Letter 2 America for August 30, 2013

Dear America,

I saw Republican former Arkansas Governor Mike Huckabee on his Fox-TV show, and while it was farcical in its content, I have to give him credit for at least feigning to propose an alternative to the Affordable Care Act rather than just claiming that it usurps some contrived right that he claims is guaranteed by the constitution.  And he started with the great conservative "American Exceptionalism" argument that we have health care that is the envy of the world.  In reality, we probably do have more of the highest paid experts in the world, but we are well down the list of nations when you compare them for life span, success in curing cancer and, unbelievably, infant mortality.  But setting aside the opening canards about rights and the nature of the problem--and incidentally, the failure of the fair market as a health-care paradigm never got mentioned other than to deflect blame from it--he did make some sound suggestions.  First, he wants to focus on prevention, which the Affordable Care Act also emphasizes in terms of required coverage, though Huckabee didn't mention that either.  But though he sees that particular light, he blames the failure of our free market system to do so on Tom Cruise demanding that we "show him the money" and the fried food he grew up on, not to mention the fact that no one cares what the insurance company pays for the care we get, while it never occurs to him that if you cut the insurance companies out of the process, you save at least 20% of the nearly $3 trillion per year that health care costs in this country.  And while he acknowledges that Americans pay almost 18% of total Gross Domestic Production for health care--over one and a half times as much as the next most costly industrialized nation--he claims that doctors are underpaid and are hence leaving the profession at a time when they are in short supply...the former a claim that I had never heard before, though the shortage of doctors, especially in poor areas, is a long-term problem.  Tough to make the bucks out there where people have more chickens than money, and we all know that magnanimity won't make your Mercedes payments for you.

Overall, Huckabee's proposal is just rehashing old purported solutions, like healthy life styles and free-market style price pressure with a few antique ideas, like health savings accounts and "it's all the Democrats' fault" thrown in for spice.  As to the health savings accounts, the way he would have them work is that everyone would have a certain sum...he chose $2,500...set aside for him, "perhaps by his employer," and that money would be spent on medical care before the catastrophic coverage of the insured kicked in, and of course, that plan would be only as effective as what the patient chose to afford, if affording something is a choice at all.  Of course, Huckabee never addressed the Panglossian nature of the notion that someone out there would put that money aside for us, nor did he talk about the fact that when families have to choose between clothes and shoes for school and catastrophic care health insurance premiums, usually the clothes and shoes take priority, but that was one of the central concepts on which he relied.  As to the Democrats, he complained that they had been against the Republican solutions...like health savings accounts...but he never mentioned the fact that when the Clinton administration set up a commission to study universal health care, the Republicans proposed Obamacare as an alternative to a single payer system, which generally means a public healthcare system, and Republican governor of Massachusetts Mitt Romney even created one.  He also complained that 80% of what we spend on healthcare is incurred in the last two years of life.  It sounded like a vague plea for what he and his Tea Party compatriots were calling death panels that would surely emerge, they argued, from the passage of Obamacare.  Of course, they were never part of what the Democrats passed, but maybe Huckabee wants to enlist Sara Palin for a second attempt to create them.  And he droned on for about half an hour about all these putatively advanced ideas, never saying a word that wouldn't lead one to believe that more federal spending on funding cures for major diseases--which Republicans are against as they oppose increasing the deficit and the debt--and letting the healthcare marketplace set its own prices--which is what has led us to the place we are in now with 48 million uninsured before Obamacare has taken effect--are the real solution to our healthcare problems.  No wonder his candidacy for the Republican presidential nomination in 2008 only lasted about ten minutes.  But he at least got on television and said something that acknowledged the problem that thousands of people die needlessly every year because they don't have the money to participate in our healthcare system.  Even though his little talk was more of a bad joke than a real lesson in sagacity, it was an effort to participate in the search for a solution to the problem, and his observation that what we got in the Affordable Care Act wasn't healthcare reform but rather was insurance reform was profoundly accurate in my opinion, which is important because we should be only at the beginning of the search for a solution to a problem that belies our claim to exceptionalism.  That puts Huckabee ahead of the vast majority of his Republican colleagues, and to my way of thinking qualifies him to lead the discussion for his party.  Unfortunately, the only way he will be able to do so is if he runs for president again, but it looks as though the Republicans have already selected enough guys like Rick Perry to fill their slate of idiots for consideration to be their nominee.

Your friend,

Mike