Monday, August 17, 2009

Health Care Reform - It's Gonna Suck

…Health care has been moving target for republicans …. the Democrats will shift, thinking they have something that the Republicans will go for, and then the Republicans will shift further. And [the Republicans] make a big deal about something that distracts and frightens the voters like those so-called death panels, then the Democrats drop that and Republicans find something else to object to.

Cokie Roberts, NPR’s Morning Edition, August 17, 2009.

Health care reform, as I want it (legitimate socialized medicine, with doctors employed by the government) has always been doomed. Health care reform, as I would accept it (mandatory single-payer government baseline insurance with plenty of room for supplemental insurance policies) has also been doomed for a long time. But it's looking more and more like health care reform, as the President originally wanted it (public "option" insurance) will also be doomed. If a final bill makes it all the way through both chambers of Congress this year, that bill would be generously described as "watered-down" and more accurately described as "gutted". Both Democrats and Republicans will claim victory, both for the actual passage of the bill and for the holes shot into it. Bipartisanship in action.

But even I can't dismiss all of the points that have been made by conservative analysts in the media over the last month. One in particular that I've heard only a couple of times is this: you can't expect to have a government option on health care, or provide semi-universal coverage, without raising taxes. This is true. For any meaningful reform to take place, it's going to take a lot more efficiencies than just computerizing medical records. A lot of inefficiency comes from the complicated method of filing and paying insurance claims, and fighting with insurance adjusters for money, which is mostly done by people in the doctor's office. Like any other marketplace, health care works more efficiently when there isn't market friction caused by complicated rules, policies, procedures, and differences in plans; and substantial savings could be derived by simplifying the terms of all insurance plans, or of course by having a baseline plan for which the rules about what is covered and what isn't are widely known and accepted (socializing medicine, for instance). But the inefficiency involved is paid for by the private marketplace; no public savings could be achieved by such a reform. It would benefit society as a whole, but at an expense to government (and therefore to taxpayers). And yet no Democrat wants to admit this.

Another Republican-derived point is that it would be unfair to the upper 5% of income earners to be taxed to pay for a service that gets used entirely by the lower 95% of income earners. I sort of agree with this. I understand progressive taxation, but on a government program as expensive as a proposed Medicare-for-all, I would want it to be paid for like Social Security is now (or for that matter, like Medicare is now); that is, as a social contract with everybody so that everybody pays a little bit and everybody gets to use the service. I'm saying I'd be in favor of tax increases on everyone if I got to have a medical insurance program that everyone got to use. Mr. Obama, please raise my taxes.

As usual, the problem with having politicians in charge of social programs is that politicians play politics all the time, and only consider the good of society if the good of society is popular at the moment. What's popular at the moment is views from "Main Street, America" of people angry about the government paying for things they can't afford, and are feeling like outsiders, which pays dividends for the Republican congressmen who believe they too are outsiders. The lock-step-feel of Congressional Republicans is back now that they've been put back into their comfortable roles as outsiders from beyond the Beltway. And as the Obama administration wastes more and more time trying to get a weak health care bill passed, the Republicans may use the time to get another Newt Gingrich-like movement going.


Jacob said...

"Health care reform as the President originally really wanted it?" Didn't he campaign on an even more minimal health care overhaul? Like, subsidies for the poor to purchase from insurance companies, and no mandate at all? I guess my expectations were just lower than everyone else's (about health care reform, at least) to begin with.

I don't think I ever thought grand reform was possible in one fell swoop. It always seemed to me like they'd have a much easier time passing this issue-by-specific issue, reform-by-specific reform, and slowly growing the program. Creating a giant new social contract/entitlement program that sits outside the regular fiscal system is a huge deal, and obviously something we haven't done in decades. It just doesn't seem politically feasible anymore.

I know Democrats get frustrated when they look at their majority in both houses (hell, supermajority, technically), but they don't seem to get that so many of the gains were made by running conservative Democrats in conservative areas. Were people really stupid enough to believe all these places just got really liberal over the last four years? It would've been a lot harder for the conservative Democrats to vote against, say, an April bill targeting pre-existing conditions, and then a May bill that covered medical records, and a June bill that chartered a co-op, etc. In a few years, if they're lucky, they could up the regulation of the co-op until it's basically a government-run public option in all but name. Next year when tax cuts expire and military withdrawals eliminated expeditionary expenditures they could sell those as funding health care. It'd be a lot harder to sneak "death panels" or "socialism" into things so cut-and-dry.

Steve said...

I completely agree with your assertion that grand reform was never possible in one fell swoop. Which is why I don't understand why we're trying to do it that way. This health care reform takes the form of one bill passing through several committees and taking months to plan and finagle through Congress. I guess I thought for some reason that health care reform had to be done all at once due to some parliamentary procedure or something, because it sure doesn't make a lot of sense to do everything all at once otherwise.