November 20, 2006
This article on Schwarzenegger's halting, halfhearted attempts to bring universal coverage to California neatly encapsulates the central hurdle facing Republican reformers: Taxes. You simply cannot cover a new segment of the population without the addition of some revenues. And since Schwarzenegger's advisors are already ruling out funding streams as minors as cigarette taxes, you've got just about no place to turn.
The example of Massachusetts has, in some ways, been destructive here, as governors have looked to that state and then done some throat-clearing about replication. Problem is, Massachusetts was a rare case that didn't need new revenues. As I explained in this article, a previous wave of progressive health reform had already created a massive fund to care for the uninsured in the Commonwealth -- which meant the Roney plan only had to redirect revenues, not create new ones. Add in a huge hospital-industrial complex, a very low number of uninsured residents, the threat of an expansive, universal care ballot measure, and the government's withholding of a $750 million health waiver, and you've got an easy path to change.
That said, there is something to the federalist strategy on universal health care, wherein various states give it their best shot and create models for the rest of the nation. Problem is, it's hard for states fund such experiments. That's why I've some affection for Russ Feingold's idea (mp3), which would guarantee a handful of states tens of billions to institute such plans. I'd amp up both the money allocated and the number of states included, but it's an interesting compromise proposal that could, in a Democratic Congress, make it through the legislative process with few enemies, and even attract a presidential signature.
Well, on the California tax items a lot of them were voted on directly and defeated in earlier this month.
Looks like the favorite son of NYC has a solution to health care costs: free labor. Not sure if he is looking at the crop of slaves that he will get in his latest draft proposal as almost-free hospital workers, but I am sure someone will see the possibility.
Frankly, I was surprised that I did not already see posts of a Republican conspiracy to bring back the draft while pointing to the Rangel proposal. Check the link, it took a few months last time.
Posted by: Guy Montag | Nov 20, 2006 10:42:03 AM
On federalism: I fear a race to the bottom.
Posted by: SomeCallMeTim | Nov 20, 2006 10:53:54 AM
ezra sez: (regarding MA) a previous wave of progressive health reform had already created a massive fund to care for the uninsured...
There's danger in pursuing this course, especially in states that aren't so progresssive. One of the reasons Medicare is successful (and that the Republicans try to undermine it) is that everyone gets some benefit from the program.
Trying to fund what is essentially a welfare program for the poor by looking for the votes of the representatives of the upper-working-class, middle class and wealth class, is that it depends upon the slender reed of guilt (or obligation to do the 'right thing') in these groups that won't receive any benefits. MA had wide support for building their fund for the uninsured ahead of their 'reform'. That won't be usual.
Feingold's approach also is essentially subject to this same problem. In addition, the Feds aren't exactly awash in cash for new programs either - probably even in worse shape than most states in regard to unbalanced budgets.
The more I think about this, the more I'm convinced that the Dems need to construct a long-term strategy that leads directly to universal coverage, perhaps even of the single-payer kind, and then figure out what steps lead logically to this result and concentrate on those steps in the short term. I'm fearful we will take short-term actions that make it harder to get to a good long-term outcome without such a plan.
I do think this will likely be a federal solution of some kind though. The states have the freedom to innovate (although the insurance industry has an easier time working state-by-state to oppose progressive moves). The feds just won't be able to gain the kind of majorities of Dems in the House/Senate and simultaneous control
Posted by: JimPortlandOR | Nov 20, 2006 11:30:07 AM
(darn: hit post by accident - so will wrap up quickly now)
...simultaneous control of the Presidency to put together a comprehensive, funded, nationwide national health care plan anytime soon.
But if we acknowledge this political/budgetary fact of life in Washington, we shouldn't also accept the idea that some overall long-term plan shouldn't be in mind and on paper (as law).
Posted by: JimPortlandOR | Nov 20, 2006 11:34:33 AM
There is another part of the problem with universal coverage, and this is often not given any exposure. You could cut the overal cost of such a system if you cut the overall costs!
Nearly all the proposals out there, with the exception of expanding the VA univerasally (with its own host of problems.) simply talk about paying for people to have coverage. They seek to take the current costs and cover everyone.
Talk with people in the health care industry and they speak about how costs need to be high to cover all the nifty 21st century technology which is the pride of our system. However a great majority of our techniques have been in used for 30 years. 'Simple' treatments and routine surgeries have gone up along with the rest.
A good way to limit just an outright subsidy for enriching the entire medical industry is to cap out the costs for given proceedures. Of course this needs to go along with a strict adherence to 'standards of care' to avoid a stampede to unnecesary high tech/ high cost proceedures for simple maladies.
Posted by: david b | Nov 20, 2006 12:25:24 PM
Canada started as a "states up" solution when Universal healthcare was launched. The Federal government joined later. And it started in a poorer province (Saskatchewan) first.
Posted by: Northern Observer | Nov 20, 2006 3:15:05 PM
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