Karen is absolutely right about the health insurance vicious cycle–unless you really go for it and put health insurers under even more public control and regulate their profits, like public utilities, you can’t stop the health premium spiral that would occur if the insurers were forced to cover everyone. But does anyone actually think something like that can pass the Congress? Yeah, me neither.
The strong sense I have is that significant health care reform is quite dead for the forseeable future…
absent a perceived crisis–like, say, a world where 80% of Americans are no longer satisfied with the health care they receive. Most of the politicians I’ve spoken with recently, on both ends of Pennsylvania Avenue, believe that the whole thing has gone on too long, that every day spent messing around with health care now is a day they lose altitude in the polls. They want to try working their legislative wonders on other issues. One can hardly wait to see how the Congress guts financial reform. (In that regard, if the President wants to tax banks, he probably should have proposed a full-fledged financial derivatives transaction tax–and allowed the Congress to trim it down to the less painful levy he proposed.)
As for health care, there are four other things that can be done this year: A modest expansion of coverage, to the parents of children eligible for the SCHIP program…and the passage of the national health care exchange included in the House bill, a supermarket where individuals and small businesses can go and have the negotiating power with the insurance industry that big companies like Time-Warner now do. A third incremental bit–a crucial cost containment piece–would be to push as hard as possible for Medicare reform, in which the system begins to look more like the Mayo or Cleveland Clinic, with doctors paid salaries rather than for each separate service performed. The fourth increment would be to overturn the anti-trust protections that the insurance companies currently enjoy. (If the Tea Party crowd is really against the depredations of the powerful, I’d like to see them oppose that one.)
A long-term strategy would be to gradually expand coverage to more people…and to allow employers to join the Exchange. Over time, you’ll reach a critical mass where Karen’s vicious cycle would no longer apply.
Yes, yes, I know. A single payer system would be more efficient and sane. I still believe the real bargain to be made here is with big companies–as Ron Wyden’s wise plan proposed–in which a system of progressive tax credits and subsidies for the working poor allows corporations to exit the health-care business…and the government, by virtue of its tax credits and subsidies, becomes the single payer of health insurance premiums, as in Switzerland. But right now, I don’t have the confidence that this Congress could pass a bill putting a stop sign on my street corner. There is blame is shared across the board, but there is a hierarchy:
1. Republicans get the most blame. They are not interested in the public weal at all, just in beating Democrats. They are the Death Panels, every day and every night, for thousands of American who lose their lives because they can’t afford, or be eligible for, health insurance. The two Senators from Maine, who showed signs of wanting to pass this bill but caved to political pressure, should be reminded of this constantly.
2. Moderate Senators like Joe Lieberman and Ben Nelson–and yes, Max Baucus, too–for forcing embarrassing deals and allowing the process to drag on for far too long. Lieberman was particularly dreadful, standing full-square against the public option, a minor provision. I wonder how many other bills he voted for, despite minor provisions he didn’t like. Nelson special Medicaid deal from the good people of Nebraska was disgraceful
3. But then again, why on earth did the White House allow itself to get into a position where giving Nelson that bribe became crucial? The Administration should for political malpractice for not getting it about the legislative dynamics here–the unanimous Republican opposition, the leverage thereby given to slugs like Lieberman and Nelson–and for not moving forward first on legislative projects with more popular appeal.
4. Moderate Congressmen like Bart Stupak, who used health care reform as an excuse for expanding anti-abortion legislation beyond the Hyde Amendment, which was perfectly sufficient before.
5. House liberals who kow-towed to the labor unions on stripping down the Cadillac tax to pay for the plans. (The unions also stand as a roadblock against the passage of Wyden-like legislation.).
Then again, as I said, I’m not sure this Congress–in a city corroded by cynicism and special interests and Fox News–can pass anything at all that has social utility.
