America’s “Peculiar” Health Reform Struggle

Government is either organized benevolence or organized madness: its peculiar magnitude permits no shading.

John Opdike (1932-2009)

November 19, 2011 – In his new book, Remedy and Reaction: The Peculiar American Struggle over Health Reform (Yale University Press, 2011), Paul Starr, Princeton University Sociology Professor and Health Care Guru, repeatedy uses the word “peculiar” to describe U.S. health reform."

By “peculiar” Starr means the U.S, is unique among nations in not guaranteeing health coverage for all. Starr implies the Accountable Care Act is organized benevolence while itsopposition is organized madness.

I will let Starr speak for himself.

• “The search for a remedy to America’s problem in health care has turned into a peculiarly arduous struggle – peculiar in its duration, its rancor, and its salient and centrality in national politics.”

• “The American struggle over health care has also been peculiar because of the unusual lines over which it has been fought" (i.e., special interests, rich against poor, entitled vs. unentitled groups).

• “What is also peculiar about the American struggle over health care is that the problems in the society do not just afflict the least powerful in society" (i.e., but the more influential, affluent seniors, and the middle class).

The Word “Peculiar”

“Peculiar” is a word with different meanings- unusual, unique, particular, distinctive, exclusive, out of the ordinary, and exceptional. Many Americans think of their health care as exceptional. Even Starr concedes American medicine at its best is exceptional, but as he ruefully laments: it is not all that good for most of us compared to othr countries.

I do not wish to demean Starr’s book. It is evenhanded, beautifully written, and full of memorable insights and language. In his last chapter, “Reform’s Uncertain Fate,” he serves up these gems.

• The Affordable Care Act depended on “early deliverables” to win over the public – ending lifetime limits and pre-existing illness as conditions for coverage and expansion for coverage for young adults up to age 26 under their parents’ policies.

• “One reason the electoral map turned red in 2010 was that the electoral map turned gray: the elderly flocked to the polls to vote Republican while young people stayed home.”

• “The Democrats created a huge political problem by delaying major benefits for four years, mainly to reduce the deficit, but instead it opened the gates for four years of bitter debate, in other words,as LBJ remarked, ”dead cats were going to sit on the porch for a very long time.”

In closing,

What’s “peculiar”about the reform struggle,
Are the many political forces it must juggle,
It’s not one-for-all,
It's a free-for-all.
Into the mix, reason we must smuggle.