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”.

7 replies »

  1. “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.”
    Medicare, Medicaid, HMO Act 1973, BBA, Small Group reform none of that had ANYTHING to do with our asinine system did it? How shocking that someone who buries their head in the sand can’t see what the problem is.
    “It’ll be achieved by some tough President running over some of them, having shown the rest the consequence of keeping the consensus.”
    That’s just how Kennedy passed the HMO Act, boy was that a rousing success! More please more!
    “Businesses need to be taken removed from the burden of insurance.”…
    …and tax collection, and child support enforcement, and countless other regulations. Funny I don’t hear any opposition to those. Health Insurance has far more to do with compensating employees for the service they provide then taxing them does. Why is it an employers responsibility to garnish wages? Becuase it is efficient and effective, the same way delivering health insurance through employement is more efficient and effceitve then 340 million individual policies. The same way it being an employer liability means someone is watching the cost compared to public free for all plans.

  2. Can anyone clarify for me how an individual eager to implement healthcare financed using a social insurance model can at the same time decry “this inane desire to come to consensus” on ways to solve the problem his solution would address?
    One needn’t be opposed to health reform that relies on implementation of social insurance to be struck by this incongruity, which would seem to blight the future of any such initiative in a republic, let alone a democracy.

  3. Peter– almost 4 years of you and me going back and forth and you are FINALLY getting it…
    The reality is this— universal health care = healthcare-by-lobbyist.
    There will be no other way— and individual patients will be the ones left out, with no seat at the table.

  4. “The lack of acrimony, the air of cooperation toward a common end, is quite refreshing.”
    Why do I get the feeling that they’re just deciding how to divide the profit pie? Is anyone concerned that no one on the round table represents those that don’t belong to an association or union?

  5. Earth will be rules by few brave ones. In this case we have the masses suffering but it is not the masses but few CEO make the decision and of course they carry the rest of us with them.
    As mentioned here, many of the people who went all out against Hillary care now tend to think it is good. You have to question the basic ability to strategise or we react more to what we are told than what must think and conclude.
    For America to be the 21st century country we need a good healthcare system. And even the current one in discussion is not much different. Businesses need to be taken removed from the burden of insurance. And should individual.
    For example, in my 3 tier system, I propose the tier 1 should be basic and should be free. For others premiums should be based NOT on risk but healthy behavior. For example, if a person smokes, no matter how healthy the person is, he/she should have to pay more premium. And so on….

  6. With that said, why don’t we stop worrying about how healthcare is financed and start worrying about how we’re going to reverse our chronic illness trends? There’s no better way to reduce the cost of healthcare than to reduce the demand for it. I might lean toward the “loony right” as you have called it in the past, but there ain’t nothin’ political or ideological about working toward a healthier population. The problem is, it doesn’t generate the vigorous debate that drives a lot of traffic to THCB. Getting healthier is a reform soluton that requires ALL of us to chip in. I guess that’s why a lot of people shy away from it.