Gutting the Trout

I'm a little baffled by the tone of some of the reactions here, including Kevin's. A mandate is a good thing. You can't get there from here without it.

And it's not crazy or scandalous that the insurance industry isn't willing to concede community pricing at the outset. This is bargaining, after all. Their asking for mandated coverage is what will make it possible for reformers to ask for community pricing. The insurers couldn't afford?and couldn't be expected to afford?community pricing without the universal, individual mandate.

And the best thing about this from the progressive perspective is that the universal, individual mandate is universal health care. In the worst-case scenario it might be initially very unequal...but there will be no going backwards to non-universal health care once that line is crossed. Aside from adopting it at the outset, I can't think of a faster way to a single-payer system than starting with a universal, individual mandate because it creates an important part of the regulatory apparatus and many of the lingering problems that will remain will quickly be understood to be solvable with a single-payer system.

Also, there's some important psychological reasons why even many single-payer, universal coverage health care systems that ensure availability for even the poorest use an insurance model with "premiums" and an individual mandate. It teaches people that their participation in the system when they are healthy is what makes it possible for the system overall to be available to those who are sick. If it's completely invisible, paid for by general tax revenue, then it's simply an entitlement.

Finally, the insurance companies are also doing progressives a sort of a favor in bringing this to the table even before Obama et al have asked for it. A lot of conservatives will balk at this, saying that a mandate is intrusive and an example of the "nanny state". But when the insurance companies, as a business community, brings it to the table with the (true and valid) rationale that they can't be expected to be able to afford to cover all those currently uninsured sick people without all those currently uninsured healthy people being forced to enroll, too...well, then, it turns the politics of it upside-down. What was a nanny-state big-government intrusion and burden becomes a reasonable request from businessmen who want to be able to make a profit when they're being asked to extend coverage to all those people who are now crowding ERs when they have the flu.

All in all, this is a fantastic development.

If a mandate that everyone must buy health insurance passes, I hope they pass a blink-breathe-walk-drink water tax.

"Gut them like trouts" I love that! Thanks Kevin.

I'm with you, and these are well-fed trout you're talking about.

On the positive side, the health care insurance industry is looking at the political wind behind universal health care and they now face the fact that they can't stop it. They are now quibbling over how it will be implemented. They'll recognize a mandate to accept anyone who applies for insurance, but they want to guarantee a universal pool paying in. Separately they have also accepted dropping the right to screen out for pre-existing conditions. They are going to fight to be able to rate them up, of course, but they have not said that.

But one thing is clear. Harry and Louise aren't going to be fighting against universal health care this time. That battle is over, and the insurance companies have lost it. The war that Harry Truman was fighting 60 years ago in 1948 has at last been won.

Every significant politician this year was running with some kind of revision plan for health care, even McCain. Something will pass, and it will try to be universal. If it doesn't succeed, then the effort will be revised until it does. That is now as much of a given as can be politically possible.

Now we get into the battles to determine the shape of the outcome. The proposal of Tom Daschle as Sec DHS and Health care Czar is a big part of organizing for the fight over the details. So is the report in yesterday's NY Times that Democratic Senators Max Baucus of Montana, Christopher J. Dodd of Connecticut, Edward M. Kennedy of Massachusetts and John D. Rockefeller IV of West Virginia, together with Republicans Michael B. Enzi of Wyoming, Charles E. Grassley of Iowa and Orrin G. Hatch of Utah all intend to work together to pass universal health care.

It's like the end of WW I. The war itself was fought to determine which side won. Then the Treaties after the war were fought out to determine what winning meant. We've won the war for universal health care, and the health insurance industry knows it. The new battle is what it will mean, but whatever it will mean, the new system has to be better than the older non-system.

Keith M Ellis has the right of it.

Kevin's concerns about pricing can be addressed in a number of ways. As long as we're creating a whole new slate of regulations of the health insurance industry, some regulations on pricing would not be much to add on. Also, we can go with Edwards plan of have a government provider in the mix, "competing" with the private insurers. This can begin as a sort of provider of last resort, who insurers the most difficult to insure or the unemployed, poor, underclass, etc.

However, the government system is pretty much guaranteed to have lower overhead than the private insurerers, so it will be able to offer much lower premiums. Soon, the small business owners will want in for their employees. Then the larger business will want in as well. Eventually, we'll have a single payer system without ever having to call it that.

Yes, there will be a lot of little battles along the way, but the insurance industry conceding on insuring everyone with pre-existing conditions and only asking for a mandate to participating in the risk pool is a HUGE victory for universal health care. Anyone who does not realize this has not been paying attention to the debate.

It's neat rhetoric, but I don't remember it in the Constitution. Seems the role for government is to set limits on private behaviors and, in the mode of FDR, to set up structures which enable people to create things like corporations and coops.

If we want to say to doctors that they can't refuse to serve any customer with real problems then we get universal health care.

If we want to say to insurance companies they can't refuse coverage to someone with pre-existing problems, then you get universal coverage.

We have to look at the boundary we want to set and the burden we would put on individuals and companies who are benefitting from the largesse of government (and the taxpayers who back it).

We offer bailout loans to banks and maybe car companies, but always with strings attached. The same has to apply to all corporations who use government's assistance to achieve wealth.

In case of the health care industry we're just seeking to readjust the boundary lines a bit to include everybody to get good health care at costs we can all afford (even if government has to subsidize the poorest among us).

Exactly how much health care we would consider 'good' or 'sufficient' is debatable. Exactly how much cost we would consider 'affordable' is debatable. But, those broad issues need to be agreed upon to some extent before the details of any of these new Senate plans can be considered complete.

Then there's the Obama plan...

Are those numbers before or after the $100million salaries to the CEOs?