Health Care Reform and Musical Chairs

A great deal of the public behavior surrounding the health care debate can best be described as "childish". When six year-olds do this sort of thing, any responsible adult will respond firmly with "you need to learn to share."
And, in fact, the political economy of American health care is structurally similar to an extended version of a children's game- musical chairs. Musical chairs, remember, is the game in which there are fewer chairs than players. The players circle the chairs to music- I remember "Pop Goes the Weasel" as the usual tune- and when the music stops, they scramble for one of the scarce chairs. Without careful adult supervision, the scrambling can become quite ugly.
Think of individuals who currently have insurance- through government-funded programs, individually-purchased policies, or employment- as those who have chairs. For one reason or another, they have resources that allowed them to win the insurance game as it is currently structured. Those without insurance are the losers. The music has stopped, and they have no chairs.
If the number of chairs is fixed- that is, if there are only so many chairs to be had- then this arrangement is what game theorists call "Pareto-optimal." Optimal sounds good, doesn't it? But what it means here is that for anyone to become better off, someone has to become worse off. There are only so many chairs, so a loser can get a chair only by displacing a winner. Why would a winner voluntarily give up his chair? That would be silly.
Now for the political part. Assume that everyone who has a chair has resources that he or she can use to pay guards to stand around their chairs so that, if the music starts up, the losers will still be unable to get a seat. The resources in real life include campaign contributions, votes, media contacts, and so on.
When the music starts again, the guards swing into action- they know what to do in order to make sure that the winners keep those chairs. The guards, in fact, have routines that they regularly use to keep things as they are. The distribution of chairs has become "institutionalized." There is a structure that supports the status quo.
And there is one more thing. The winners all sit together, all have the same advantage (the chairs) , all agree that they want to keep it, and all know that in order to stay seated, they just have to make sure that things keep working the way they always have. The losers mill around, are dispersed, have different ideas about how to get chairs, and have trouble concentrating-their feet and backs hurt from standing all the time. The people with chairs, in other words, are better-organized and more focused than those without them. This is a "collective action problem" and it makes the the effects of institutionalization even stronger.
It gets worse. Some of the winners sit in chairs that the losers have helped to pay for. If we were talking about, say, health care reform rather than musical chairs, this would mean that people who were receiving government assistance with health care (like Medicare) would be showing up at town meetings to complain that the losers might get the same deal.
If this were a real game of musical chairs, there would be some easy solutions. The winners could stay seated and send the guards out to get some more chairs, using resources that were being spent on other, less necessary things. Or the rules of the game could be changed- everyone could agree to share chairs, figuring that it was better to be a bit uncomfortable than to have some people standing all the time.
Of course, it couldn't be that easy. In fact, if we were indeed discussing health care rather than musical chairs, there would be entire industries dedicated to insuring that it never would be that easy.