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Sunday, December 16, 2007
The health care crisis is amazingly an issue that is both incredibly complex and devilishly simple. It is incredibly complex because it involves such things as: (1) the fact that 40 million or so Americans lack insurance; (2) the overuse of emergency room care and the effect of unpaid hospital billings on the credit system; (3) the control of health care costs; (4) the amount we should spend on elective care, and experimental drugs and treatments; (5) the desirability of a link between employment and health care; and (6) the choice of young, healthy people not to participate in the risk pool.

It is devilishly simple because the Medicare system solves all the problems with respect to seniors, and extending it to all Americans, creating a single payer like they have in Canada, would be the preferred public policy outcome.

However, Americans are easily scared by the insurance industry and therefore the public support for single payer isn't there. So the Democrats have settled on lousy ideas for health reform. In 1992 it was "managed competition", where employers were forced to buy insurance through private insurance companies, who didn't play any constructive role except to drive up costs and make the system more complicated. Now, it's the "individual mandate", supported by Hillary this time around and by John Edwards as well, where rather than actually providing insurance to all Americans, the government solves the problem by legal fiat, by forcing us to buy coverage, with alleged subsidies for lower income Americans.

Here's the dirty little secret, however. The individual mandate, in addition to being immoral (you do not solve poverty problems by simply passing laws requiring poor people to purchase things they can't afford), won't work.

Here's what I envision happening. First, the Republicans in the Senate will filibuster any universal health bill, like they are stopping the expansion of the S-CHIP Children's health program. So, to buy off the Republicans, Edwards/Clinton will have to either eliminate the individual mandate and/or reduce the subsidies. So you won't get a workable plan to begin with, because the Democratic candidate was unwilling to open the bidding with single payer and bargain down.

Second, let's suppose the thing gets passed. Now you have a program with two components: an individual mandate, which powerful insurers may like, because it means more customers, and big subsidies for poor and some middle-class people, which Republicans hate. Now, what gets cut every year? If you don't believe me, look at how Medicare, a single payer, universal program, is sheltered from budget cuts while Medicaid, Women Infants And Children, and other such programs are placed under huge cost constraints. Because we don't have a single payer plan, we will have a big subsidy for poor people that the Republicans will target and cut. Or, even more likely, they just won't let it rise at the rate of inflation of health care costs (which is greater than the rate of inflation for most consumer goods). The result is, we'll lose the subsidies and be left with a mandate for the poor and middle class to spend money they don't have. A nice regressive tax, put in by Democrats.

Now, there's also, you may have heard, a prong of these plans that features a public health care plan that will be in competition with the private plans. Don't bet on it surviving. That will be the first things that Republicans kill in negotiations, because it will be seen as a back door to single payer. Even if it gets passed, it will be gutted. Don't believe me? Bill Clinton created a public student loan program that competes with the private bank loans. The Republicans have decimated that program to ensure that it never becomes the preferred method of getting a student loan. All that campaign money from private industry will do that to you.

In contrast, all we have to do is slowly expand the single payer plans we already have, show the public that the sky doesn't fall, and we will be well on our way to a single payer plan that will actually solve the problem.

This is a good reason, one of many (the Iraq War being the biggest) why people shouldn't vote for Hillary Clinton or John Edwards. But if they do win, I hope their health care plan goes down in flames. We don't need something that is structured to turn into a regressive tax on the poor and which is designed to prevent us from getting to the single payer system we need.


Imagine a future in which families are mandated to buy a health plan with a $10,000 deductible (the cheapest legal option?) -- okay, they obeyed the law -- but now they end in the emergency room MORE OFTEN because they have even LESS money left over for family doctor visits.

Again and again: Medicare for all ought to be the easiest program in the world to sell: Medicare is the plan most folks happily look forward to relying on when they are older and perhaps much more in need of even critical care -- why in the world should they hesitate to rely on it now while they are young and usually healthy?
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