Zaniya Project: Cognitive Dissonance Abounds

Terry Woster gives us a peek inside the thinking of the Zaniya Project Task Force this morning [Terry Woster, "Task Force Looks at Government's Role," that smut-peddling Sioux Falls newspaper, 2007.07.22]. If there are any big, new ideas brewing, the big dogs on the task force aren't saying so.

The article leads with State Senator Tom Dempster's assertion that (as Woster phrases it) "Government will always be involved in health care funding but shouldn't run the system." That position smells of cognitive dissonance, bred of the conflict between the obvious plusses of a single-payer system and the free-market theology that we dare not blaspheme against. We demand government cover nearly half the medical expenses in the country, and we see the government providing that payment more efficiently than the for-profit system, yet our leaders say government can't effectively manage health care.

The Zaniya Task Force isn't angling toward a Massachusetts-style plan to require citizens to buy health insurance, either. Says State Representative Joel Dykstra, mandatory proposals "wouldn't be something I'd support." (Ah, a Republican talking like a Republican.) This disavowal of the Massachusetts plan gives cause for relief. The Massachusetts plan seems an absurd intrusion on the free market. If we believe in the free market, we shouldn't allow government to skew market forces by requiring consumers to buy a certain product. On the other hand, if we, like Massachusetts, are willing to so grossly violate free market principles, why not go whole hog and just eliminate the free market in this realm and make health care the purvey of the government? Other free market forces already fail in health care: people don't have time to comparison shop when they are birthing, bleeding, or broken, and even those who can ask about price can't get accurate information from the doctors and nurses, the main point of contact in the provision of service. Plus, insurance plans discourage comparison shopping with their exclusive networks. To say free market forces and personal responsibility hold sway in health care stretches credibility.

The Zaniya Project seems nowhere near new thinking on health care, though. This resistance to obvious new approaches exhibits itself in some cognitive dissonance on Dykstra's part as well. After turning up his nose at mandatory proposals like the Massachusetts plan, he turns around and says (in Woster's words) "He expects discussion of a personal responsibility program, though. That concept wouldn't force a person to have insurance but would require some showing that the person could handle the cost of health care." Hmm, that sounds like a mandate to me, cloaked in the usual blind rhetoric of personal responsibility. But what would Dykstra propose? What does it mean to "handle the cost of health care"? Will teachers making $30,000 a year be thrown in jail for not leaving the profession to make twice as much elsewhere so they can handle catastrophic illnesses that their insurance plans won't cover? Do my wife and I get a ticket and probation for incurring $12,000 in expenses for our daughter's delivery when we only had a couple thousand in available savings? A mandate's a mandate, and either of the mandates Dykstra mentions is a bad idea mired in oldthink.

(Here's a thought, Rep. Dykstra: maybe personal responsibility should be left to individuals to decide -- another Republican-sounding, while legislators, those individuals elected by society to represent society's interests as a whole, ought to focus on how we can meet our social responsibility -- there's a social contract theory term of the day.)

The task force is also tinkering with incentives to get employers to provide coverage. Even those efforts may be hamstrung, though, as "some members have said one concern with that is how to make it fair to employers who gave that benefit to their workers without state incentive."

Again, the Zaniya project sounds like it's wedded to the status quo and dares no more than to work around the edges rather than to consider serious and fundamental reform. Employers are abandoning health coverage because of the skyrocketing costs. The only incentive that will draw most of those employers back to providing health coverage would be big subsidies. Again, in for a penny, in for a pound: if the state is going to spend its money and skew the free market system, it might as well do so in the most efficient way possible and set up a single-payer plan that will put all businesses (and workers, and families) on an equal footing.

We hear again of the task force's attention to health information technology. "'It's just crazy,' Dempster said, that he can go halfway around the world and use a debit or credit card but must fill out 'name, address, allergies and prescriptions every time I go to the clinic.'" Certainly a big health info tech push will bring efficiencies, but not enough to reverse total health care inflation. Dempster also thinks South Dakota's medical cost-reporting law will help "boost competition and hold down cost," but again, the Zaniya Task Force is putting its hopes in free market theology that just doesn't apply to the warped world of for-profit health insurance companies, who make their billions by finding ways not to provide their service.

The Zaniya project takes its name from the Lakota word for health and well-being. Perhaps the task force members could learn a lesson from an old Lakota holy man, Black Elk, whose greatest challenge was to deal with a broken "hoop" -- i.e., a worldview that was challenged by the ugly reality around him. As he watched the white man advance across the prairie and his people lose their freedom, he saw fellow Lakota who sold out to the "Wasicu" enjoying the support of the white soldiers, while his own people, who tried to resist the Wasicu and stay true to their beliefs, suffered. "I could not understand this, and I thought much about it," he said. "How could men get fat by being bad and starve by being good?" [John G. Neihardt, Black Elk Speaks, University of Nebraska Press, "21st Century Electronic Edition," Chapter 10, pp. 105-6.]. Black Elk's beliefs told him one thing, but the facts of the changing world around him said something different.

The Zaniya Project Task Force members -- businessmen, insurance agents, other Chamber of Commerce types -- face a challenge to their "hoop" of free market theology. To see real solutions to the health care crisis, the leaders of this state and this nation have to recognize that the realities of the problem may require changing or even abandoning some fundamental beliefs. That's a radical and difficult step for anyone, and alas, this morning's report indicates the Zaniya task force members are nowhere near considering accepting that challenge.