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December 03, 2007
A Man Date And A Movie
Jon Cohn has a long exploration of the policy debate involved in how many people Obama's plan leaves uncovered. The answer is...we really don't know. It depends how strong the employment mandate is, how lavish the subsidies are, how much the plans cost, what's defined as the minimum coverage threshold, etc. Jon's conclusion is forthcoming, but mine basically remains: If you're not substantively striving for universality, you're not going to get universality. Too much will get bargained away. Additionally, you can't make the necessary reforms to the insurance market without putting everyone in the coverage pool. The point of the reforms is not merely to keep insurers from gaming consumers, but to keep consumers from gaming insurers. You can't have one without the other. And lastly, because he's not relying on a coverage mandate, Obama relies heavily -- more so than Edwards or Clinton -- on employer-provision. I'm not necessarily against channeling some insurance through employers, but further strengthening your reliance on that system seems like a tremendous mistake to me.
This seems to me like a policy compromise that's searching for a rationale, and because various people want to support Obama, rationales are being constructed. The world is full of smart people who can think up smart reasons for not-so-smart things. But at the end of the day, even folks like Jacob Hacker, who are supportive of Obama's plan, had mandates in their plans. And even Obama, who is supportive of Obama's plan, has a mandate for kids in his plan. How you explain that in contrast to his attacks on a mandate for adults beats me. Obama could, of course, have come out and said that his sense of the political landscape was that a mandate wasn't popular enough, and would harm the chances for passage. But because he's made a big deal out of being bold and unbound by political considerations, he had to pretend that this was a decision made on the policy, rather than political, merits, and it's just not a very credible claim.
December 3, 2007 in Politics of Health Care | Permalink
Comments
Ezra,
The point of the reforms is not merely to keep insurers from gaming consumers, but to keep consumers from gaming insurers.
This is exactly where the politics of Obama's approach are better. His plan stops "insurers from gaming consumers" (community rating, stopping pre-condition exclusions) now, with "consumers gaming insurers" i.e. mandates to be dealt with down the road-- in an inevitably more receptive political environment (those paying their premiums prospectively surely won't like others not paying for insurance until after they're sick). In the meantime, Obama's plan will allow people to everyone to access health care who need it (those who are sick will sign up for a plan) and will lead very likely lead to mandates later.
I've said this a slew of times with no response-- aside from the ideological purity, Obama's plan seems simply better.
Where am I wrong?
Posted by: wisewon | Dec 3, 2007 3:07:43 PM
"The answer is...we really don't know"
Well, the answer is...we have a best guess at 15 million without healtcare coverage under the Obama "universal" healthcare plan.
Cohn is a ninja.
Posted by: Petey | Dec 3, 2007 3:12:29 PM
I'm not necessarily against channeling some insurance through employers, but further strengthening your reliance on that system seems like a tremendous mistake to me.
Yes.
Obama's counterclaim is that he'll offer some kind of public program as 'competition', but he goes to far toward endorsing the status quo and enters the negotiation with a weak hand - not a winning strategy in legislative sausage making.
I just don't 'get' him. I want to like his ideas and support him, and he keeps pulling the rug from under me and other progressives. Not a good sign. Obama may be setting himself up as the triangulator that exceeds Bill Clinton in DLCism - small moves in centrist ways that don't solve big problems with equally broad scope solutions.
Why oh why does Obama want to sound more cynical than Hillary?
Posted by: JimPortlandOR | Dec 3, 2007 3:14:04 PM
"Obama's plan seems simply better. Where am I wrong?"
- If you think universal healthcare is unimportant, then you're not wrong in thinking the Obama plan better.
- If you think 15 million Americans without healthcare is unimportant, you're not wrong in thinking the Obama plan better.
I think both of those things are important, so I think you are completely wrong.
Posted by: Petey | Dec 3, 2007 3:16:47 PM
Petey,
As I wrote the other day:
This is real nuanced, but important. People will get health care from Obama's plan. What they won't have is health care coverage prospectively.
