Seven Years Until Single-Payer (2/3)
Hey, Jordan!
Wow. There is so much here!
First, I’m glad we’re having this exchange. “Healthcare” is such an important issue both in impact on individual lives and implications for the future of America. As I’ve written about in my books, essentially nothing else in our national budget matters except for healthcare spending. On its current path, it’s guaranteed to explode already-scary deficits.
To write this, I’m chunking into three groups: Response to your various lobs, core answer to your question about health care as a right, re-frame of the question. Let’s start …
Well, I can’t dive right in without responding to a few of your comments. Unless you’re being ironic, I’m flabbergasted that you think the first failed healthcare bill was just “negotiation.” If that was true, then I suppose all the histrionics and drama was planned?
Second, I don’t agree with “no one has a clue how to fix this disaster.” Just because someone thinks it’s too complicated to see clearly that doesn’t make it universally true. I don’t see this as akin to foreign policy with so many variables that it feels inherently unknowable due to unexpected consequences. While there’s some of that, like all things, I see the healthcare system as closer to a math equation.
Finally, “Obamacare failed at every level” (which is you quoting the guy), I also disagree with. To support this, he points to lost elections. Yet Obama’s re-election and the impact of redistricting (and the traditional oscillations in party power) were also big things that he doesn’t address. I predict that 2018 will be a huge wave election — something close to 2010, the year of the Tea Party, and the wave that my own congressional campaign got washed up in. I suppose using this same logic, one could say that’s all a reaction to the Republican alternative to healthcare? It’s a spurious connection. OK, I couldn’t bite my tongue on that stuff. Let’s dive into the 2nd part.
“Is healthcare a right?” you ask. Interesting that you chose not to answer your own question. I will. Yes, I do see it as a right. Other things like education, police, military, etc. are considered “rights for all citizens” — so I put healthcare in this camp. To wit, we already clumsily believe this: Regardless of ability to pay, anyone who turns up in an ER gets treated.
Do I think a child born into a poor family should have access to medical care? Yes, I do. Taken further, I’d say that all Americans should have access to healthcare. You submit that the real question is “who pays?” I think this is obvious, we all do. More specifically, it’s a progressive tax just like the rest of the system. The rich pay more than the poor (a lot more, as it works out).
As a re-frame, though, this is really a question of specifics. To start, a single-payer universal system is the most obvious solution. Healthcare resists many of the traditional mechanisms of a market. Market forces should drive up quality, and drive down costs. There are many reasons why healthcare doesn’t work as a free market system: the consumer of the service is different that the payer (insurance) so consumers aren’t price sensitive, there is heavy regulation and compliance that results in a lack of transparency and can limit competition, short-term costs vs long-term costs and who pays for them mean there is often a lack of incentive for the long-term investment that would drive down costs — the list goes on and on. Single-payer is the world’s default for a reason, and it’s not some intrinsic love of socialism.
That said, there would need to be clear limits. If you look at the NHS in the UK and other systems, there are boundaries on what’s paid for and what’s not. Essentially, I’m generally in favor of a single-payer public system and a private system for the many things that would not be included. Obamacare was exploring some of these concepts (though not single-payer because there was no appetite for that fight) and what came out of it were “DEATH PANELS!” Well, yes. Some treatments will fall outside of the bounds of costs and there will be a standard of care. Also, not a minor thing, this de-links insurance from employer benefits, and I’d have it paid for out of a value-added tax (VAT). This would help make American labor more competitive cost-wise and also allow the market to work via selling add-on healthcare plans using people’s real dollars as consumers.
I guess I ask you: What do you want to happen? What do you think should happen? I hear a lot of hand-wringing, but very little clarity on what you think should happen.
surya
