Any healthcare bill is better than no healthcare bill
That, at least, is what Ezra Klein thinks. Responding to Marcia Angell, who thinks we should scrap the whole thing and try again in some undetermined future, he writes:
Failure does not breed success. Obama’s defeat will not mean that more ambitious reforms have “a better chance of trying again.” It will mean that less ambitious reformers have a better chance of trying next time.
Conversely, success does breed success. Medicare and Medicaid began as fairly limited programs. Medicaid was pretty much limited to extremely poor children and their caregivers. Medicare didn’t cover prescription drugs, or individuals with disabilities, or home health services.
But once the programs were passed into law, they were slowly and continually improved. They became more expansive, with Medicaid growing to cover not only poor families but also poor adults, and the federal government giving states the option, and matching dollars, to include more people under the program’s umbrella. Medicare was charged with covering people with long-term disabilities, and it was eventually strengthened with a drug benefit, more preventive coverage, the option of supplementary plans and much more.
It is not hard to imagine health-care reform following a similar path. The exchanges can be opened to all employers and all individuals, creating a competitive insurance market virtually overnight. The public plan could be strengthened, or the government could begin to set payment rates for insurers who participate in the exchange (as is common in other countries). Subsidies could expand, and new funds could be used to encourage the development of integrated care organizations rather than simple insurance companies. The public option could be strengthened and the employer tax exclusion converted, as Ron Wyden has long advocated, into a standard deduction, which would strike at the heart of the employer-based market.
This is a very good point, and one reason why I’m so conflicted at the moment. The two bills in question – the Senate and House bills – are both far from perfect, but so too is the system we have now. I’m not particularly swayed, for instance, by arguments that this is a major government takeover of healthcare. It isn’t. At most it’s a new regulatory structure for the insurance industry. Healthcare remains virtually untouched – especially since these reforms do little to make the insurance industry more competitive or better able to negotiate with the supply side (drug makers, doctors, hospitals, etc.)
But Klein may be right that down the road it will be easier to touch up the reform to include some of Wyden’s suggestions – namely, a national marketplace for insurers and an end to the tax subsidies going to employer-provided benefits. Those two reforms alone will dramatically improve healthcare and equally importantly, will help to contain costs over the long term.
If I were a congressman I’d be pretty conflicted right now, but for all the reasons I think these bills are far from perfect, a stronger part of me realizes that if we don’t do something about the status quo now we may never be able to. The Christian in me says that it is less important to draw lines in the ideological sand and protest the looming hand of the state, and more important to help bring stability to our country and healthcare to our less fortunate. Perhaps we can tweak the programs later to make them better.
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[...] think that E.D. Kain is right on here. The two bills in question – the Senate and House bills – are both far from [...]
With all the public support for change when this debate started, if no bill is passed you can bet the house no politician will ever touch the issue again and Obama will be in a much more compromised position than Clinton was after his attempt was defeated.
Klein is right on this one. There is absolutely no question that whatever bill gets through will be subject to years of amendments – which is how it is supposed to happen. There will be unintended consequences and flat out mistakes. Nobody can do something this substantial without getting things wrong. But the only way to start – is to start. We know that leaving things as they are will produce an unhappy ending. Therefore, there is no choice but to do something. And better more expansive than less, as it is far easier to pare back over time than to try and expand. We know this to be true given the extraordinary difficulty we face whenever we try to do anything.
There is, of course, an elephant in the healthcare reform room. None of these bills really go very far in controlling costs, except for whatever cost benefits might flow from a public option. As Klein also pointed out in one of his blogs, this entire process is about moving the bill. Any republican suggestions that would lower costs would be included in a heart beat if it got so much as one Republican vote in the Senate. They haven’t provided any because they don’t have any. Neither do the Democrats. We still haven’t worked out how to lower the costs of medical care and this will have to be addressed at some point soon.
Exactly. I keep saying this is a golden opportunity for conservatives, but I’m pretty sure the political class on the right disagrees with me entirely.
In response to another comment. See in context »The perfect is the enemy of the good, as they say.
I would agree that the perfect was the enemy of the good – if I saw a real attempt to get the perfect. There was none – not from day one. This whole thing was copromised from the start, and it will be further compromised before it’s over. It’s my understanding that the public option – weak as it is – is still on very shaky ground.