As long as Obama's plan has community rating, then everyone has full access to health care. If you're not covered and get sick, then you'll sign up for a plan and get health care. There are no pre-condition exclusions and you pay the same rate as everyone else under Obama's plan.
Is this sustainable in the long-run? Definitely not. Is this feasible from an actuarial standpoint in the short-run? Yes. Which is my point, allowing for these "free-riders" will have a small impact on insurance rates/actuarial planning in the short-run so that issue is improperly stated by Ezra, Krugman and others. In the long-run, these free-riders make madates a political winner, as the electorate will not be happy with an inevitably increasing number of free-riders in the system.
PS I meant to say Obama's point is better... on the policy and politics of universality. I think there is little substantive difference between the three plans-- Wyden is the one with a plan that is actually worth calling "better."
Posted by: wisewon | Dec 3, 2007 3:23:23 PM
wisewon- Ezra explained where you were wrong in the original post. If Obama didn't believe in mandates, he wouldn't have his weird partial mandate in his plan. Obama is introducing a big moral hazard into his own plan by leaving the mandate partial and incentivizing 'free riders.'
Is this sustainable in the long-run? Definitely not.
It is rarely good politics to enact a poor plan. If the plan is seen to be failing it will be politically risky to re-open it two years in, where all kinds of shenanigans are apt to slip in.
Posted by: AJ | Dec 3, 2007 3:35:34 PM
Ezra,
If you're not substantively striving for universality, you're not going to get universality. Too much will get bargained away.
Here's someone who disagrees with you and believes in "sequentialism" instead-- his name is Ezra.
In reformer-speak, this is called "sequentialism," and all the major plans have it. But what you're seeing in these plans is the candidates attempting to create as good a health care system as an anxious public will allow.
On Hillary's plan:
All in all, I'm very positive on the plan. But there's a substantial distance between Clinton's proposal and my perfect plan...That's why I'm positive on Clinton's plan: I think this is damn close to the best policy you can get while retaining something politically sellable.
So you believe in sequential approaches. You believe in putting forth a plan that is politically feasible.
The difference is that Obama has seen the political calculus slightly differently-- he doesn't think individual mandates are sellable today and as I wrote above, there really isn't a difference between plans in actual access to health care.
This is ideological nitpicking, at best. At worst, its wrong on the politics and substance of the policy.
Posted by: wisewon | Dec 3, 2007 3:43:13 PM
If Obama didn't believe in mandates, he wouldn't have his weird partial mandate in his plan.
Not necessarily true. He may not believe in unfunded mandates. Concurrent SCHIP expansion can may a child insurance mandate different than a full mandate because the latter is unfunded.
Obama is introducing a big moral hazard into his own plan by leaving the mandate partial and incentivizing 'free riders.' ... It is rarely good politics to enact a poor plan. If the plan is seen to be failing it will be politically risky to re-open it two years in, where all kinds of shenanigans are apt to slip in.
This is the nut of the argument. Krugman, Ezra and others keep saying that the insurance market will fall apart because of rampant free-riding, hence Obama needs to have mandates or give up community rating.
Let's be clear about one thing. It is far from obvious that there will be rampant free-riding. Increased over today's levels? Yes. Significant enough that insurance is not feasible actuarially speaking? No one knows. The pundits can stop pretending they do. I'm sure there are actuaries at Aetna or UHC that have the modeled the level of free-riding that needs to exist for this to be a problem, and others like Gruber that can extrapolate the level of likely free-riding that would exist given the other specifics of the package (subsidies, etc). But no one knows the answer right now.
It may be feasible, it may not be. As I wrote above, my hunch is that the level of free-riding would be less than we expect (for those with insurance today via employes, most pay at most 20% of premiums-- are they really going to give up their insurance because the "know" they can get it after they are sick?) and the insurance markets would be fine.
The point is Krugman and Ezra are coming after Obama on this point with far too much of a black-and-white picture, when much is really left to be figured out on this issue. Obama is for universal access, he's on record saying he'd support mandates down the road if needed and there are much bigger issue distinctions to be made on health care.
