The horizon is not so far as we can see, but as far as we can imagine

Why I’m pessimistic on health reform and the argument for doing it anyway

Yesterday Brett asked why I’ve become negative on health care reform when so many other bloggers aren’t.

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.)


How stupid do they think we are? (Executive Compensation edition)


How insurance works and why private insurance costs more than universal government insurance


  1. “I think the Senate bill will be worse”

    Considering that 3/4s of the Senate is miserly conservatives, of course it will be. On the other hand, Obama is having Reid and Baucus (the obstacle-in-chief) to the White House today. I think Obama is making an honest try of it, at least. My guess is that the insurance industry will over-reach and be asking for another hand-out in a few years, perhaps even next year. Somehow I doubt they will get it.

  2. Valley Girl

    Ian- what does this part mean?

    ~~Before I ride off into the sunset next thursday..”

  3. Ian Welsh


    oh, left in from Open Left. I ‘m filling in at Open Left up to and including Wednesday of next week. At that point, I’m no longer filling in (and I have some other urgent things I have to take care of) so I won’t be writing as much. In particular I’m traveling to Victoria the week after, and since my laptop is broken, will have only very intermittent internet access.

    The posts here are almost all reposts from open-left with a few hour delay to be fair to OL.

  4. Valley Girl

    Okay, I guess I understand. But not entirely. I can understand the “not writing as much” (for only a bit I hope), but when you decide to/ are able to write/ write more, is this the place to look for you? This blog? I’ve pretty much taken a break myself (from reading and commenting) for at least a few months, and only discovered this location.

  5. Ian Welsh

    This is the best location to find me, yes. If I’m posting somewhere else (open Left, FDL, Crooks and Liars, etc…) I’ll almost always post here also, just on a time delay to be fair to them. (Huffpo, otoh, doesn’t care, so if I post there I’ll post here at the same time, as a rule.)

    At this point I’m mostly blogging when asked to by someone, or when I feel I must say something that isn’t being said by the usual suspects. That may change, but I feel we’re in a period where what I say doesn’t matter all that much. For various reasons it’s hard to influence things right now.

  6. On hard to influence —

    Yes, perhaps. But it’s also important to lay down markers and keep the record straight. We learned that during the run up to the Iraq war, and it paid off big time. And some of the Cassandras then are looking pretty good, now. The arc of history is long….

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