Using highly questionable data sampling, the New York Times today self-righteously proclaimed majority support for a plan for a government-provided health insurance plan that, using the inherent ability of the government to subsidize itself and punish its competition, would inevitably devolve into a single-payer government health care system.   And this sort of rhetorical short-circuiting of the process of debate and analysis promises to seriously damage our ability to craft serious health care reforms.

This stridently dishonest approach has been eagerly embraced by the ideologues of the left, who prefer slogans to debate.  A characteristic example is TMV’s Kathy Kattenburg, with her no-discussion-tolerated demand “We Need Single-Payer Public Health Care — NOW“.  Kattenburg’s post does identify a legitimate problem that requires reform (the practice of “rescission” — the arbitrary denial of coverage using flimsy and even dishonest excuses), but its willingness to only consider one possible solution and its intolerance for any discussion of problems or alternatives makes it a dangerous diktat rather than a progressive proposal.  (Unfortunately, the general TMV policy of refusing to even respond to critics exacerbates the problem — one can peruse TMV threads essentially forever without finding an example of its authors seriously engaging a single critic.  While its across-the-board application to all issues at TMV is not shared everywhere, this no-dissent-allowed practice is tragically quite common specifically among advocates of single-payer health care.  Like Kattenburg, they tend to view their proposals as good-versus-evil rather than as exercises in coming up with pragmatically workable solutions to real-world problems.)

If single-payer health care were the nirvana its advocates claim it to be, this wouldn’t be a serious problem.  But continuing experience in Canada, for example, shows that serious problems with availability and rationing in critical care areas such as cancer treatments persist in single-payer systems.  The hostility to debate and discussion among single-payer advocates like Kattenburg is thus revealed as more than simply self-righteous arrogance — it is a serious threat to the viability of a future post-reform system.  Refusing to discuss potential problems may marginalize and disempower opposition, but it will not prevent those problems from occurring in reality.  And the economic logic that causes rationing is impervious to proclamations from high atop a moral white horse:  Providers in a single-payer system can only expect to receive whatever the government’s political process deems an “appropriate” payment.  Since those payment levels will inevitably remain fixated solely on present costs, there is no room left to invest for the future.  As a result, investment in new equipment and technology is slow and unreliable and, as a result, available capacity inevitably lags behind demand.  The outcome in the end is that cancer patients and other patients who would benefit from immediate treatment have to wait in line and, inevitably, some of them die while waiting.

But, of course, such matters are of little interest to self-righteous purists like Kattenburg.  All that matters to them is demonizing the other side enough to score an easy rhetorical “win” before blithely moving on to the next item on their infinite list of political vendettas.  Actually making the system work is Somebody Else’s Problem.  And, after all, any problems that do crop up can always be blamed on Republicans, conservatives, or “the rich”.  A big advantage of refusing to even talk to your critics is that you can continue that same practice to evade accountability later on as well.

Fortunately, not everyone embraces this vicious and irresponsible approach.  Moderate Democrats in the Senate are eschewing the temptations of the extreme purists and are trying to craft a compromise that might address some of the legitimate concerns about single-payer health care.  Whether such proposals can gain steam in spite of the dogmatism of the purists remains to be seen, but the willingness of pragmatist liberals like Justin Gardner at Donklephant to actually recognize and discuss legitimate concerns about purist approaches to health care reform is a very hopeful sign.

The bottom line is that the choice is entirely in the hands of liberals.  Partisan Democrats dominate the entire political playing field, from the Congress to the elite media to the blogosphere.  If they choose to embrace the intolerant purism of their Kathy Kattenburgs, then Americans may have little more to look forward to than a dreary march to technological stagation, rationing, and the decreased quality of care that results from decreased timeliness of care.  The fact that enlightened liberals will have “won” over evil insurance companies will be of little comfort to the breast cancer patients who see their tumors metastitize while they linger on the waiting list for radiation and chemotherapy treatments.  But if they instead adopt the willingness to compromise of Senator Kent Conrad and Donklephant’s Justin Gardner, a centrist consensus might just be possible.

UPDATE: Newshoggers’ Ron Beasley is even more direct in rejecting all compromise and all debate in favor of a Manichean crusade against “the Oligarchs”:

And what does he need to do?
1. Go to the nation
2. Be LBJ. So far, Lyndon Johnson has been the only president to defeat American Medical Association and the rest of the medical-industrial complex.
3. Forget the Republicans. Forget bipartisanship.
4. Insist on a real public option. It’s the lynchpin of universal health care.
5. Demand that taxes be raised on the wealthy to ensure that all Americans get affordable health care.
6. Put everything else on hold. As important as they are, your other agenda items — financial reform, home mortgage mitigation, cap-and-trade legislation — pale in significance relative to universal health care.

It is fascinating to behold the shameless hypocrisy here. Leftist purists are using the exact same kind of good-versus-evil rhetoric that they excoriated George W. Bush for using regarding the threat of terrorism. Apparently, those who would blow up huge buildings in the pursuit of an extreme religious ideology are no where near as threatening as “the Oligarchs”, eh, Ron?

But even if we “get” those nasty “Oligarchs” and put them up against the financial wall, Ron, the ones who really pay the price may be the cancer patients who must wait months or years for their treatment due to rationing. Why do you refuse to even debate the issue?

I guess your campaign of rhetorical and financial vengeance must be important enough to sacrifice their lives in the process?

UPDATE 2: In a move that is hyperbolic even by their standards, FireDogLake compares the campaign for health care reform to the fight against slavery. The same lot who used to complain about the Bush administration’s rhetorical excesses is showing that Rumsfeld and Cheney can’t hold a candle to them. Next up: Anyone who questions single-payer health care is a Nazi terrorist.

UPDATE 6/22: Kathy Kattenburg has responded with a respectful post at TMV. (It is a hopeful sign that at least some at TMV may be willing to respond to critics.) Unfortunately, her response continues to evade key points of contention, including the propensity of many public-health-care advocates to immediately reject all proposals for compromise (Paul Krugman adds his voice to the purist chorus today) and the problem of how to handle rationing and equipment-investment problems that occur in publicly-funded systems like Canada’s. Hopefully, at least some on the left side of this issue are willing to sustain a debate as it moves into details.

UPDATE 6/22 5pm: Well, Kathy Kattenburg’s respectfulness didn’t manage to last the day before she returned to the purist approach of misrepresenting and demonizing all opposition. This is the dysfunction that seems likely to continue to plague the health care debate in this country — self-righteous purists who believe in win-at-all-costs actively destroying debate from the left and know-nothing purists refusing to even offer debate from the far right. Meanwhile, the moderate majority stuck in the middle can look forward to paying the higher tax bills for a poorly designed system built on ideology rather than analysis.