Posted by: wisewon | Dec 3, 2007 4:13:40 PM
I had a clarifying thought (for me) the other day:
If Barack Obama is our next president, we're not going to get universal health care.
That's a depressing thought. And who knows when our next chance will be? The stars may never be as well aligned as they could be after the 2008 election. For Democrats to hold the White House and Congress and not even try--what a letdown that would be.
Posted by: Steve | Dec 3, 2007 4:58:07 PM
Ezra,
Here's my short version, reading this again:
Jon's conclusion is forthcoming, but mine basically remains: If you're not substantively striving for universality, you're not going to get universality.
You could just as easily say: "If you not substantively striving for single-payer, you're not going to get single-payer."
You've let all of the big three off of the hook by claiming that its a "sequential" process because of what's politically feasible (see above). Now you're criticizing Obama because he made a choice of no full mandates using the same guiding principle.
Posted by: wisewon | Dec 3, 2007 5:04:22 PM
"Universality" may be a goal, but that doesn't mean that any means of achieving it is acceptable.
Individual mandates are the equivalent of solving the homelessness problem by requiring everyone to buy a house. They blame the victim, shift the costs onto people who can't afford them, and do all this for no policy reason but rather to protect a group of very wealthy rent-seekers who suck lots of money out of the system that could pay for care.
One could also achieve universality, for instance, by executing everyone who didn't have insurance. That would actually be extremely effective, because it would also reduce future health care costs.
The individual mandate scheme fails because it is immoral, the product of a belief, either merely craven or downright evil, that the interests of insurance companies are more important than those of poor people.
Posted by: Dilan Esper | Dec 3, 2007 5:41:40 PM
What wisewon said.
I want to emphasize one point that I think is important -- the free-rider assumptions that are the basis for the attack on Obama's no-mandate are just that: assumptions. They are based on simple ideas about self-maximizing individuals who will do everything always to get the most for themselves.
There's an antidote to this type of economic modeling: empirical data. The part of the Left that rightly criticizes the dominance of Microeconomic thinking in other areas should not parrot the idea of moral hazard as a time-tested universal truth now. I don't deny that there is something to the argument; that some will game the system; but should the progressive litmus test be about whether you think people will free-ride in large numbers? Let's get a more dynamic picture here...
Posted by: eli | Dec 3, 2007 7:28:21 PM
The more I think about an individual mandate to purchase health insurance, the more I think it may become a huge political liability for Clinton (and Edwards, if he mattered any more). Timothy Noah summarized the basic problems in his latest Slate piece on health care reform:
Enrolling people in a private health care plan isn't the hard part; forcing people to pay for a private health care plan is the hard part. Yes, the government has procedures to collect student loans and unpaid taxes, but it's understood that such payments are obligations. There's little disagreement that if you take out a loan, you're obliged to repay it, and only slightly more disagreement (mostly among crackpots) that as a citizen you are obliged to share in the cost of government. I believe there would be a lot of disagreement about whether the government could compel you to buy a private health insurance policy.If you want to drive a car, it's accepted that you have to buy private auto insurance. But that's conditional on enjoying the societal privilege of driving a car; you can avoid the requirement by choosing not to drive one. A mandate to buy private health insurance, however, would be conditional on … being alive. I can't think of another instance in which the government says outright, "You must buy this or that," independent of any special privilege or subsidy it may bestow on you. Even if such a requirement could pass muster in the courts—and I have my doubts—it seems to me that politically it would give the inevitable conservative opposition a nice fat target to rally around. Big Brother will steal your wages if you don't buy a health insurance policy! Harry and Louise had a lot less to work with.
Posted by: JasonR | Dec 3, 2007 7:51:41 PM
I want to emphasize one point that I think is important -- the free-rider assumptions that are the basis for the attack on Obama's no-mandate are just that: assumptions.
