services as you need them. Of course, such a system would eventually become the opposite of the moral test imagined by our Calvinist friends, with the market slowly weeding its true believers out of the population.

And the clincher:

The righteous individualists among us might also consider that our current health-insurance system, which delivers them the medicine they think they’ve earned, is in fact massively subsidized by government, with Uncle Sam using the tax code to encourage employers to buy health insurance. And were it not for government programs like Medicare and Medicaid taking over the most expensive populations, the political scientist Jacob Hacker pointed out to me recently, the system of private insurance would probably have destroyed itself long ago. That image we cherish of our ruggedly self-reliant selves, in other words, is only possible thanks to Lyndon Johnson and the statist views of our New Dealer ancestors.
One reason government got involved is that our ancestors understood something that escapes those who brag so loudly about their prudence at today’s town-hall meetings: That health care is not an individual commodity to be bought and enjoyed like other products. That the health of each of us depends on the health of the rest of us, as epidemics from the Middle Ages to this year’s flu have demonstrated. Health care is “a public good,” says the Chicago labor lawyer Tom Geoghegan. “You can’t capture health care just for yourself. You have to share it with others in order to protect your own health.”

So next time a conservative ideologue at the local tavern starts bellowing about how he/she shouldn’t have to pay for someone else’s health care, explain in the most dulcet of tones: “You already do, my friend. That’s what insurance is. When you get sick, others pay to help you recover. And when others don’t get health care, it makes your family more vulnerable to epidemics. That’s why real reform should include everyone.” It probably won’t change the ideologue’s mind, such as it is. But maybe, just maybe, a nearby listener will nod and get it.