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August 24, 2005

Feingold on Health Care

I talked yesterday about how liberals are losing the essential arguments for health care in this country. The day before, I went to a forum with Russ Feingold. His speech was mainly on Iraq, but he mentioned that the top domestic concern of his constituents was health care so, when Q&A came, I asked how he'd fix it. His answer shows where we've fallen to. This is paraphrased, but accurate:

I've always been for single payer. In the Senate, it was me and Paul Wellstone, we sponsored the bill. But recently, I came to the same conclusion Paul did towards the end of his life, which is that we need to establish a universal floor, but after that, give each state full autonomy over their programs. We don't need a big federal bureaucracy doing this, we need to rely, instead, on the "genius of the states" and let them experiment and decide what's best.

Let's break that down a bit. He's for single payer. His alliance with Wellstone is used to give that cred. But when he gets into his actual plan, he needs to reinvoke Wellstone because the idea, while progressive in some respects, is quite conservative in others, and is in any case bad. Using Paul's name heads off arguments that it's illiberal.

Wellstone's name aside, Feingold consciously adopts two conservative arguments here. The first, that federal bureaucracy is bad, and the second, that states can do it better. Neither make any sense outside a fear of being labeled a big-government liberal. Structurally, fracturing the system across 50-states is absurd. The genius of some states is more than matched by the idiocy of others. And now each gets to take an IQ test with your health care cdependent on the outcome. So Alabama has HSA's, California single-payer, etc? How is that funded? Does CA pay for Alabama's sick? Does everyone pay the same no matter their system? Do the states fight with the fed for money, as they do now with Medicare? Every time you move, do you need to enter a wholly new and unfamiliar system? And considering all the problems with integration, all the new positions that couldn't be standardized across the board, and all the variation across systems, how is this not a much more byzantine bureaucracy we're creating?

Feingold, like other liberals, is afraid. So he promises single-payer but promises it won't be the federal government's. Which doesn't make sense. But liberals, for now, aren't allowed to make sense. We know, or think we know, the direction we should be going in, but lingering nightmares from 1994 have taught us to keep those naughty thoughts to ourselves. Deep down, I've little doubt that Russ knows the government needs a united system to bargain effectively, to reduce administrative costs, to ensure easy portability, to make the system work. That doesn't mean states can't have any freedom, but they can't have total license to go whichever way Haley Barbour, Jeb Bush, or, for you Republicans, Bill Richardson, wants to.

Feingold's heart is in the right place, but his fear's leaving the product incoherent. As he said on Iraq, someone needs to break the taboo over talking about withdrawal. Well, if he runs for president, someone needs to break the Party's taboo on speaking truth about health care. And after the firestorm he started on Iraq, I can't think of anyone more experienced at that kind of thing. Here's hoping he gives Wellstone another read and takes the assignment.

August 24, 2005 in Democrats | Permalink


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I don't know if its supported by actual evidence, but a lay theory of federalism suggests its easier to trickle up a universal system from State Gov. to Federal Gov. than fit a universal system on the states.

Instead of arguing about some mythical health care system, we can argue "Hey, let's adopt the California plan".

Posted by: talboito | Aug 24, 2005 1:36:35 PM

Just to provide some context, here are some graphs that show how different the states are:
Publicly-, privately-, and un-insured by state
Life expectancy and child death rates for states and countries

As a bonus thought experiment, here is a version of the first graph with the states coded by how they voted in the last election. Wisconsin is near (75,13).

Posted by: Robert | Aug 24, 2005 2:29:54 PM


I don't know that he's as incoherent as you suggest. Canada's system, after all, is managed at the provincial level.


Don't forget that there is a proposed California plan now, and all of you Californians should be working to get th word out. More information on State Senator Sheila Kuehl's SB 840 are available at the Health Care for All---California website.

Posted by: Abby | Aug 24, 2005 2:39:01 PM

WHere it's managed and where it's created are very different things. Canada manages at the state level, but there's significant uniformity across the board. Feingold, from my read, was talking about giving states the freedom to experiment with whatever structure they want, considering some very basic needs were met.

Posted by: Ezra Klein | Aug 24, 2005 2:46:09 PM

I can't wait to see faith-based medicine and no birth control coverage in the cracker-barrel states.

Posted by: CParis | Aug 24, 2005 3:33:53 PM

I guess I'll be the liberal to say it - I suspect Feingold's pretty much right - National Single Payer has too many moving parts to work, but a "basic services" floor that establishes some good basic starting pints for greater coverage is probably both doable and workable. It reframes the discussion, hits a sweet spot that reasonable Republicans can agree with, and doesn't make a hash of all the current systems out there. I think it's at least worth some more conversation.

Posted by: weboy | Aug 24, 2005 4:02:31 PM

No. This is idea is ridiculous. One reason our system is such a mess is because there's no standardization. Canada has 13 provinces with much less population density. We have 50 states, many with enormous numbers of people. One key cause of our ineffiency is the fractured nature of the system. Different standards everywhere, different kinds of hospitals everywhere, rural areas with next to nothing. A system run by states, without any overhaul of the private system, as Feingold seemed to suggest (I was there and that was my impression) is nothing more than a bandaid.

Posted by: Kate | Aug 24, 2005 6:37:25 PM

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