"We're Number Something!"

So I'm thinking that this...

... is the reason health reform looks to be skidding off the road.

Other, better bloggers have covered the ups and downs and all arounds of the American health care reform process. Personally, I think Ezra Klein has a point when he says that when six different presidents have tried and failed to pass health reform, it might be an institutional issue more than anything. The furthest anyone got was LBJ, who was a) a legendary Senate arm-twister, b) had the ability to wave JFK's ghost around when needed and c) even then, only gave single-payer to the olds. I also think that Matt Taibbi's article in Rolling Stone on how the whole process is lurching on, half-gimped by side deals from the White House and Senate, to be informative - even if it does lapse a bit into his trademarked "you're all dumb fuck you all" hyperbole.

But the issue I want to talk about is how it's being sold and how it's fought against. A lot of comparisons, some sane and some out of Fantasyland, have been made to the health care systems in Canada, in Britain, in France, and in other industrialized nations. Apparently we're either a land where health care grows on trees or a land where the hospitals are riddled with skeletons. Neither description is accurate, though I'll take Canadian health care over American health care any day. But I think that the fact that it is being compared to other systems is a sign of trouble, though no fault of its own - but through a fault in the American cultural character.

The picture up there is basically how most Americans think of their country. In America, "I live in the greatest country on Earth" is the default position. In some ways it's even true. And consequently there is a mental resistance against anyone telling an American that no, their country is not number one, at least when it comes to health care. They'll point out the few areas that American health care's profit motive does excel and pretend that's the whole system. And they can get away with this because there's a reason doctors have to study super-king-kong-hard to do their job, because medicine is really complex, and medicine-related bureacracies even moreso.

So a sales pitch on health care is, by path of least resistance, going to focus on areas of comparison with the other models out there in other countries, and that's where I fear the sales job keeps smacking into resistance, the down-in-the-bones ingrained mentality that if American health care becomes more like Canadian health care then American health care will get worse, because it's just not possible for America to be at any position but the top.

For the wonks pitching reform, it doesn't occur to them. A good system is a good system, regardless of its origin. For the liberal activists pushing reform it doesn't occur to them because they're operating from the mental framework that America is not number one. But I do think that this is ingrained deeply in the American character - at the least, from my observations of American media, where America tends to win World War 2 by itself - and it's partly why you see so much resistance to it. All the guy on the street hears is someone on the TV going "snobby snobbity snob America sucks" and that stirs the fire in the belly that leads to activism at town halls. This is a country where Obama not always wearing a piece of jewellry shaped like a flag was considered a legitimate point of controversy.

(Before my comments post fills up with Americans - as if that'll happen - let me hasten to add that it's not like Canadians are free of massive flaws in our national character either.)

I don't see a solution to it other than 'give it time.' It's tough to change the mood of an entire country. I do think that as people who grew up with the Internet fill out the population, this will shift. Just like I have a tough time dismissing Americans as a buncha gun-happy brutes now that I know over a dozen of them, people in America will have a tough time seeing Canadians as semi-socialists who talk funny once they know us. It's a lot easier to forge a friendship with a person in another country if it's via high-speed Internet. But right now, in this moment, I'm not sure how you sell the upsides of a complex overhaul of a massive bureacracy without taking the shortcut and comparing it to another - and I can't see how that comparison would be done so well that America gets over its pride enough to buy it.