Jonathan Cohn, in the New Republic yesterday, writes another excellent article that succeeds in conveying what a weird amalgam the current health insurance proposal is. The guiding principles of the current debate are these: (a) reform should be as bipartisan as possible, (b) it should push as much insurance as possible through employers (the “you can keep the plan you’ve got” clause), and (c) it should be revenue-neutral. The difficulty, of course, is that both of these principles make for worse policy—fewer insured, less choice, higher costs, worse care.
Because we are trying to claw our way gradually up a continuum to a sustainable solution (single-payer health care, for example), we end up with this bizarre and universally suboptimal middle-ground. Take the case of the exchanges, which I’ve written about before. The current plan will establish a marketplace through which individuals could purchase insurance from both public and private providers; the exchanges are regulated, exclusion because of pre-existing condition is prohibited, subsidies are provided to low-income families entering the exchange, and so on. The trouble is that the current plan would prohibit any individual who currently receives coverage from their employer to enter the exchange. This makes employers unhappy because small businesses will have to provide costly health insurance; it gives consumers worse care because they’re prohibited from entering an efficient market that drives down costs if they so desire. And even if the exchange does attract a significant number of uninsured Americans, they may not have the benefit of a competitive public option now, or this public option will be made worse off.
The long and short of it is, the principles that Obama has put in place to guide the debate make for worse policy, no matter how much maneuvering is done within those guidelines. The guidelines, not just political opposition, prohibit reasonable options from rising tot he surface. Notice that there is a perfectly simple middle-ground between a single-payer plan and the current proposal: allow any American to enter the exchange or keep their current option as they please. Those who don’t want a public health care plan because they’re worried Obama is going to come into their homes and put a pillow over their children—just don’t switch. It would be difficult for those who do leave their employers’ plan, join the exchange, and opt for the public option to argue that they are being coerced simply because the government can offer better care. You will have ever liberals’ heartfelt condolences for being enticed into health. This is not even what many experts feel is the optimal solution, a single-payer plan; this is a simple adjustment to the current compromise that would provide better coverage.
So here is the point: more and more it seems like health care is not an issue that this polity can cope with adequately. There is too much vitriol, too much opposition, too much fascination with democratic procedure to accomplish anything worthwhile. The Democrats botched this thing from a start: you can’t fight hyperbolic fire with an ongoing negotiation. Health care reform is one of those things that should be negotiated by technocratic, bipartisan experts, behind closed doors, with access to every shred of information and data available to the American populace, and then voted on by congress, yes or no, in one fell swoop. Health insurance is not a point for compromise and posturing: health insurance is one of the basic duties of a civilized populace, and one the United States currently does not live up to. Health insurance should be expensive for its government, unabashedly successful, so capable it becomes transparent, and this accomplished by any reasonable political means necessary. Our government do what it takes to ensure that none of us have to think about health care again—because it is one of that scant handful of things a government must do for its people.
a.j.m.
Filed under: Domestic, Health, Practicing Politics , single-payer