Eli: But Obama's plan, too, is based on an assumption: namely that significant numbers of people won't drop insurance coverage and pocket the premium dollars. Maybe they will. Maybe they won't. Why take the risk? It seems to me reckless -- because (and this to me is the biggest danger or the Obama plan) if we're fortunate enough to enjoy a political environment a year or two down the line that is conducive to enacting universal healthcare, it seems crazy to squander it on a piece-meal plan that maybe gets us to 100 % coverage a few years down the pike.
Sure, you can supposedly go to a hospital and get care under Obama's plan, so I guess that means we'll have 100% access to healthcare, but we kinda sorta have that already. After all by law, nobody, not even an illegal immigrant, can be refused emergency care at a hospital.
The point is, it's pretty much guaranteed that any plan a Democratic president/congress manages to adopt will require a fight. And even if the fight is won, there are bound to be recriminations, with plenty of critics on the right looking to stir up resentment for a counterattack. I'm worried that when we reach this stage -- the post "passage" phase of healthcare reform -- we'll be far better off if everybody in the country has been entered into a bonafide insurance system. I just think once we get 99.9 % of the country's residents covered, it will be politically very difficult to force a retreat. As far as I know no western nation that has adopted a universal healthcare system has abandoned it.
With Obama's plan, on the other hand, we'll enter that post-passage phase with millions of people not yet enrolled in an insurance plan of any kind. And when the inevitable reaction from the right takes place, I think it's entirely possible roadblocks could be successfully put in place that will prevent further progress.
As I've written before, there's a lot to like about Senator Obama's candidacy. But if universal healthcare is a big priority -- and for me it's probably my number one priority -- you can't help but be disconcerted. I'd really really like to see him come down from his ill-advised position, and perhaps announce that, upon further policy sessions with his top advisors, he's made changes to his plan, and that he intends to push for 100%, bonafide UHC from the getgo.
In the long-run, these free-riders make madates a political winner, as the electorate will not be happy with an inevitably increasing number of free-riders in the system.
Wisewon: I wish you could share your political crystal ball with the rest of us. Perhaps you're right. But I think it's entirely possible with Obama's plan we'll get some major reforms, these major reforms will piss off certain people (namely insurance companies and right wing ideologues), a vicious counterattack will begin, and it will be several more years before any more substantive healthcare reforms can be enacted. When we reach that stage, I would much prefer that we've already arrived at 100% universal insurance coverage. If you're really concerned about universal healthcare coverage, swinging for the fences seems like the safer bet. Of course, maybe Senator Obama is not really that concerned about universal healthcare coverage. Doesn't make him a bad person. It just makes him a person you probably don't want to vote for if UHC is a major priority.
Posted by: Jasper | Dec 3, 2007 8:27:50 PM
The more I think about an individual mandate to purchase health insurance, the more I think it may become a huge political liability for Clinton (and Edwards, if he mattered any more).
Very unlikely. Something like 85% of the country's residents are already covered by private or public health insurance. A significant portion of the remainder are non-citizens and therefore can't vote. We're left with what, eight to ten percent of the electorate? Among this number, surely poor and lower-income voters will make up the lion's share, and they'll vote overwhelmingly for the Democrats in 2008. The tiny percentage that's left -- I'm picturing a healthy 29-year old with a decent income who would understandably rather spend his cash on pimping his ride or hitting the slopes than health insurance -- is probably not very fruitful territory for the Democrats anyway.
Posted by: Jasper | Dec 3, 2007 8:45:44 PM
That's right, Jasper. Everyone who currently has insurance will just blindly assume that the mandate will never actually affect them, or their family, or someone they care about, because their economic circumstances, or the cost of health insurance, or both, are guaranteed never to change so that insurance becomes unaffordable to them at some point in their lives.
And quite apart from such obvious risks, I think most people just deeply resent the government telling them, and their fellow citizens, that they must buy something, on pain of having their wages confiscated or being thrown into jail. Especially something that is very expensive and may provide them with very little benefit. It's just not consistent with the national psyche.
Posted by: JasonR | Dec 3, 2007 9:47:39 PM
'Health care' has become a skyrocketing health 'business', and I mean that in a negative way. I just drove past a local hospital today and was amazed that the hospital is now, in just a few short years, a complex taking up several city blocks, not counting the parking lots.
