June 30, 2005
James Hamilton, talking about Mitt Romney's attempts to restructure health care by ending free medical care in emergency rooms but subsidizing the needy, writes:
Even so, I count it as progress of sorts if we might in this fashion find ourselves at least able to agree on what we want to buy, leaving just the little matter of haggling over the price. A proposal like Romney's strikes me as a constructive way to frame a public discussion of exactly where America stands on who should pay the medical costs of the uninsured.
I don't know about that. Outside of the blogosphere, it's fairly impressive how much of the health care debate really is about haggling over prices. The constituency actively pushing single-payer in this country is quite small, in large part due to fears about its political viability. Moreover, support for health care entitlement programs like Medicare, Medicaid, CHIP, is widely bipartisan, almost sacrosanct. Even with a budget deficit spiraling rapidly out of control, the most radical Republican majority in memory couldn't force serious cuts in Medicaid. Back in the mid-90's, Newt's Revolution suffered a major public defeat when they tried to simply restrain the growth of Medicare. Bush just tacked a massive prescription drug enhancement onto the same program. Conservatives have no stomach for cutting health subsidization, and often find themselves expanding it.
So what we have in this country, to a large degree, is a health care consensus. Some degree of subsidization is necessary, particularly for the elderly, children, and the impoverished. That part's not a problem. What is a problem is that the status quo can only last so long, health care costs are moving too fast and our system is becoming too burdened for this consensus to hold. And that's when we'll really see folks have to pick sides. Not now, when it's safe to support what exists and prudent to oppose what doesn't, but when what exists becomes untenable and what comes next becomes pressing.
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You got it, Ezra.
Today, everyone's spending all their energy protecting their turf, making sure that their programs aren't cut and that they don't lose their share of the pie. And mostly, it's been working. Everyone just cost-shifts, finds a new accounting trick, costs spiral up, and a handful more folks go uninsured every year. It's a steady bleed, but nothing lethal, and all the interests have got their asses covered.
What nobody seems to be realizing is that in 2011, the boomers are going to hit like a freight train full of bricks.
And all the shit we should have been doing today--putting in universal health care, working on chronic care management, making huge IT investments, figuring out how the hell to deal with the obesity epidemic--all the stuff that's a smart investment but pays its dividends down the road--that's not gonna be an option anymore.
All it's going to be are cuts, cuts, cuts, and everyone desperately trying to protect themselves. Quite literally, fighting for their lives.
Of course, it doesn't have to be that way. We could be making these infrastructure investments now, and setting up systems that will let us absorb the shock of the boomers. Unfortunately, we've got this great fiddle and, hey, wanna hear a song?
Posted by: theorajones | Jun 30, 2005 5:21:40 PM
Being from MA, considering I've heard Romney assuage about the beauty and efficieny of private industry, I'm more than just a little skeptical about Romney's plan. Honestly though, I really don't know the details, so I can't say for sure.
I will say one thing, Romney is not an idiot, and honestly, he really does believe in removing unecessary waist and getting the state on good financial grounds. He hasn't, at least from memory, talked about nonsense things like cutting taxes or any such thing. He really has not been a bad governor by any account. My question is whether this move is supposed to shore up some slightly left of center support for a Presidential run.
Is this plan something liberals should be onboard with? Or is this YACAFTA (yet another Cafta,) where while the overall mission is acceptable, i.e. free trade, its the dirty details of the actual legislation that make it worth opposing. I guess I have to read up on it.
Posted by: Adrock | Jul 1, 2005 12:03:48 PM
Posted by: peter.w | Sep 16, 2007 9:00:14 PM
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