Health Rhetoric

In The Economist this week, an interesting analysis of the rhetorical and policy wisdom of appointing Tom Daschle Secretary of Health and Human Services and putting him in charge of persuading Congress to pass comprehensive and universal health care for the United States. Such a program was originally to have been part of the package that gave us Social Security in 1935, but health was dropped because of Congressional resistance. Congress has been resisting ever since, with the notable exception of Medicare, passed under Lyndon Johnson. The Economist appears to argue that the problem is partly a matter of policy, partly a matter of politics, and very much a matter of rhetoric. The choice of Daschle is itself read in partly rhetorical terms.

This looks like a pretty shrewd pick, and the fact that it is the first cabinet job to be sort-of-announced is an indication that Barack Obama is in deadly earnest about one of his main campaign promises: comprehensive health-care reform. . . .

By appointing a big cheese to the health job, Mr Obama seems to be defying the gloomy view that the state of the economy rules out such an expensive initiative. His proposed plan has been costed at anything from $50 billion to $100 billion a year, which many people argue can not be afforded in the current environment. He could, of course, make the opposite case. The deepening recession is likely to have dreadful consequences in health-care terms, as people lose their jobs and the health insurance that goes with them, and as companies scale back or even abandon the packages they offer their workers. So reform is more urgently needed than ever.

In addition, there is such widespread agreement on the need for fiscal stimulus at the levels of hundreds of billions that it might, paradoxically, become politically easier to slip another large programme into the mix, especially one that benefits ordinary people rather than bankers. Last, stressed American companies are actively backing radical reform, because the burden of health insurance costs is crippling their ability to compete abroad. In the early 1990s, they opposed it, and helped to kill it off.

This last observation is perhaps crucial -- American business is crippled by its health care obligations. A comprehensive and universal federal program could make American business more competitive and might even reduce the incentive to send jobs abroad. If businessmen pressure Congress for reform, that may at last make it happen. The time is right, and the rhetorical forces that have stalled reform may now be aligned to create change.

The photograph that accompanies the article in The Economist abstracts Tom Daschle in the act of speaking, with an operation apparently in progress behind him. The positioning places him in the apparent role of speaking for doctors, nurses, and patients--a switch on the traditional opposition of the American medical and insurance establishment to universal health insurance.

See "A Shrewd Choice: Can Tom Daschle and Barack Obama Fix American Health Care?" The Economist, 21 November 2008.

photo credit: AP, from The Economist