POLICY/POLITICS: What might turn the tide?

I just got back from a rather frustrating talk by veteran liberal investigative journalists Barlett and Steele, on their new book Critical Condition. These geezers have just discovered that the health care system is in a bit of a mess, for-profit players in the health system are bad, and a single payer system with a few wrinkles (in that it’ll be run like the Fed not the Medicare program) will fix it. While these two veterans have done great work looking at the transformation of the American economy and its impact on the lower end of our society in the 1980s and 1990s, their health care speech was a hackneyed re-tilling of ground gone over by many others before. I have much sympathy with their cause, but they didn’t generate one new idea in their talk, and they made several basic mistakes — such as not being able to explain why non-profit hospitals make more money from doing more procedures. Neither for that matter could either of them explain to the moderator, (the silky-voiced but ignorant of the health care system Scott Shafer), why Kaiser was different to a typical non-profit hospital chain. They many times confused the problems of over-use, under-use, system quality, and uninsurance, and basically added to the fog that surrounds this whole issue. The short discussion group which I joined afterwards was full of health care professionals even more confused than when they arrived.

Finally Barlett and Steele gave no reason as to how, in a nation which for better or worse — OK, OK for worse — just re-elected a President and a Congress with no interest in either cost-control or covering the uninsured, we are gong to get serious health reform. They suggested it would take a a collapse of employment-based health insurance and an increase in the uninsured up to 90 million. Well no matter how rough it is, things are not getting that bad in the next decade barring a massive 1930s style depression

Realistically we are not getting reform in the next 4 years and probably not in the next 8. But there are seeds of the environment for wider-scale reform if you care to look for them. Here are two culled from the business pages.

The first is from that commie rag The Wall Street Journal which reports that health insurers often reject the ‘Near Elderly’:

Though health insurance is an issue that affects young and old alike, it is a particularly tough problem for people aged 50 to 64 who are too young for Medicare, the government’s health program that covers those aged 65 and over. As a group, they are often vulnerable to layoffs or pushed into early retirement at a point in their careers when it is difficult to get another job with benefits. Those who retire early thinking they are covered may see their benefits scaled back, as employers have tried to cut these costs in recent years. Still others lose coverage when an older spouse switches to Medicare from a plan that had formerly covered both members of the couple.

Whatever the reason, many in this pre-Medicare age group find themselves in the individual insurance market at the very time they are developing health problems that scare insurers. A recent study by the Urban Institute found an 18% uninsured rate for "near elderly" (aged 55 to 64) middle-income consumers who reported being in "good" health. That is double the uninsured rate for those who said they were in "excellent" or "very good" health. The contrast suggests that the near elderly with some health issues may have difficulty getting affordable insurance at a time in life when — unlike healthy young people who can risk going without — they need it, says John Holahan, the study’s author.

Meanwhile another bastion of sociaism, General Motors Corp., recently reported reduced earnings, due in large part to its out of control health care expenditures.

Putting these two factors together we can see the makings of a coalition. The Bush-voting Nascar dads living in the red states will increasingly find that as they age into near-Medicare, they are getting laid off from their full-time jobs, scrambling around in the temporary or contract labor force, and having a terrible time getting health insurance. And if you want to check how bad, even the WSJ couldn’t come up with one

decent strategy for buying health insurance. Although they didn’t mention the obvious choice of moving to Canada, they did mention that you’d do better if you didn’t get sick or use any health services. No shit, Sherlock.

So if you have a grumpy bunch of red-state Republican voters who might be persuaded to vote for someone who can fix their uninsurance problem in a non-threatening way (extending Medicare to all perhaps?), and you have big business sector that not only says that it cant go on that way, but also starts to agitate politically to gets its liabilities onto the governments’ shoulder, then you have at least the recipe for another run at reform.

This may be the route back to the White House for the Democrats and it may be where we’ll see the real consensus emerge after the next four years of increased chaos. But even if that happens we’re a long, long way from getting real reform done.

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