Ideology vs. Values in Health Reform: We Deserve Better

Following the collapse of the housing market back in 2008, former Federal Reserve Board Chair Alan Greenspan appeared before the U.S. House Oversight Committee for a rather painful post-mortem examination. Over the course of several hours, he endured biting criticism for relying on what was described as a flawed free market "ideology." Henry Waxman's metaphysical questioning of the humbled former Fed Chief was a masterful combination of partisan opportunism, photo-op politics and angry revenge.

It was also a demonstration of the political process run amok.

David Brooks, writing recently in the New York Times, has it right: the political classes' ideological anger is out of step with Main Street citizens' anger over values. While the two concepts overlap, the former deals with creed and belief systems, while the latter deals with interests and materiality. The former has led to intellectual/political gridlock that now presides over a bloated, metastasizing and unwieldy thicket of statutes, regulations, law suits, lawyers, unions and craven complex of private sector government contractors. Mr. Brooks argues this has ultimately short-circuited a key American value: being able to benefit or suffer from the upsides and downsides (including luck) of personal initiative. He's not sure that things will necessarily change after the midterm elections, but he does predict that to succeed, a future President may need to understand the difference.

And look no further for a poisonous example of recent ideological jousting than HHS Secretary Kathleen Sebelius' editorial in the September 28 Wall Street Journal. In it, Ms. Sebelius retreads an ultimately ideological perspective that the purpose of health insurance, apparently in the absence of a preferred single payer system, is to guarantee access to care by selling "reasonably" low-priced insurance policies that cover all the medical costs for anyone who wants to buy it anytime. And, as typical for ideologues, falsely contrived good vs. evil battle lines are drawn: in this instance she pits down-on-their-luck self-employed, hard-working persons against faceless and avaricious health insurers.

As testimony to the righteousness of Ms. Sebelius' side, her Exhibit A is a recent North Carolina Blue Cross Blue Shield premium rebate. It turns out that the story is a little bit more complicated. For that, see Carl Mecurio's excellent summary of what happened here. Basically, the introduction of exchanges in the near term meant that the insurer's reserves against long term costs were becoming redundant. Sending checks out for a few hundred dollars to the involved BCBS enrollees was based on an actuarial decision that had little to do with the HHS' saintliness.

The Disease Management Care Blog will be the first to admit that it and its fellow bloggers suffer from a sometimes overzealous dose of ideology, but heck, they're blogs. Their role is to use all the tools of rational thought to uncover points of view that deserve higher visibility. Public service and governance, on the other hand, calls for a far more subtle, balanced and difficult job of reining in ideology and reconciling the important notion of personal responsibility with our other cherished values of progressivism, justice and others. It's not easy, but the talent is out there.

The Wall Street Journal editorial only demonstrates how badly this Administration's lack of that talent is failing in that key attribute when it comes to health care reform.