Monday, December 17, 2012

Take It Back 10: Health Care, Katrina, Community, and Closing

I finished James Carville and Paul Begala's Take It Back: Our Party, Our Country, Our Future (copyright 2006).

My latest reading covered health care and Hurricane Katrina, then the book closed with a resounding call for communitarianism, even going so far as to praise Ronald Reagan for his optimism and faith in America.  Here are three items:

1.  The chapter on health care was good, overall.  It went into how the cost of treating the uninsured results in higher health care prices for consumers, the fact that the uninsured consist largely of people who work, and a proposal to allow people to buy into the same health care options that are available to federal employees.  According to Carville and Begala, this proposal works well for federal employees, for the "government gets to say which plans participate, then negotiates prices, covered services, and other standards for care", and the "health care companies" accept those requirements because they want the nine million government employees as customers (page 279).

I appreciated Carville and Begala's discussion about the pharmaceutical industry, though I wish that they had gone a little deeper.  Carville and Begala say that "Drug companies that invest in research should be able to keep their patents until they've made back the amount they spent on research plus a reasonable profit" (page 280). This is an important point because Carville and Begala are acknowledging that the profit motive plays a significant role in the development of new drugs.  A number of conservatives and Republicans have argued that such measures as allowing the importation of cheap prescription drugs and permitting Medicare to negotiate for lower drug prices would discourage the pharmaceutical companies from researching and creating new drugs because those measures would reduce the companies' profits, thereby undermining the profit motive for research and development.  But Carville and Begala are sensitive to the role of the profit motive, and so they say that drug companies should be able to keep their patents on their drugs until they have made a "reasonable profit".

But then Carville and Begala criticize drug companies for being "hell-bent on keeping their patents" and for seeking to inhibit cheaper "generic versions of the same drug from coming to market" (page 280).  According to Carville and Begala, Senator Chuck Schumer introduced a bill to prevent the gaming of the patent system, even as Republicans sought to restrict competition against the pharmaceutical companies.  This bill passed when the Democrats controlled the Senate.  I wish that Carville and Begala had gone deeper by explaining how they could support patents as a way for pharmaceutical companies to make a profit, while also not wanting for the patent system to be abused.  What exactly is abuse of the patent system?  Is it the pharmaceutical companies trying to hold onto the patent longer than they are permitted?

Another beef that I had with this chapter: Carville and Begala talked about how a Toyota plant chose to locate in Canada on account of Canada's national health care system, rather than in the U.S., where Toyota would provide employees with costly health insurance.  That's a good point, but Carville and Begala appear to stop short of advocating a single-payer system, the sort of system that attracted Toyota to Canada.  This issue is arguably relevant to Obamacare, as businesses in the U.S. are reducing workers from full-time to part-time status so that they don't have to pay for health insurance.  Leftists have contended that the big businesses are merely using Obamacare as an excuse for their own failures, and they may be correct on that.  But, in my opinion, a single-payer system is better for businesses than is requiring big businesses to provide health insurance to their employees.  

2.  The chapter on Hurricane Katrina was about how President George W. Bush failed to provide sufficient funds for the levies (since money was going instead to the Iraq War) when he was warned that this sort of policy would be disastrous, and how Bush appointed inexperienced political lackies to FEMA, whereas Bill Clinton had appointed competent and experienced professionals.  One of my conservative relatives once told me that Bush should not be faulted for failing to provide sufficient funds for the levies because Bush didn't know how bad the hurricane would be, or if there would even be a hurricane, but Carville and Begala narrate that Bush was warned that his policy could have ill effects, that "Bush's own federal government designated a major hurricane hitting New Orleans as one of the three 'likeliest, most catastrophic disasters facing this country'" (page 284), and that there had been another hurricane earlier in the year.

I tend to agree with my conservative friends and relatives that others besides Bush dropped the ball on Hurricane Katrina----there were the local authorities that failed to use buses to help people to evacuate, for example.  But I still think that Bush failed to provide adequate leadership during that disaster.  I wonder if things have gotten better, in terms of the federal government's management of natural disasters.  President Barack Obama has been praised for how he handled Hurricane Sandy, but there are still people who complain about FEMA, and who say that they are not getting enough help.

3.  On communitarianism, I agree with Carville and Begala that we should try to see society in terms of "us" and not just "me".  Carville and Begala contend that Republicans tend to support a mindset of "What's in it for me?" (my paraphrase), but a number of conservatives and Republicans would come back and say that Democratic policies themselves engender this sort of attitude by creating an entitlement society in which people receive free stuff from the government.  I think that Democrats do well when they combat this narrative----when they show that it benefits society as a whole when people don't go broke because of medical bills, when people can receive a decent education, etc. 

I'll close this post by saying that I prefer Carville and Begala's self-reflection after the Democrats lost to how a number of Republicans reacted after Obama's defeat of Mitt Romney.  There were many Republicans who reacted to their loss by portraying the majority of voters in the election as moochers, who merely voted for Obama because he was giving them stuff from the government.  Even when Republicans lambasted this narrative, they did not appear to be overly authentic, for how often did they question this narrative before Romney lost?  Moreover, I'd say that the view that many Democratic voters are moochers is widespread among Republicans.

Carville and Begala, by contrast, did not seem to look down on those who voted for Bush in 2004.  You could say that a number of Democrats did look down on those voters, seeing them as duped by Republicans, who spoke to their values on wedge issues while undercutting their economic security.  But my impression was that Carville and Begala did not have that attitude (though they did recommend What's the Matter with Kansas?).  Rather, they acknowledged that Democrats had to work on showing that they were not hostile to the values of those middle-class and lower-income people who voted for Bush.  And Carville and Begala were authentic about this, for they talked about the place of God, guns, and the military in their own lives.  I did not always agree with their policy analysis, but I appreciated their outreach to American voters who differed from them politically.

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