Re: The market doesn't have an M.D.

Carlos responded to an earlier post with a thoughtful comment, which I thought I'd reproduce here in case you missed it:

Dude, you just opened the healthcare reform door...

So, yes, our healthcare system is incredibly inefficient and wasteful, with spending rising faster than inflation and GDP, while our country's health indicators remain at the bottom of the industrialized world.

Why is it so inefficient? You hit one point on the head: People can not be expected to make good spending decisions regarding health care. If people knew exactly what they needed when they were sick, we wouldn't need doctors! We'd only need a few pharmacologists and a few surgeons who'd set up shop and just fulfill their customer's orders. Also, since many people have health insurance, most are completely unaware or unconcerned about the amount of money that goes in to providing them with care, and so they seek care freely. And health insurance companies distribute payments on a fee-for-service basis, so doctors are incentivised to over-treat so that:

1. They don't get sued.
2. They get as many insurance payouts as possible.

Health insurance companies were initially designed to be the watchdogs of the system. They would make profit by covering as many people as possible, and reduce costs by promoting cheap preventive care and denying payment for unnecessary care. But here, we find that:

1. Insurance companies are not very good at determining what is necessary since they aren't the patient's doctor.
2. It's easier to just assess the riskiness of each potential enrollee and deny "high-risk" customers from the get-go.

So this is where all the "health insurance horror stories" come from. Stories of people getting denied treatment for their fatal cancer. Stories of construction workers getting injured on the job, not being able to work, and being denied private health insurance.

And of course, this is all ignoring the fact that there are millions of people in our country who are completely without any kind of health insurance, and so become exceedingly risk-prone and are unable to get care they need due to prohibitively high costs.

So, what do we do? The government is in the health industry's pocket, and the health industry is benefiting from the status quo, so change is slow, nonexistent, or retrograde. The people suffering the most are the uninsured who are already relatively quiescent in the political realm and are not able to leverage much pressure on the political system. Further, conservatives bust out their best "socialism" fear mongering whenever anyone tries to talk about healthcare reform. And so we wait until the middle class gets pissed off enough with the system that change can be made through the ballot.

What kind of change? Well, that's a whole other rant, but for a quick hint, look at France's health care system.

Evolving the campaign

Carlos has the idea that to really deliver on his message of change, Obama should leverage his massive campaign resources to start producing real results right now, even before he is elected:

It is a necessary evolution of his message, but luckily for Obama, it's also within reach if he acts soon. In this age of gigantic campaign bank accounts (Obama's in particular), and with his fervent support from young liberals and other political newcomers, he is in a unique position to convert his followers into organizers for more than just getting out the vote....

If the Obama campaign organized an event to raise funds for clinics that accept the uninsured in my city, I would be there in a heartbeat, and I'd stand by that campaign through thick and thin. But until he turns his message into action, my support for him will be timid and fleeting.

I think this is a great idea, and jibes particularly well with the sort of out-of-the-box/bottom-up thinking that has characterized the Obama campaign from the beginning. Obama has always claimed that he is but a figurehead for a movement, a grass-roots movement of ordinary people who are desperately worried about the direction of their country and who, if sufficiently well-organized, can usher in a new era of less divisive, more effective politics. If he could actually mobilize his supporters to implement significant local improvements in communities across the nation during the campaign, he would empirically vindicate his own theory of change--he would be demonstrating, in real time, the power of "ordinary people" to work together to achieve "extraordinary things".

There would also be a lot of other benefits. Clinton's primary rebuttal against Obama's "movement for change" argument is that it is nothing but empty rhetoric--flowery and nice, sure, but completely ineffective in a nasty political reality that requires "hard work" and "taking on the Republican machine". Obama would be turning Clinton's argument on its head. "Look," he'd say, "you say I'm all talk--fine. But while you were spending $100,000 on an attack ad in Pennsylvania, my campaign decided instead to help build low-income housing in Philadelphia and to raise funds for a struggling veteran's hospital in Pittsburgh. My 'talk' has resulted in bricks and mortar and hospital beds--what has yours accomplished?" I'm not sure what she could say to this.

Moreover, the whole concept works to Obama's advantage because it--like Obama's candidacy--is in some sense extra-political. Obama frequently claims that he will "transcend" partisan politics by bringing in fresh players to the democratic process and instituting change on a level not possible within the current political framework. Coming together to do community work wouldn't be about the political goal of electing Obama, per se--it would be about the more primal, pre-political desire to work with fellow Americans of all ideologies toward a goal that everyone shares and really believes in.

The press would eat it up. To my knowledge, no campaign has ever done community work unrelated to the campaign to demonstrate a point about itself. Even if Clinton accuses the Obama campaign of cynical motivations, of staging a publicity stunt--who cares? Obama can say with a smile that even when he's cynical he brings people together. He can mock Clinton's distorted, Washington-poisoned worldview, where "integrity" means sliming your political opponents to the max and "cynicism" means organizing people in the community for change.

And, of course, some veterans and low-income individuals might appreciate the effort, too--no matter who gets elected in the end.