Matthew Holt

Perhaps Obama will have to do rather more than he says he will

I feel like Mrs Miggins in my favorite comedy show, Blackadder. It’s the scene when Blackadder says “The hustings are down, the candidates have spoken and after the madness of a general election, we can return to normal” and Mrs Wiggins says “Has there been an election? I’ve never heard about it?” (Yes that is a much younger version of Dr House playing the Prince Regent).

Anyway I’ve had my head so far up the Health 2.0 rear that until this week I haven’t really paid too much attention to the election. In all honesty (speaking as a Democrat who could never conceive of a Republican win in the current circumstances) I’ve been trundling along expecting an Obama win with the same set of Democrats running Congress but not with the vicious efficacy that Tom Delay & friends showed in getting their bills passed in 2001–2004. So I haven’t been expecting that much change in the healthcare system.

But if you do believe something is going to happen, over at the HuffPo Susan Blumenthal, whom I saw earlier this week, nudges me towards her side by side comparison of the  U.S. Presidential Candidates’ Health Care Plans.

On the other hand, and I’ll be writing more about this before the election, if the recession is bad enough—and this morning’s numbers suggest that it could be—what Obama is proposing may be torn up and we might do something much more radical. It sounds crazy, but then again a year ago you wouldn’t have thought that the US taxpayer was going to own the biggest insurance company and most of the banks. After that actually IS socialism according to Lenin’s “owning the commanding heights of the economy” definition, no matter how much Sarah Palin rails against it. And socialism in health care makes rather more sense than socialism in banking, or autos.

So if there are 90 million uninsured and 15% unemployed, perhaps a Federal rescue package for health care is on its way—we just haven’t seen it poke its head out of the water yet. And if it does, it will likely be much more radical than the gentle proposal Obama is starting with, which the conventional wisdom says is a non-starter anyway.

8 replies »

  1. Mitch, I’m curious about exactly what it is that you think the health insurance industry will block. AHIP has come out in favor of universal health care (as long as it is multi-payer). Every segment of the industry will support UHC if it increases their revenues, though they will try to influence specific regulations that come with it. Only Republicans, and then only the more ideological subset of that party, will oppose UHC in any form.
    So the real fight is not over UHC, but over reform to the delivery system (a major part of which is reform to the incentive structure) that will allow us to stop increasing the share of GDP eaten up by health care, or even allow us to reduce that share. Of course I may be biased, but I just don’t see health insurers as being as great a barrier here as the provider (physician, hospital) and supplier (pharma, device) industries when it comes to reform of the delivery system and incentives. Not that the insurance industry, particularly the for-profit part of it, won’t also resist some reforms.

  2. The health care landscape isn’t going to change all that drastically whether it’s Obama or McCain, I hate to say. I’ve always been of the opinion that the insurance industry is just so powerful in this country that anyone trying to make big changes is going to be in for the shock of their life. Hillary Clinton was right many years ago, but I knew it was naive of anyone to think it actually had a chance to pass. There will be some minor movement, but in the long run neither plan was going to work as the candidates felt it would, and we’ll be running healthcare same as usual.

  3. wile-t-coyote (still bitter about the missed open goal about “on the internet no one knows you’re a coyote”)
    This is a “what I think MIHGT happen” piece not a “what I want TO happen”.
    I’ve always thought that universal reform would end up being expansion of Medicare to everyone when things get bad enough after the health care industry stops every sensible alternative.
    It just appears that things might be getting bad enough rather more quickly than I thought. Of course if you believe instead in a long (baby) boom, you might not agree….

  4. “Those who make peaceful evolution impossible make violent revolution inevitable.” — John F. Kennedy
    tcoyote, true no matter what system you use. The economic foundations of our society ARE being destroyed by the same people who brought them to us. Failed policy is just that – FAILED POLICY. The destruction, if there is any, will be self created. jd might be on to something, although it will be very painful, that is the cart before the horse solution.

  5. So, what you’re saying is: it might be WORTH IT if the economic foundations of our society are completely destroyed so we could “reform” healthcare? You’re sounding like Maggie Mahar!
    Also, define “reform” please. Not clear that coverage=access=better health. . . Where do you start? And who’s going to do the “reforming” anyway: Charlie Rangel, John Dingell, Pete Stark, Henry Waxman?
    The problem w/ socialism is that, eventually, Stalin or Kim Jong Il appears. And the ruling party ends up with their dachas and their own “private” health system. . . Don’t get me started, Matthew.

  6. Matt, I completely agree and had posted the same thought yesterday. Right now, the provider and supplier lobbies wipe the floor with any would-be reforms that reduce the total cost of care. It had seemed that we needed to first enact universal health care without deep reforms to the delivery system or incentive structures. This is exactly what the major Democratic plans have all done. Then, as the cost trend continued and more of the health care burden shifted to taxes, the true cost would become more visible and resented, and that would build public sentiment to support deeper reforms that would reduce the share of GDP devoted to health care.
    But now with such a severe economic crisis, it might just be possible to make major changes in Medicare and Medicaid to incentivize quality instead of volume, allow for negotiation on drug prices, etc. Once given cover by CMS, private insurers will follow suit. But it is almost impossible to overestimate the power of the physician, hospital and drug lobbies (particularly when they join in opposition to a reform). That, plus the fact that most people still don’t understand the true cost of care and the true drivers of that cost, makes me still think that only minimal changes to the incentives and delivery system will happen in the next few years. If we’re lucky, we start the ball rolling in 2009.

  7. What if unemployment goes beyond 15% – which appears to be possible? I think we are just seeing the beginning of the problems. What’s with the market bouncing back (somewhat) this week (today is Halloween)? What a joke!