Why I’m pessimistic on health reform and the argument for doing it anyway
Of course, it’s dangerous to speak for other bloggers, but I think the calculus which many are operating under is that if you get a bill with some sort of public option, and some sort of subsidies, some lives will be saved. Something, in other words, is better than nothing. I also think that people need to believe. Many bloggers worked really really hard to elect Obama, to get a House and Senate majority, and the that it can’t deliver on something so fundamentally important as making sure every American has the health care they need is something they just don’t want to believe.
Also most other bloggers are not fundamentally econobloggers and econobloggers who don’t buy the “TARP saved the universe” disillusionment started much earlier than for most other bloggers. For me it started at TARP time when Obama pushed through Paulson’s highway robbery act Then Obama hired Geithner and Summers as his key economic people. So I started down the path of “no hope” a lot earlier than most bloggers.
I use the stimulus bill as my model for looking at healthcare. As with the stimulus bill I think that the House draft bill is the high point. I think this is the best bill we are going to see. I think the Senate bill will be worse (Daniel reported last night, as I was writing, that the Senate bill probably won’t have a public option) and that it may well be worse than nothing even if a weak public option is in the bill. In particularly Medicare and Medicaid are being hit to pay for this, people will have deductibles on “non preventative” care (and maybe preventative by the time it gets through) and so on. The Massachussets experience, which is the closest parallel, has not been good.
There is a counterargument, I made part of it the first day I wrote at OpenLeft. The public option could drive out private insurance or at least drive costs lower. Getting people into the system turns them into real patients and suddenly there are doctors and so on who don’t want to lose them, and that gives them a constituency, and above all, you do save some lives and help some people and isn’t that better than nothing?
I’m not a single payor purist, though I think the fact single payer isn’t even on the table is a terrible indictment of the system—however, I’ll settle for a good public option, or even a non-sucky one. But I’m becoming convinced that any public option will either be too compromised, or non existent, and at that point, all that happens is you have slashes to Medicare and Medicaid, forced purchase of bad insurance, and through those purchases more money being pumped into the system.
Is forcing people to buy insurance the real goal? The best way to make money, bar none, is to have government force people to buy your product. It’s a wet dream for any industry, so if it’s going to be done, it has to be done right—it has to be very highly regulated and controlled with rates of return set like utilities.
Will it be?
(Addendum: Before I ride off into the sunset next thursday, I’ll see if I can pull together a post on what is required for a good public option. One of the reasons I favor single payor is that it has many fewer moving parts. It’s easier to do single payor right than it is to do a public option right. Not least because there are many different working models of single payer and variations. Getting the public option right is very complicated.)