The Lingering Preference for Ideology Over Fact

While President Obama and congressional Democrats have haltingly advanced legislation aimed at reshaping the health insurance landscape, Republicans have dug in their heels, spouting bromides about tax cuts and the need for change, but opposing substantive steps of any kind, and studiously ignoring their own complete inaction during the Bush Administration, a period of 8 years when they dominated Washington.

The current debate over health care reform, may have starkly divided the political class, but that doesn't appear to be the case with the citizenry. A June poll, for instance - the results of which are in line with a host of other surveys - indicated that fully 83% of the public supports a public option for health insurance coverage. (Click image at right to enlarge.)

If this is the case, from where does the raging conflict over giving Americans better access to health care coverage originate? If Republican pols truly advocate the desires and interests of their constituents, how can a poll like this be accurate? The answer, of course, is not that modern polling is consistently missing the mark, but that GOP positions truly do not represent the needs of the people in red states.

If that sounds like an arrogant exercise in divining the true intentions and best interests of others, it isn't. Last month, the Commonwealth Fund released the 2009 edition of their ongoing research, Aiming Higher: Results from a State Scorecard on Health System Performance, and the idea that Republican politicians are markedly out of sync with realities on the ground is entirely quantifiable.

Of the states with the best health care scores, nine of the top ten voted for Barack Obama in the 2008 election, while seven of the ten worst performing states voted for John McCain. (Click image at left to enlarge.)

On one level, this is not necessarily the fault of Republican politicians - people keep voting for them, for whatever reason - but the fact remains that there is a clear correlation between state health care performance and whether or not it leans conservative. In general, if it's got one of the worst-performing care systems, it's a red state.

On another level, of course, GOP politicians are very much to blame, as they work to reinforce the memes that keep them in power. A perfect example of this occurred earlier this month, when former Speaker of the House Newt Gingrich and Texas Governor Rick Perry lobbied in the op-ed pages of the Washington Post to Let States Lead the Way, writing:

Texas, for example, has adopted approaches to controlling health-care costs while improving choice, advancing quality of care and expanding coverage. Consider the successful 2003 tort reform. Fewer frivolous lawsuits have attracted record numbers of doctors to the state as medical malpractice insurance premiums dropped by half.

Unfortunately for Governor Perry and Speaker Gingrich, the Lone Star State is the epitome of what is wrong with the current health insurance system. Fully 25% of its population goes without insurance, the highest percentage in the nation and far worse than the already alarming national average of 15.4%. Of course, given that Texas pays so much attention to "frivolous lawsuits" this is not entirely unexpected; according to the Congressional Budget Office, medical malpractice judgments represent just one half of one percent of total health care costs in the United States. Personal injury lawyers might be an easy target, but any plan that uses "tort reform" as a centerpiece is pretty much guaranteed to miss the mark.

With one in four Texans without health insurance, why do people in that state continue to support politicians like Rick Perry, John Cornyn and Kay Bailey Hutchinson, all of whom have come out against health care reform? Probably for the same reason that Republicans decry "government intervention" and tout themselves as bootstrapping champions of personal responsibility, despite the fact that red states take far more in federal handouts than they contribute in tax dollars.

The widest gap between rhetoric and reality may be behind us with the long-overdue departure of George W. Bush from the White House. But like the lasting damage inflicted on the nation by his administration, continued claims that the United States has the best health care in the world - despite ever-taller mountains of evidence to the contrary - are ample proof that, within GOP political leadership, there remains not just a lingering preference for ideology over fact, but for political power over the interests of people.

---