I really do resent the idea that my government would legislatively force me to support that new huge profit-making business. A friend of mine is a doctor who laments that, for years now, the insurance industry [another huge business] has more control than a doctor on what kind of care a patient will get. Colluders.
I want the 'business' model out of the health field before I have anything to do with being forcefully mandated to support that system. Unfortunately, i have known some beloved relatives and friends who have died or suffered because of getting trapped in the profit health business, especially being frightened into invasive tests, the procedures of which did lasting damage. That those individuals were' well insured' probably was the primary reason those expensive invasive tests were given in the first place. And, whatever happened to the idea of choice? If I were sick in this proposed mandated system, could I choose alternatives to allopathic medicine, which I believe has lost its original meaning?
Consider the human nature 'sense of entitlement' whereby most every person wants to receive a return for one's investment money. With a whole life insurance policy, there is at least a savings feature going to survivors. But, with health insurance, the only return one will ever get is by becoming ill or injured!!! That seems to be the opposite of an incentive to take good care of oneself and to be willing to die of natural causes. What a novel concept, huh......dying of natural causes.
I know I have drawn this argument to a far edge, but I do so because I think what is being considered in these plans is too much about supporting a profit-generating disease care than about health care, and that, today, disease care is part of a whole monstrously huge profit-generating industry playing on folks' fear of life and fear of death.
Posted by: Donna | Dec 3, 2007 11:00:30 PM
Ezra-
Even though I don't have a horse in this race, I think it should be clarified that Obama doesn't attack the notion of an individual mandate--he defends his decision not to include the requirement, but even suggests he eventually may have one.
Robert Reich, one of your editors at TAP, has a very credible opinion that Obama's plan is *more* universal than Clinton's. Why? I'll let Reich explain
"But in my view Obama’s would insure more people, not fewer, than HRC’s. That’s because Obama’s puts more money up front and contains sufficient subsidies to insure everyone who’s likely to need help – including all children and young adults up to 25 years old. Hers requires that everyone insure themselves. Yet we know from experience with mandated auto insurance – and we’re learning from what’s happening in Massachusetts where health insurance is now being mandated – that mandates still leave out a lot of people at the lower end who can’t afford to insure themselves even when they’re required to do so. HRC doesn’t indicate how she’d enforce her mandate, and I can’t find enough money in HRC’s plan to help all those who won’t be able to afford to buy it. In short: They’re both advances, but O’s is the better of the two. HRC has no grounds for alleging that O’s would leave out 15 million people."
I would rather that the candidates were debating the benefits, rather than the burdens, of their plans.
I talk a lot more about this in the California context on my blog, here:
http://www.health-access.org/blogger.html
Posted by: Anthony Wright | Dec 4, 2007 2:56:27 AM
Jasper,
If you're really concerned about universal healthcare coverage, swinging for the fences seems like the safer bet.
Agreed, but this is one of my main points. Clinton/Edwards' mandates are not swinging for the fences. They are an unfunded mandates, which has been a Republican-style approach to a universal system (see Romney/Schwarzenegger for Health Care, Bush for No Child Left Behind) with an unclear chance of success. As Cohn rightfully points out, it isn't clear what the estimated percent of people will not have insurance with mandates.(Surprisingly, no one it appears has even made an estimate, something he'll come out with soon. Even then, its still an estimate.)
Wyden's plan is swinging for the fences.
Single-payer is swinging for the fences.
Unfunded mandates are not swinging for the fences.
I'm not the one claiming to have a crystal ball. I gave my view of what I think would happen under Obama's plan, but I've been very clear that I think all of the big three plan's are inadequate. To believe any of them gets you to 99.9% coverage requires you to use a crystal ball. The reality is that we just don't know. To jump on Obama here on this question of universality is wrong-headed.
