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March 21, 2005

Forward-Looking

I'm not really sure what Garance Franke-Ruta is getting at in this post. She moves from saying that the task for Democrats is "finding the big story that explains our world and politics today in a way that sounds real and fresh" -- a true, if less than novel, assertion -- to arguing that conservative ideas aren't wrong just because they were thought up by conservatives. Well no, they're not. Indeed, conservative ideas are often quite right, which is why Democrats have adopted so many of them in recent times. Welfare reform was not identified with our side of the aisle, no matter how many times Moynihan is invoked. Deficit reduction was not thought to be a particularly Democratic thing to do, at least not until Bill Clinton did it. And James Galbraith not withstanding, we're not going back on it. We also pushed NAFTA through, passed a crime bill, and began adopting sensible, targeted tax cuts as a cornerstone of our economic policies. In fact, Democrats have been surprisingly willing to betray party dogma over the past 10 years, a trait attributable primarily, but not entirely, to Clinton.

But that shouldn't give us the idea that everything shiny, new, and advocated by Newt is worth adopting. Health Savings Accounts will destroy health care in this country. Seriously. As Matt says, and Arnold Relman argued in a TNR cover story a few weeks ago, HSA's might hasten the coming of a complete health care overhaul and, in that sense, be positive, but there'll be a lot of pain involved in that path. And if Garance is really just being sneaky and cunning and hoping to destroy so we can build, consider my comments moot. But know that HSA's will leave people like my girlfriend, who was born with hypophosphatemia, completely screwed, as the healthy opt into HSA's and those with chronic (though entirely manageable) conditions, like her, have no community on which to disperse costs. Under that scenario, health care becomes prohibitively expensive and many to most of those who need it worst will be unable to pay.

As for Flex accounts, they're fine, but they're really not forward-looking. They're an incremental step which makes things a touch better for folks. That's great -- hell, if the Prospect hires me, I'll be sure to take advantage of them. But this sort of small-bore proposal is only good for a sitting leader, not for a party that needs to prove itself visionary and in-touch. The way to assure voters that you see the future is to promise to radically upend the present. That means that health care can't be fixed by the tiny steps Garance is proposing, and certainly not by a simple willingness to trawl CATO and AEI for good proposals the right may have missed. Democrats need to find the courage put 1994 behind them and propose a radical restructuring of health care in this country. That's tough and dangerous to do, but it's also necessary, important, and the sole way to prove ourselves more than the party of tweaks. And that, in the end, is what forward-thinking means: able and willing to break out of the paradigm we're in and propose answers that the shackled politicians of the day are too scared to reach for. That's not, contra Garance, a call for compromise, but a recipe requiring vision.

March 21, 2005 in Democrats, Policy | Permalink

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Comments

Democrats need to find the courage [to] put 1994 behind them and propose a radical restructuring of health care in this country.

I wish. I truly do.

But..., it won't happen:
- entrenched power of the insurance industry at -both the federal and state level;
- Democratic congressional fear of yet another 'third rail' of "Hillary Care";
- state governments struggling (through Medicaid) to meet the health care needs of their citizens with inadequate federal support that continues to be stripped away, making them greatly distrust a congressional 'solution';
- Die-hard Republican opposition;
- Citizen/consumer fear of major change to a vital part of their life - for those insured; and,
- no really successful and affordable model that can be pointed to and expanded upon, anywhere in the world.

I think Howard Dean had it right. Fill in and substitute portions of existing programs, private and public.

Single payer, national health insurance for all makes sense if we were starting from scratch, but we aren't.

The hitch to single-payer would be who is the payer? Certainly not business - they want desparately to get out of health care insurance funding. Certainly not the federal government - the current deficits are not going away soon. Certainly not the individual citizens given that many have employer insurance now which is viewed as a treasured benefit, or those who have no insurance and could not afford it, or those who are unable to work and depend on Medicaid or nothing at all.

A Dean-like strategy of filling holes, and perhaps altering/expanding some programs does have some promise, but such a plan must pass two (or more) tests:

First, is the proposal simple enough that maybe 65-75% of the citizens would say, "Yeah, that would work" - without a great deal of complicated explanations, and

Second, would the existing entrenched power-interests (big and small business, labor unions, health insurance companies, the two political parties, state governments, and the medical community) not be unduly harmed, but expect to gain in obvious ways for each of them. That's a tough test to pass.

Dean, and to a lesser extent Kerry, had the right idea - the kind of incrementalism that is pragmatically realistic, non-threatening, non-ideological, and OBVIOUSLY BETTER.

Neither Dean nor Kerry was able to make their plan obvious enough to gain significant support, so that approach isn't an obvious winner, but might resonate if single-mindedly focused upon and was VERY simple to understand.

The one idea that did surface that rings true to me is the concept "What's good for Congress, and the federal Executive branch would be good for you".

Optional buy-in to the Federal employee health care system by employees (through their employer, or privately by citizens - perhaps with diversion of Medicaid funds by states and the federal government for those unable to pay the standard federal insurance rates) seems like a good first step toward creating a consistent nation-wide health care system based primarily on private insurance but administered nationally like the current federal insurance program, and supported for those .

I think you are right that the Democrats (and the nation) would be served well by stepping up with a plan and fighting to make to happen.

For better, or worse, we have a health care system based on non-governmentally provided insurance - including the federal employee health insurance, which is viewed by many to work and be first class. That federal health insurance system via private companies is the obvious place to start from, even with its administrative inefficiencies and overhead marketing costs.


Posted by: JimPortlandOR | Mar 21, 2005 10:27:01 PM

Sorry for the truncated 3rd paragraph from the end (I was impaired by too much verbage, which is characteristic of health care discussions):

consistent nation-wide health care system based primarily on private insurance but administered nationally like the current federal insurance program, and supported for those segments of the economy that now are supporting or dependent on the existing-system's reliance on private health insurance.

Posted by: JimPortlandOR | Mar 21, 2005 10:35:07 PM

I think Garance's use of health care as an example in the service of this larger point is, at the very least - stupid. Ezra, you're right, but you don't go far enough.
Garance, most likely, isn't ever going to have to worry about not having health insurance; using her experience as a writer at the American Prospect is quite frankly the sort of typical inside-the-Beltway, out-of-touch BS that's gotten us nowhere on this issue (and a lot of others) for so long. Look - there are 45 million people who don't have health insurance, and tens and tens of millions more who teeter on the edge, and tens of millions served by Medicare and Medicaid that this administration seems to be going out of their way to boot and/or bankrupt.
The simple fact is - the whole fucking system is way broken. Way, WAY broken. Every player involved in health care - even the ones currently making windfall profits - can see that the system is damn close to coming crashing down in an extraordinarily painful way.
Thus - every player actually has an interest in finding a large-scale solution that spreads the pain as equitably as possible. They're not stupid - it's just that nobody is going to voluntarily hoist themselves on their own petard, first.
So - think big. People - incl. businesses and the health care industry - want big solutions. 'Cause it's all fucked.

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