In the end, Liebrman’s ass will be covered with lip prints, and the Democrats wil have something other than egg on their faces.
Can any of you imagine a scenario in which you would say that the good is the enemy of the perfect? (I’d really like to know.) To me, the Democrats would have greater success if this was their mindset at the start of all negotiations. They would be seen as truly standing for something.
The good should always be seen as the enemy of the perfect: as something to be settled for when all else fails. It should not be seen as the goal. If today’s Democrats were starting the space program, their goal would be jump 3 feet off the ground.
(Rick – before you ask – This is not anger for anger’s sake. It is anger at the continued lack of bold ideas from those who stand for change.)
Gotta agree with Klein on this as well. Though I do want Stupak removed from the final bill. It goes way to far.
http://www.thehamandlegsshow.com
On Aug. 6, 1912 Theodore Roosevelt introduced his version of needed health reforms. (He also in that same document pointed out the need for campaign finance transparency, imagine that) Other than medicare, nothing much has happened since.
No politician wants anything to do with such a hot topic. Why should they? No matter what conclusion they come to in the current debate, there will be those calling for their heads. If no reform happens now, no one will touch the issue for the next couple of decades.
I had hoped for something much, much better then what the senate will be debating. Perhaps I am being naive. The need for reform was based on two fronts. Expanding coverage, and controlling costs. Both are necessities. Congress is addressing the former, I don’t see much there anymore to address the latter.
I just can’t understand why supposedly intelligent, rational beings seem unable to make decisions based on logic and the best interests of their society.
I suspect when the world finally does come to an end, we will still be debating the need for healthcare reform.
Actually, nothing happened when TR suggested his reforms. He did so during his second campaign for the presidency — the one he lost! Further, most of the changes in healh care that took place in the years preceding Medicare went unnoticed by regulators. Health care insurance, which has started out as no-profit cooperative plans designed to take advantage of the pooling to benefit consumers, quietly turned into for-profit businesses, setting the stage for what would come a large part of our current problems. Pharma practices of laying off their R&D in the US went largely unnoticed because we were so grateful for the chemistry they were coming up with to help solve some serious and deadly illnesses. None of these things were ever challenged, and for some good reasons. It wasn’t until he grew out of hand that the politicians began to pay attention. While people in FDR’s administration understood the need for reform, the boss couldn’t get excited about it. Then came Truman who did get excited about it but failed. Kennedy intended to make some moves but was killed before he could. That brought us to LBJ and Medicare. Also Medicaid which was something of a give-away to the Republicans, if you can believe that. Nixon actually took a shot at what he thought was further reform with the HMO Act. That didn’t work out exactly as planned. That’s pretty much the history up until now. Not much for such a big problem eh?
In response to another comment. See in context »Until your comment I was unaware that the original health insurance programs in the U.S. were “non-profits”.
One of the issues I have with the current proposed legislation is the insurance mandate. I have a real personal problem being forced to do business with an industry that I have reason not to trust. The Swiss model, (which I believe is partly being used for what is on the table right now) has one big difference compared to the American model. The base insurance policy, although bought through private companies, is non-profit. This makes more sense to me. It is an incontestable fact that insurance companies have a financial incentive to deny claims. For every dollar they don’t pay, that adds one corresponding dollar to the plus side of their balance sheet. Having a mandated policy handled as a non-profit event, should (in my view) mitigate this conflict (somewhat).
In response to another comment. See in context »I don’t get the “conflicted” position…this piece of trash they’re calling “health care reform” is little more than a hand-out to the private insurers. Obama promised up a strong public option or a shot at single-payer & we should hold his nuts to the fire. He bargained away any position he had before the debate had even started in hopes of “bipartisanship”. Bullshit! The GOP has melted-down to the party of Palin, Limbaugh & the rest. SCREW THEM! I personally believe health is a RIGHT and I intend to keep fighting for it!
If the government is doing it, why call it insurance? Real insurance companies invest all the money they take in to finance the “insurance”.
Does Obama plan on investing the money to make it grow…or spend it as it comes in like social security?
Why should we have to sign up for government health care if everyone has to be in it? Everyone should automatically be in it and taxed equally according to the number of family members using the services…..?
[...] 7. If I were a congressman I would support the healthcare bill. I talk about that at American Tory. [...]