The Fourth Rail of American politics, or why we must stay sane on healthcare

(Yes, I know that electric trains generally only have a powered third rail. I'm just extending the metaphor.)

One of the most tired phrases in politics is "Social Security is the third rail of American politics."  The problem is that it's true - Bush figured that out by squandering all of his political capital trying to reform it back in 2005.  It turns out that old people vote and they can be easily scared when the spectre of taking away their government checks is brought up.

We face a similar problem with health care.  It's obvious that the system doesn't work, and not just for people with pre-existing conditions and those who lose coverage.  It costs too much and isn't portable.  The lack of a true national market and the employer coverage model is a failure.  Too many people lack coverage and those people stick hospitals with huge bills for admissions that could have been solved with a visit to the family doctor, if they had one.

That being said, there are a lot of solutions better than Obamacare.  We've heard them before on this site and others and they aren't the point of this post.  The problem is that if Obamacare is defeated, no politician in their right minds will touch the healthcare issue with a 10-foot pole.  In persuing the worthy goal of defeating one specific bill, the issue has been demagogued to the point of insanity with threats of "death panels" (Sen. Isakson (R-GA), who put the provision nominally at issue, thinks this is nuts), "keep government away from my Medicare (note: WTF?) and all sorts of hyperbole about the continued "existence of the republic."

And don't think for a minute that every accusation about killing grannies and such lobbed against government can't be lobbed at private insurers.

So instead of a debate on what to do, we have people holding up pictures of Obama with a Hitler mustache shouting down elected officials before they can answer questions.  We have liberals convinced that people who oppose Obamacare are foam-at-the-mouth dittoheads and birthers organized by lobbyists.  And they're partially correct - many (not all) town hall shouters have spouted a lot of nonsense and many are making this personally about the president and anger at losing the last election.  It's embarrasing to people who have real issues with Obamacare who want to and make something work instead of yelling until they're red in the face.

The window for reasonable debate has closed by conservatives who want to make this Obama's Waterloo and liberals who are circling the wagons against a perceived onslaught of crazies.  The next reform proposal from either side will fall into the same pattern.  Eventually, everybody with power to do anything will throw their hands up.

Now healthcare is a "third rail," just like Social Security.  There are other, smaller, third rails to contend with.  Our primary system is rigged to prevent any serious talk about ethanol.  Serious agriculture subsidies reform is stymied because the committees that make ag policy are filled with congressmen from districts that feed off the USDA teat.  We can't have a serious discussion about Israel for long without someone getting called an anti-semite or a zionist likudnik stooge.

The problem?  You can't cut the size of government with all of these third rails in the way.  Everything has to be on the table.

Healthcare isn't just a sixth of the U.S. economy, it's a very big chunk of government spending.  The problem with the deficit hawkery I've heard recently is that it's small bore.  Spending freezes avoid the difficult choices about what exactly we want to cut.  Pork appropriations, non-military foreign aid and arts funding seem like ripe targets for popular cuts, but they make up a vanishingly small part of the budget and won't change the overall fiscal picture.  Survey after survey shows that people think government is too big, but they don't want to cut funding for Medicare, Medicaid, Social Security education, defense or anything specific beyond the amorphous "waste."  The only real solution is to slow and reverse the growth of healthcare costs while still providing the care people demand, and we are in the process of blowing it for the next several decades by turning a deadly serious issue over to the loudest, angriest, least reasonable wing of the movement, destroying any hope of comprimise a la Wyden-Bennett.

In the zeal to stop a bad new policy, we have guaranteed decades of the bad old policy.  Good job guys.