PS I'm not an Obama fan. I'm just disappointed to see so many on the left worked up about much ado about nothing. If one was offering a fully-funded plan of health-care for all and the other wasn't-- that would be something worth making a distinction on. But the differences here are small-- and honestly speaking-- to see smart folks like Ezra and Krugman to fall hook, line and sinker for political tricks is disappointing. Clinton's campaign has gotten everyone to make the "mandates= 99.9% coverage, Obama = 85% coverage" leap when that's far from what's actually known today. As I wrote above, Wyden's plan would be 99%. A single-payer plan would be 99%. Clinton's plan is not 99%. Could be higher than Obama's, may not be. But this is a difference that hasn't been worth the amount of words used to debate it.
Posted by: wisewon | Dec 4, 2007 7:24:15 AM
Is it really this hard for Ezra to accept that people just don't like these mandates? I prefer Edwards to Obama by a great deal, but all the same I think obama's plan represents the most politically feasible method of obtaining universal healthcare. I think Obama's plan can be expanded on. I think the horror stories that will be generated by Edwards or Clinton's plans will probably prevent their expansion.
I know people here think people will see the problems with Edwards or Clinton's plans and clamor for them to be fixed, but that's not really how humans operate. Especially not with a hostile media basically saying 'I told you so' about universal healthcare.
Posted by: soullite | Dec 4, 2007 8:38:42 AM
To believe any of them gets you to 99.9% coverage requires you to use a crystal ball. The reality is that we just don't know. To jump on Obama here on this question of universality is wrong-headed.
wisewon: To know which one gets you to 99.9% coverage requires a crystal ball. To believe one one will requires simply assessing the odds. I think the odds are better for a plan that requires, as a matter of law, that all Americans be covered by a health insurance policy.
Agreed, but this is one of my main points. Clinton/Edwards' mandates are not swinging for the fences. They are an unfunded mandates, which has been a Republican-style approach to a universal system.
They're not "unfunded" mandates. Both Clinton's and Edwards's plan encompass subsidies to cap premiums at a percentage of income. Perhaps we'll need more money that is called for initially in these plans. But it's simply wrong to say they're "unfunded." And let's not forget, there's nothing in the constitution to prevent a Democratic congress from pushing the legislation to the left (ie., more robust subsidies, greater affordability, etc.).
Posted by: Jasper | Dec 4, 2007 1:37:07 PM
Jasper,
Of course it's an unfunded mandate. If it were funded, the mandate would simply be to "sign up" for health insurance, instead of to purchase it with their own money.
And the fact that you freely admit that one of the purposes of the mandate is to redistribute wealth (take money from some people to fund health care for others) is a tacit acknowledgment that for some people it just doesn't make sense economically. You're forcing them to buy something that not only they may not want to buy or believe they need, but that they would be able to get more cheaply if you weren't forcing them to help fund health care for someone else.
Posted by: JasonR | Dec 4, 2007 2:09:27 PM
You're forcing them to buy something that not only they may not want to buy or believe they need, but that they would be able to get more cheaply if you weren't forcing them to help fund health care for someone else.
Yup, I'm a mean, evil, free market liberal who actually believes government ought to enact policies that promote the greater good, and benefit society as a whole.
For the record I think that individual mandate + community rating + guaranteed issue is likely to wreak havoc with the economics of the health insurance industry in the fullness of time, and that, eventually, we're likely to move toward something more along the lines of the single payer solution favored by my paleoliberal friends (my personal favorite is the French model, where private insurance still plays a prominent role). When we get there, eventually, I think for most people, paying the extra taxes for healthcare access will be a better deal, financially, than the mostly private system we now have for the non-elderly. If you don't believe me, get a COBRA quote and then compare that with the tax burden paid by someone in, say, Toronto. Our system is just insane.
Posted by: Jasper | Dec 4, 2007 2:46:02 PM
Jasper,
Yup, I'm a mean, evil, free market liberal who actually believes government ought to enact policies that promote the greater good, and benefit society as a whole.
No, you're a mean, evil, authoritarian liberal who wants to confiscate people's wages or throw them in jail if they don't spend their money on health insurance they don't want, don't believe they need, and don't think they can afford. One doesn't need to be a conservative to find such a policy grossly illiberal, as the many liberals speaking out strongly against it attest.
