Matthew Holt

Divided we might get somewhere, but not yet

Matthew HoltThe NY Times describes the Republican-less lobbyist meetings with Democrats that are allegedly getting 
towards a consensus on an individual mandate as the way to universal health care. Funnily enough some of those same groups (e.g. The Business Roundtable & the NFIB) appear to be lessening their commitment to the worthily named “Divided we Fail” campaign.

And then on the second page of the NY Times article there’s this:

Many businesses, crushed by soaring health costs, say they now support changes in the health care system as a way to control their costs. But in its summary of the recent discussions, Mr. Kennedy’s office said, “There was little consensus on the employers’ role.”

Many insurance executives say they are willing to accept stricter regulation, including a requirement to offer coverage to people with pre-existing medical conditions, if the federal government requires everyone to have coverage.

The lobbyists have discussed two ways to make insurance available to all, by offering subsidies for private insurance, based on a person’s income, and by expanding public programs.

In other words none of these suckers are prepared to stand up and scream loudly that employer-based health insurance sucks and is the cause of our asinine system. But neither do any of them have a solution for the insoluble problem of how to get low wage paying employers to cover their low wage employees with really expensive health insurance.

So the result is we’ll not tackle employer-based insurance, and more and more companies will drop it, and Medicaid expansion will be the de facto public policy option preferred by this consensus. After all no way will AHIP and the AMA want to see a real public plan option offered. Which will result in an unsustainable combination of poor programs for poor people being treated poorly. And we’ll be back here in a few years again wondering what happened to the “universal” system.

Which means that the only real successful way to create a universal insurance system is to put aside this inane desire to come to consensus to solve the insoluble, and instead to break employer based insurance—replacing it with a tax-based social insurance system. As does every other country in the world in some way.

Besides Zeke Emmanuel and Ron Wyden (who now appears to be retreating on this issue) no one has dared to propose this, and it won’t happen. At least not this time around.

If and when we do get real reform (and I don’t mean the incrementalism that the Republicans are gearing up to gut anyway), it won’t be achieved by a consensus of these worthy groups. It’ll be achieved by some tough President running over some of them, having shown the rest the consequence of keeping the consensus. I don’t hold out much “hope” for that in our time of “unity”.