Wednesday, September 16, 2009

How Radical Is Health Care Reform?

In the interest of healing the political divide in this country, perhaps we should spend a little more time talking about where we're coming from on each side of the debate. I know that one of the things that I'm having the hardest time with is understanding how anyone can look at the health care reform package currently being debated, and consider it to be some kind of extreme, radical socialist program. It is, from my perspective, right there in the middle of the road.

If we think about the healthcare debate as a 5-point spectrum, on the furthest point to the left you would have government-run healthcare. Doctors and nurses are employees of the government, hospitals are government-run institutions. This is the system they have in the UK. We also have it in America. It's called the VA system, and it's customers are generally happier with the results than customers of the private insurance agencies are. Nobody, not Obama nor Hillary nor John Edwards, ever even suggested we employ such a system in the U.S. I don't even think Dennis Kucinich went there.

A little to the right of that, we have single payer plans, where healthcare remains a private enterprise, but is entirely paid for by the government. This is the system they have in France, which is ranked the highest in the world by the World Health Organization. Maybe that ranking doesn't count for much, and I know there are plenty of problems with that system, but people living there seem to be generally happy with it. We also have a single payer plan in America. It's called Medicare, and it generally produces higher customer satisfaction than the private insurance industry. In the lead-up to this reform, President Obama refused to even consider a single payer system, incurring the wrath of many of his supporters on the left.

In the exact center of this spectrum, you have the plan that is being offered right now: a package of perfectly reasonable regulations on the health insurance industry, a government-administered pool to buy health insurance through (thus getting better deals for the consumer through collective bargaining, without having the government actually administer health insurance), and an OPTIONAL public insurance plan for those who want it. It's an inobtrusive way to fix the problems that actually exist, without imposing anything on people that are happy with their current insurance. It is, quite literally, the exact middle of the road. It's a compromise between left and right. It is not, by any measure, a radical, socialist takeover of the healthcare industry.

In the center right, I suppose you could have the same plan without the public option. Or, alternately, a few other fixes, like allowing interstate commerce in health insurance, or tort reform to ease up malpractice costs.* And to the far right, you would have the idea that there isn't really anything wrong with the system as it is, and we should just let the market work it's magic.

So here we have a moderate liberal president, starting off by offering the exact centrist plan for healthcare reform. Not only that, but he's even said that he'd sweeten the deal by throwing tort reform in there. And he's indicated that if he can't get this plan passed, he'll compromise further by passing it without the public option (I personally feel that this would make the plan essentially ineffective, but there it is). Does that sound like the megalomaniacal extremist that you hear described by the right? (And personally, I think it's the right plan for America. We're a different country from the UK or France or Sweden. Libertarianism is part of our national DNA.)

And yet, there's nothing gained from these compromises. Conservatives talk about this modest plan in EXACTLY the same language they would use to talk about literal socialized medicine. I don't know how the conservative mind works. To a conservative, is this the equivalent of Bush wanting credit for not invading Iran?

*The thing of being able to buy health insurance from different states seems perfectly reasonable to me, just as being able to buy drugs from Canada seems perfectly reasonable. I'm all for it, although I don't see where that alone is going to solve all our problems. I'm a bit less sure about tort reform--I'm suspicious of anything that limits consumers' rights to sue corporations--but hey, what the fuck, let's put it on the table. I'm all about compromising.


Blogger Megan said...

hi chris, i liked your essay and reposted it to my facebook account. cheers, megan

9/16/2009 1:42 PM  
Blogger Unknown said...

ditto what Megan said

9/16/2009 1:57 PM  
Anonymous rbubp said...

Very nice, and very thoughtful. I have come to realize that my own very liberal positions will not actually result in change, and this is why I support Obama even when he moves to the middle like this. Ultimately change does come most easily from the center; the bi-cameral system supports this, that we'll almost have to do things in an incremental way that may sometimes divide but will necessarily be supported by a large number of people.

Doing things unilaterally, however, leads only to angst on the opposite side and increases the chances of reversal upon a new administration.
In this light I think the co-ops can work...they just have to be interconnected in such a way that they can tally enough resources to absorb the already ill.
I am not for it against other choices, but there comes a time when you have to take the momentum you have and see it as an incremental step, try it out, and know that you can come back to it for tweaking if demand warrants it.

But big change all at once scares people and usually does not allow enough of the two sides to both take credit in a way their constituents can support. Right now the Republicans have no credit for anything, so the only to create an agenda for themselves is to force their point of view into an issue by blowing it up.

And in the end we'll be better off with almost anything as a starting point as long as it's more substantial than that ridiculous "tax credits" proposal by John McCain (remember that?).

9/16/2009 4:35 PM  
Anonymous Jeff Foster said...

I'm so disappointed that the public option was forced out of the Finance Committee bill. All I see now is a bill that criminalizes poor people for refusing to do business with insurance companies.

10/15/2009 3:25 PM  
Blogger Chris Oliver said...

That's my fear, too. We'll get a plan without the public option, it'll cost a lot of money, not accomplish much, and put an additional burden on poor people, and fools'll be like "Man, this healthcare reform sucks. More Republicans!"

I really think the fine on people who opt out of the system is a bad idea anyway, even with the public option.

10/16/2009 3:41 PM  

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