For the record I think that individual mandate + community rating + guaranteed issue is likely to wreak havoc with the economics of the health insurance industry in the fullness of time, and that, eventually, we're likely to move toward something more along the lines of the single payer solution
So you keep saying, but you have yet to articulate a clear line of argument as to how the claimed effect (single-payer) is likely to follow from the premise (mandate + CR + GI). It seems to me at least as likely that, assuming you can even get it passed into law, such extreme regulation of the private insurance industry will lead to an even higher rate of health care inflation than we have today and that the response will be to demand that the regulation be reduced.
Our system is just insane.
Whenever I see these our-system-is-INSANE type statements, and I see them all the time from proponents of health care reform, I know I'm dealing with someone whose position is basically driven by anger and frustration rather than reason. You just usually do a better job of hiding it.
It's one thing to argue that, all things considered, we'd be better off under a single-payer system. I think there's a respectable argument to be made for that proposition, even though I don't agree with it. It's quite another thing to dismiss the U.S. health care system as "insane." Health care reform basically means trading one set of strengths and weaknesses for another. People who value universality and equity most highly will tend to be drawn to a single-payer model. People who value excellence and choice most highly will tend to be drawn to a multi-payer, mixed public-and-private model, like we have now. Neither system is "insane." Mainly, they just reflect different political and social priorities.
Posted by: JasonR | Dec 4, 2007 6:52:16 PM
No, you're a mean, evil, authoritarian liberal who wants to confiscate people's wages or throw them in jail if they don't spend their money on health insurance they don't want, don't believe they need, and don't think they can afford.
I see no difference between my position and a desire to force people to pay higher taxes to achieve the same end. Money is fungible, after all. No doubt plenty of Swedes and Frenchmen and Australians, too, don't want their wages "confiscated" to pay for universal healthcare. Are people in these countries who support the maintenance of their systems "evil authoritarians?" At any rate, I'd prefer to pay for universal healthcare out of general taxation, and believe we're slowly but surely evolving toward that end. I just see little likelihood that such a course of action will be enacted as the first stage of reform. Second or third stage? You betcha. Moreover, I strongly support the use of generous subsidies with any individual mandate plan. I don't think any American who is playing by the rules should face financial hardship in acquiring access to decent healthcare.
It seems to me at least as likely that, assuming you can even get it passed into law, such extreme regulation of the private insurance industry will lead to an even higher rate of health care inflation than we have today and that the response will be to demand that the regulation be reduced.
You are undoubtedly correct that such likely outcomes as higher healthcare inflation will lead to demands to reduce or reverse reform. That's why I want to push for genuinely universal insurance coverage from the beginning. I see little prospect of Americans giving up their right to guaranteed coverage once they possess it. But to answer your question: my guess is the "extreme" regulation of the health insurance industry will lead to either financial difficulties/insolvencies for many insurers, or unsustainably large premiums increases. Either of these scenarios, in my view, will create pressure in favor of a larger role for the government as a guarantor of health insurance and as an insurer of last resort. America can't put of the inevitable forever.
It's quite another thing to dismiss the U.S. health care system as "insane."
I'm not "dismissing" it as insane. I'm using said adjective to argue for reform, not destruction. I've argued here and in other forums I see much to admire in the US healthcare system. US medical research is a boon to all humanity. The overall product is often the best in the world. I simply see lots of problems with the system that delivers that often excellent product that need rectifying. Are you seriously content with the status quo? Do you think, say, an employed single mother earning $45,000 per year should have to spend 40% of her take home to afford COBRA premiums? Do you believe it's desirable that a 50 year-old with a preexisting condition should pass on accepting a dream job offer because the exciting new start up he's interviewing with doesn't offer health insurance? Do you feel it's acceptable for the richest country in history to allow millions of its children to go without regular checkups, or consistent access to preventative care? You're damned right I'm frustrated with the status quo. We should -- and we will -- do better.
Posted by: Jasper | Dec 4, 2007 7:47:55 PM
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