Health care

Krugman brings up the issue this morning:

According to a recent Gallup poll, 82 percent of Americans rank health care among their top issues. People are happy with the quality of health care, if they can afford it, but they’re afraid that they might not be able to afford it. Unlike other wealthy countries, America doesn’t have universal health insurance, and it’s all too easy to fall through the cracks in our system. When I saw that the president’s economic report devoted a whole chapter to health care, I assumed that it would make some attempt to address these public concerns.

Instead, the report pooh-poohs the problem. Although more than 40 million people lack health insurance, this doesn’t matter too much because “the uninsured are a diverse and perpetually changing group.” This is good news? At any given time about one in seven Americans is uninsured, which is bad enough. Because the uninsured are a “perpetually changing group,” however, a much larger fraction of the population suffers periodic, terrifying spells of being uninsured, and an even larger fraction lives with the fear of losing insurance if anything goes wrong at work or at home.

The report also seems to have missed the point of health insurance. It argues that it would be a good thing if insurance companies had more information about the health prospects of clients so “policies could be tailored to different types and priced accordingly.” So if insurance companies develop a new way to identify people who are likely to have kidney problems later in life, and use this information to deny such people policies that cover dialysis, that’s a positive step?

— snip —

What would an answer to the growing health care crisis look like? It would surely involve extending coverage to those now uninsured. To keep costs down, it would crack down both on drug prices and on administrative costs. And it might well cut private insurance companies out of the loop for some, if not all, coverage.

But the administration can’t offer such an answer, both because of its ideological blinders and because of its special interest ties. The Economic Report of the President has only negative things to say about efforts to hold down drug prices. It talks at length about insurance reform, but it mainly complains that we rely too much on insurance; it says nothing about either expanding coverage or reducing insurance-company overhead. Its main concrete policy suggestion is a plan for tax-deductible health savings accounts, which would be worth little or nothing to a vast majority of the uninsured.

I’ll talk more about alternatives for health care in future columns. But for now, let’s just note that this is an issue the public cares about — an issue the administration can’t address, but a bold Democrat can.

I hope the eventual Democratic nominee is wise enough to listen to him, but I’m not holding my breath.

I mean, yes, a bold Democrat could address the fact that here, in the wealthiest society in the world, a substantial portion of the population does not have access to one of the basic necessities of life. And I don’t think it’s excessively partisan to suggest that our Republican friends are largely responsible for this — it was, after all, Republican strategist Bill Kristol who authored the strategy memo which helped to derail health care reform in the early nineties, by putting forth the Orwellian argument that there is no health care crisis in this country. Republicans seized upon this and repeated it at every opportunity; bottom-feeders like Rush Limbaugh explained ad nauseam that no one was denied health care because you can always just go to the emergency room. And so on and so forth.


The collapse of Bill Clinton’s incremental, insurer-friendly plan set the cause of health care reform back by at least a decade, and probably longer. Despite all the GOP propaganda to the contrary, his plan was anything but socialized medicine — it was more along the lines of a giant HMO. He actually met with the five largest insurers, and crafted a plan to their liking, probably hoping to innoculate himself against accusations of “socialized medicine.”

And of course, this incremental, insurer-friendly plan was promptly denounced as “socialized medicine.”

Add to this the Harry and Louise ads — which were produced by a coalition of smaller insurers afraid they were going to lose their piece of the pie — and the debate which followed had only the most tangential relation to reality.

My own take is that Clinton should have been a better negotiator. If you’re selling a house, and you want $300,000 for it, you don’t list it at $300,000 — you list it at $325,000, or higher, and hope someone will make a bid for $300,000. Clinton was, to be fair, probably correct in thinking that his plan was the best he could realistically achieve at the time — but he should have started out asking for more. In my best of all possible worlds, he would have started out asking for a single payer system, and allowed himself to be bargained down as necessary. (Unlikely, I know, but it all boils down to semantics. Call it something else, call it “Medicare for Everyone,” or “the Red-Blooded American Health Care Act,” or whatever. But that’s another rant.)

At any rate, here we are, still discussing the issue a decade later.

Don’t get me wrong. None of this is to suggest that there’s anything more important right now than handing George Bush his eviction papers in November. Bush suggests that 9/11 is the reason he should be “re-” elected, because it, you know, changed everything. Well, I would argue that he’s right, that 9/11 really did change everything — and that’s exactly why we don’t have the luxury of risking a second Bush term. 9/11 gave his little cadre of neocons the excuse they needed to pursue a their wildest wet dreams of global hegemony, and we simply can’t afford four more years of this. I approach this election with a sort of optimistic pessimism. While I suppose a bold Democrat could propose a bold health care reform — and I would certainly cheer him on — I’m just not going to base my vote on the possibility, or lack thereof. Our very political system is in triage at the moment. We have to staunch the bleeding, keep the patient alive — once we’ve succeeded there, we can get back to the chronic, long term problems.