25 January 2007

Starr's dialectics

Dialectic is one of the classical three liberal arts that Western culture inherited from the Greeks. It means the exchange of a thesis countered by an antithesis. Take for example:

"Healthcare is a human right in civilized societies, because healthcare is sometimes needed for life itself. " vs

"Health care is just another consumer item, like a Lexis, for those who can afford it."

Thesis and antithesis. Philosophers or the guys at the corner bar pick it apart and come up with some kind of synthesis that is closer to the truth than the originals.

How about: "Although more money will always buy more of it, healthcare is a human right and should be universally accessible."

Now the conversation has changed direction, and we can go on to the next level — unless there are libertarians or other obstructionists in the room, at which point we're back to "is too," "is not," "is too."

Dialectics got a bad rap because most of us learned about it in school in terms of Marxian Dialectics and communism. It was something about class struggle and things getting so bad people will revolt — according to Wikipedia, "a framework for development in which contradiction plays the central role as the source of development." In other words, things getting so bad people will revolt.

Paul Starr, who wote The Social Transformation of American Medicine, the 1983 Pulitzer Prize winning history of how American healthcare system has evolved over the last two centuries, thinks that things have to get worse in American healthcare before the people will revolt. Or at least the contradictions and true costs must become more apparent to people before we'll demand a single-payer or some other universal healthcare system. He's in favor of Bush's plan for that reason.

He writes in Bad Plan, Necessary Step in the American Prospect that it would be better to go ahead and get employers out of the health insurance business, because they've hidden the true cost of healthcare. The middle class doesn't understand how much their employers and the government spend on their health insurance. Starr sees the conservatives behind Bush's plan believing: "that it would lead Americans to accept lower insurance coverage and higher out-of-pocket costs and, therefore, would slow overall cost increases. I think they have misjudged the public reaction. Clarifying the full cost of private health insurance is going to make Americans much more likely to support a public alternative."

"In a world where health costs have been submerged, liberals have been at a huge political disadvantage. In the world conservatives want to create, liberals would have a much better shot."

That may be so, and if it is, we have a problem. How many progressives have the stomach to knowingly go along with a disasterous plan because it will make things better in the long run? It's like sending men to their certain deaths in a battle, knowing that the sacrifice will, probably, help win the war. Actually it would be even trickier, because it would need to be done in the political arena instead of on a comparatively straightforward battlefield.

We face the same problem, albeit less starkly, with state proposals like the one in California that may help more people, yet at an unsustainable cost. Do we support them because they may save lives next year? Or do we stand against them, because they're unaffordable and inefficient, and may give a talking point to ideologues who will say, "You see? We can't afford universal healthcare."

As long as private insurance is in the picture they're right, we can't afford it. Every other industrialized country, however, shows how very affordable universal healthcare can be if done right.

Starr is, by the way, Professor of Sociology and Public Affairs, and Stuart Professor of Communications and Public Affairs, at Princeton University; and co-founder and co-editor of the American Prospect.

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