It was only two days ago I vowed "no more health care blogging" but I never said "no more health care book blogging," so here goes. Daniel Callahan's notable Taming the Beloved Beast: How Medical Technology Costs are Destroying Our Health Care System soon will be out. Here is his position:
I can sum up what I want to say in some simple propositions. First, ways must be found to return to more basic levels of medical care for ever more patients (e.g., to emphasize prevention and primary care) and to make it more difficult to receive medical care at the higher levels (e.g., advanced expensive cancer treatments or heart repairs). Second, the priorities for technologically oriented health care should begin with children, remain high with adults during their midlife, and then decline with the elderly. Third, if the medical care received during those first two stages of life is good, the elderly will have a high probability of a good old age even if advanced technologies are less available to them. Fourth, health care cannot be reformed, or costs controlled, without changing some deeply held underlying values, particularly those of unlimited medical progress and technological innovation.
I don't like his anti-innovation take in the fourth point but there's a lot of truth to what he says. It's also the case that the public knows, at some level however incoherent, how prevalent such reasoning is in the thought leaders of the Democratic Party. The Democrats are right about the need to constrain Medicare expenditures, but the more they attack Republican stupidity and lies, the further they are from understanding why Americans now trust them less with health care reform than before.
The Hansonian analysis of the discourse is that one needs to signal a more extreme symbolic affirmation with the proper "showing that you care" values than what the other side is doing. The Republicans have the more extreme rhetoric and in fact people are used to the idea of lies — very used to the idea of lies — dare I say welcoming of the idea of lies? — when it comes to "showing how much you care." To attack them as liars is to play into their hands. To pose as The Reasonable Technocrat, as Obama has done in response, is to play into their hands even more.