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The Politics of Healthcare
Jonathan Cohn takes a look at the many compromises Barack Obama is making in order to get a healthcare reform bill passed:
Put aside, for a moment, the policy merits of these moves. The politics are lousy. Obama would be in danger of producing legislation that seems to offer little up-front benefit, particularly for the electorally vital middle class. And if some of these people end up paying even modestly higher taxes to help finance reform they're not likely to be happy about it. It's hard to imagine such legislation provoking a backlash that could produce total repeal. It's not so hard to imagine such legislation creating bad political feelings, the kind that linger around until the next Election Day and pave the way for legislative retrenchment later on.
The key to healthcare reform is that it be popular with the public. The Medicare prescription bill, for example, was generally popular because it provided a clear and concrete benefit. Broader healthcare reform, however, is going to have a harder time. If there's no public option, for example, and most people simply keep the employer-based healthcare they already have, then what's the selling point? Most people will just see higher taxes funding better coverage for the poor, and you don't have to be the world's biggest cynic to understand that this isn't going to be overwhelmingly popular. Helping the poor is all well and good, but like it or not, most of us want to know what's in it for ourselves if our taxes are going up. That's just life.
Right now, we're running the risk that the answer is "not much." Healthcare reform needs a little more obvious sizzle if it's going to survive the coming tsunami of conservative agitprop, and the bills wending their way through Congress don't have much of that left. Jon is right: it's lousy politics.
With certainty of payment
With certainty of payment for healthcare providers, or at least of the lion's share of charges, and certainty for every American of lifetime protection against (at least) catastrophic financial loss from a health problem (whether a job is kept or not), enormous wasted costs will be swept out of the system: bills padded to cover delinquencies and late-pays, accumulating finance charges for delayed payments, huge collection infrastructures, large armies devoted to finding and fighting over pre-existing conditions. If we collectively strip off the catastrophic layer,the lowest-cost thing we can do, the cost of that protection will no longer be burdened with the uncertainty of exposure from a particular pool for which a private insurer must charge, nor with any profit assessed on those costs which a for-profit private insurer must account for. The aggregate cost of that layer of coverage will be reduced accordingly, and the remaining cost of covering the gaps underneath it will be as well. Framed in those terms, that is, with the core societal objectives always present, a plan that accomplishes those objectives to any significant degree will be enormously popular. Right now, we just have these mushy terms floating around that are not galvanizing public opinion enough to shut the Blue Dogs up. Unfortunately, our "experts" just aren't getting it.
With certainty of payment
With certainty of payment for healthcare providers, or at least of the lion's share of charges, and certainty for every American of lifetime protection against (at least) catastrophic financial loss from a health problem (whether a job is kept or not), enormous wasted costs will be swept out of the system: bills padded to cover delinquencies and late-pays, accumulating finance charges for delayed payments, huge collection infrastructures, large armies devoted to finding and fighting over pre-existing conditions. If we collectively strip off the catastrophic layer,the lowest-cost thing we can do, the cost of that protection will no longer be burdened with the uncertainty of exposure from a particular pool for which a private insurer must charge, nor with any profit assessed on those costs which a for-profit private insurer must account for. The aggregate cost of that layer of coverage will be reduced accordingly, and the remaining cost of covering the gaps underneath it will be as well. Framed in those terms, that is, with the core societal objectives always present, a plan that accomplishes those objectives to any significant degree will be enormously popular. Right now, we just have these mushy terms floating around that are not galvanizing public opinion enough to shut the Blue Dogs up. Unfortunately, our "experts" just aren't getting it.
politics
What's actually lousy politics is that the USA is a nation which does not consider adequate health care for everybody to be a positive political outcome in itself. Forget about Jesus people, he moved to europe and vacations in Canada.
1992
This is exactly the way I felt in 1992. Even though I supported healthcare reform, I didn't see what was in it for the middle class beyond valid but abstract arguments. And without their support, reform fails.
Scrapping the tax deduction on employer-provided benefits is a political loser, even if it is good policy. It will never happen. And the only way real reform can pass is if there is serious cost containment. And that's probably the real third rail of American politics even if evidence suggests that Americans with insurance are way over treated.
I give near-universal coverage a 20% chance of passing.
The middle class that's
The middle class that's insured through work has the biggest stake of all -- eliminating the fear that insurance will disappear if the job disappears, a very real risk to everyone, and the fear they will lose a lifetime of savings to an untimely health problem. So they stay in jobs they hate for the benefits, a great recipe for productivity, while that fear depresses confidence in the economic future that is the necessary underpinning for a strong economy. Meanwhile, employers are scared to death of unpredictably escalating benefit costs, so they avoid hiring and at best rely on temps as much as possible. It boggles the mind that so many people don't get how this is connected to the performance of the economy as a whole, although the entire population of the rest of the industrialized world does get it. Uh, yeah, but do you want us to become French, or socialists, or something?
Agreed. But this country is
Agreed.
But this country is obviously stuck in a situation where real healthcare reform is almost impossible.
I think it could happen in principle. LBJ passed Medicare and Medicaid. Bush got his dumb-ass prescription drug benefit through. But Obama is not LBJ, nor does he have the balls of Bush jr.
I'm discouraged. It doesn't
I'm discouraged. It doesn't look like the reform Obama is settling for will make a real dent in the problem. He may be playing chess, while everyone else is playing checkers, but it's getting to the endgame and he hasn't shown any stuff. I'm seriously underwhelmed.
Someone said on Huffpost that he was a talented guy but a terrible negotiator, and I think there's something to that. He seems to make concessions with himself. If he can't insist on a strong public option, with 60 votes and both houses of congress, then change isn't coming. I hope I'm wrong.
As nearly everyone knows we
As nearly everyone knows we currently spend a higher percentage of gdp on medical care -- about 15.2 percent according to wiiki -- than any other country in the world. If we do nothing to change the overly complex system we have while at the same time adding more members, by simple addition we will be spending in the area of twenty percent of gdp. If costs continue to rise faster than inflation and as the boomers hit, it would theoretically be higher. It will break the country. I am not sure that an unaffordable bill is not the real goal of republicans to make sure Obama's longer term goals are killed. We must fundamentally change the way we do healthcare.
I like Obama, I voted for him, but the system has to change in fundamental ways and I am not sure that the great compromiser is up to the fight.
This is Lousy Politics Only If You Really Mean to Reform
This is lousy politics only if you genuinely intend to reform healthcare.
If all you really intend is a facade, then it's ok.
Serious healthcare reform is no more difficult to achieve than Bush's tax cuts were. Arguments otherwise rest upon the unstated premise that the Democrats are actually corrupt.