The Semantics of “Healthcare Reform”

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Michael Cloud decades ago said, profoundly, “In the jungle, the rule is kill or be killed. In politics, either define or be defined. Because words are weapons; words are tools.” (From the Essence of Political Persuasion CD series.)

If you want to control the direction of a debate, find a way to control the language of the debate.

I want to talk, though, not about the linguistic tricks used in the healthcare debate, but about the term “healthcare reform” itself. The healthcare issue is exceedingly complex, and relatively little good research has been done to understand it, much less to be able to analyze possible futures. Most of what people claim to know about healthcare is just myth and conjecture. And even within the myths, there are a number of possible courses of action. But none of this stops them from leaping on the pro- or anti-reform bandwagon.

And as a libertarian, I find this deeply troubling.

So what is “healthcare reform,” anyhow?

The liberals’ tour de force in this debate was in coining the term “healthcare reform.” They did so many years ago, and we’re still feeling the effects of it today.

By their definition, “reform” means:

Do you see a pattern developing here?

“More government,” yes. More government bureaucrats, less personal autonomy, fewer personalized options, bigger government spending, higher taxes, and more laws, government regulations, and lawyers.

Do you really want more government-run healthcare? Because that’s what “reform” means.

The conservatives, on the other hand, are now forced to make the case against “reform.” And that’s not a very good case to make, because we all know that the system is broken. We pay too much for the healthcare we get, prices continue to rise, and more and more people are choosing to do without health insurance. What’s more, no one really understands why. We feel helpless, and that’s why some of us are willing to give up so much of our freedom, in exchange for just the promise that someone will “do something” about it.

So what happened to the small-government solution?

The small-government solution got lost in the debate. The Cato Institute has a good summary of it on their healthcare website: the small-government, free-market healthcare solution. It’s not difficult to explain or to understand, and it supports the values most Americans hold. Briefly, Cato’s 7-point solution is:

  1. Let individuals control their own healthcare dollars, spending them wherever they deem best meets their personal healthcare needs, because you are best able to make the best choices for your own, individual healthcare situation.
  2. Move away from employer-purchased health insurance, because your health insurance should attach to you, not to your job..
  3. Change tax laws that encourage employers and employees to include health insurance as part of the pay package, because that will will allow you to choose and control your own health insurance choices and provide you with better options.
  4. Allow people to purchase health insurance across state lines, because that will increase competition in the industry, making the right health insurance easier for you to find and cheaper for you to afford.
  5. Rethink medical licensing laws, such as allowing doctors to take their licenses from state to state, and allowing nurse practitioners, physician assistants, and other non-doctors to treat more problems within their areas of expertise, because that will open up innovation and provide you with better healthcare at a lower cost.
  6. Let Medicare enrollees spend their healthcare dollars on any plan on the market, if they choose, because that will prevent government bureaucrats from interfering in your Medicare healthcare needs.
  7. Allow health-status insurance to expand, because it is a fiscally solvent way to provide you with long-term, portable health insurance.

This solution could be discussed, debated. But in most circles on the street, people have never even heard of “health-status insurance,” and they aren’t even aware that a free-market healthcare solution would work. They blame the “free market” for the current healthcare “crisis,” even though we actually aren’t in any meaningful healthcare “crisis,” no matter how many shocking statistics big-government politicians make up to bolster their case. (Political crises are almost always fabricated by politicians in order to invoke us to action without thinking, but that’s another article.)

More importantly, if you want to talk about the “free market,” the U.S. healthcare market is hardly free, because it’s a politically devised mishmash of individual healthcare consumers (like you and me), healthcare providers (like your doctor), healthcare insurers (like your HMO), health insurance purchasers (like your employer, who chooses the insurance even though its value is part of your pay package), and government regulators and enforcers, on both the state and federal level, desperately trying to hold the whole rat’s nest together.

I was pleasantly surprised with a Cato Institute event, “Does America’s Health Care Sector Produce More Health?” I expected them to invite a liberal speaker, who would argue for more government, and a libertarian who would then be forced to argue against the liberal agenda. But instead, the libertarian started by admitting the problems with the current system, then detailed the paucity of good data, a wonderful example of intellectual judo.

Define or be defined

While the people at Cato, along with other principled, consistent lovers of freedom, have all made great strides in tearing down the big-government healthcare agenda, they are sill using the word “reform,” and I don’t know that they’ve successfully redefined it.

But they have qualified it: “free-market healthcare reform,” which is at least a step in the right direction.

Still when my liberal friends start talking about “healthcare reform,” they don’t ask me what kind of reform I favor. They assume that if I believe in small government, I must be a conservative, and therefore anti-progress. It seems to me we’re still comparing big-government reform versus the status quo.


UPDATE: David Boaz of the Cato Institute, after I posted this, coincidentally posted his own piece on the liberal semantics of “reform.” He draws an insightful point, looking at the issue from a slightly different perspective.

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