I spent summer 1984 in Boston and generally found it an oppressively hot place. I’ve spent a few winter days there and found it an oppressively cold place. I’ve always thought that, given the absence of passport controls, if you lived there and could move to California and didn’t, you were probably crazy. And yesterday the residents of that fair state proved me right.
As I said earlier this week, it now appears that health care reform is dead. I just can’t see a scenario in which there are 60 votes to pass anything. I also don’t see the Dems having the cojones to go to reconciliation or to cram the current Senate bill through the House quickly. Instead (as Bob Laszewski says below) the moderate Dems will run for their lives away from health insurance reform—although I just don’t understand what Bob thinks “reform” would have meant if it had really required 6–10 Republican Senators.
So my prediction is that we end up with nothing.
In which case 23 year old kids with cystic fibrosis, or basically anyone else unlucky enough to be marginally sick or marginally employed, are screwed. Or at least are uninsured and will be screwed if something goes wrong. Now of course that’s only a minority of people. But then there are those trying to get by under the dogmeat program known as Medicaid. And add to them the millions more with marginal and declining insurance. So for more people health “insurance” will continue to get more and more unobtainable.
On the other hand, what’s also left town has been any hope of systemic delivery system reform. And in the short run the delivery system will cheer.
Which means we get more of the same for a while longer. But eventually the increase in costs and the increasing numbers left out of the system will bring us back to the point of reform. Here’s what Vic Fuchs said in 2007
Short-term prospects for enduring comprehensive reform are virtually nil. Over five to ten years, prospects are fifty-fifty unless there were a major economic, political, social, or public health crisis. In the long run, major reform is inevitable.
No nation can continue to allow health care to drain away resources that would be more socially productive in education, the environment, security, and other policy areas. It will come sooner rather than later if policymakers recognize that the United States must find its own approach, one that is congruent with basic American values: equality of opportunity combined with exercise of personal freedom.
It’s pretty clear that policy makers have not found “its own approach”. So the next approach will come at a time of extreme need, and the response will be a lot less palatable than many inside the system would like.
CODA: Ever noticed that if it involves spending $100 billion a year and promoting the interests of corporate defense contractors, we invade foreign countries with no plan, less rationality and no debate? (Obama’s “surge” of 30,000 troops to Afghanistan will cost about $30bn a year). But if it’s spending about the same net dollars annually to give health insurance to the working poor, all hell breaks loose? Could it be that at some point the medical-industrial complex regards this as a threat?
Categories: Matthew Holt