Health Care and the Haggle

Last night at Atrios' site was a post from Avedon Carol that I thought was a great way to understand the current health-care debate in California, and would provide a valuable lesson for Democrats in the state. I'd like to highlight it.

Many of us have been talking about the need for Democrats to start high before going to the bargaining table. This is not a radical new idea - everyone knows that when you dicker for a good price, you don't start with the "reasonable", "compromise" figure.

But Democrats seem to have lost the idea of haggling. If they want single-payer healthcare, they ask for single-payer healthcare. (Or worse, they do what the Clintons did and try to offer the insurance companies something, which kills the whole idea.) If they want a minimum wage of $7.25, they ask for a minimum wage of $7.25 [...]

I want single-payer to pass, but I think single-payer would sound much more reasonable if there were people out there demanding a fully-socialized healthcare program like Britain's NHS (as Nye Bevan designed it, not the anemic thing successive governments have been turning it into). Go all-out: Demand an NHS, and single-payer will sound nice and capitalist and moderate - as it is.

Avedon is absolutely correct. You don't give up the battle before it is even joined. If politics is the art of compromise, then compromising BEFORE you reach the bargaining table is a guarantee that you won't be able to get anything near wht you really want.

Especially when the opposition is ALREADY bargaining into your position, albeit with fits and starts.

The governor has proposed covering all children, including those in the state illegally by circumstance (the number of which seems to be either consequential or not, depending on who you ask). It's cheap to cover children and immoral not to. As a starting point, I'd take this plan over the Massachusetts Mandate plan any day of the week. But, what's important here is, as Kevin Drum notes,

Details are murky so far, but I don't think the mechanics of Schwarzenegger's plan is what's important anyway. What's important is that two of the Republican Party's highest-profile governors have now publicly endorsed the idea of universal health coverage for their states. In other words, some kind of universal, or semi-universal, healthcare has now been established as the rightmost bound of the healthcare debate.

Democrats should understand what this means: (a) universal healthcare is no longer some lefty fringe notion, and (b) the plans from Schwarzenegger and Massachussetts' Mitt Romney are now the starting point for any serious healthcare proposal. Any proposal coming out of a Democratic policy shop should be, at a minimum, considerably more ambitious than what's on offer from these two Republicans.

It's important to understand who's under pressure to deliver on health care. The public knows that we pay more for health care in America and receive less. They are almost unanimous in supporting governmental solutions to providing access to affordable health care. And the governor has made health care his signature issue for 2007. It was a big part of today's coronation, and it'll be a major part of next week's State of the State.

If health care reform doesn't happen in 2007, the governor will be blamed. Bottom line. And understanding this, he's already moving toward a position that Democrats in the legislature can accept, with universal coverage for children. In fact, this is to the LEFT of Don Perata's proposal which excluded illegals.

It's absurd, as Drum says, for Democrats to do anything but push for something far beyond an on-the-margin proposal out of the box. Yet this is exactly what Perata and Fabian Nuñez have done, claiming that they were putting something together that the governor could accept. This belies a fundamental misunderstanding of the art of the deal. If you believe that health care is a right and not a privilege, you start from the position of covering everybody in the state, and then compromise. As it stands now, the middle of this debate would include HSAs and partial employer mandates, and essentially a reaffirming of the private insurance system that's making everybody sick to their stomachs.

Business, which has a firm grip on the legislative joystick, hits the panic button at talk of single-payer healthcare or universal healthcare, and it hauls out its own boogeyman phrases, such as "job-killer" and "drag on the economy."

I'll tell you what's a drag on the economy. Healthcare insurance that's impossibly expensive, or impossible to get. If the United States wants a vital economy of personal enterprise and risk-taking, then it needs to guarantee health coverage, period. Americans are willing to take chances in business and careers, but not with their families' health, or their own.

Dan Luke is an Oregon insurance broker. He told me that he runs into this "all the time — people staying in jobs they don't like. People have dreams about going into business for themselves that they can't fulfill because they don't want to lose medical coverage, and they can't pay a lot of money for [individual policies] even if they are healthy."

I gave him a professional for instance: Say there's a man who wants to switch careers, start something on his own. He's 59, married, four kids, comes to you for health insurance. He smokes cigars. ("Mmmmm," I heard Luke say.) And he had heart-valve surgery almost 10 years ago.

Luke stopped me right there. The man would never get coverage. I didn't even get to ask Luke about the risk factors of riding motorcycles and skiing.

My "for instance" is Arnold Schwarzenegger. If the governor weren't a rich man, if he were just a guy with a bold idea who wanted to give it a shot, as Schwarzenegger did when he abandoned acting for governing, he couldn't get health insurance. He'd be stuck in his old job instead of bringing something new to the economy and to his life.

That should be the philosophy guiding any baseline proposal on fixing health care. Otherwise there's no need for the Democrats to come to the bargaining table at all. They might as well let the governor write the policy. It's time to figure out the haggle and try to get something the people want, rather than what they wrongly believe is politically possible.

UPDATE: I should add that I don't think the flip side - passing a universal health care bill that essentially replicates the NHS and sending it to the governor to veto - is a smart idea either. The ground has not been sufficiently prepped in the population for that. This is about negotiating tactics and strategy. Democrats should publicly adopt something akin to the proposal that passed the legislature last year, and start from that leaping-off point with the governor.