It's Not Enough To Say "I'm for Universal Health Care"

Last night we were treated to a health care "plan" that would reward those who have shitty health insurance, punish the middle-class union workers who've bargained for better health insurance, and keep the private insurance industry afloat in the process. Ruth Marcus thinks that this actual reading of the evidence of the plan is unfair.

If George W. Bush proposes something, it must be bad. Such is the knee-jerk state of partisan suspiciousness that when the president actually endorses a tax increase -- a tax increase that would primarily hit the well-off, no less -- Democrats still howl.

....Listening to Democratic reaction to Bush's new health insurance proposal, you get the sense that if Bush picked a plank right out of the Democratic platform -- if he introduced Hillarycare itself -- and stuck it in his State of the Union address, Democrats would churn out press releases denouncing it.

Kevin Drum and Jonathan Cohn do away with this nonsense so easily that it's not worth taking an extra swipe, showing that Bush's plan is actually an attempt to preserve the health insurance industry and allow it to offer less and less services to their customers. But there is an important issue in here that needs to be addressed, that I seem to keep coming back to in this health care debate.

Republicans who say the words "universal health care" do have the effect of pushing the debate in a more progressive direction, and setting out universal coverage as the desired goal. But IT'S NOT ENOUGH for them to be lionized for doing something that human dignity and a basic belief in humanity demands. Catherine Siepp of the National Review makes this mistake, and throws in a nose-thumbing at all Democrats for good measure.

But for some reason, the only politicians pushing expanded access to health care right now are Republicans: Gov. Arnold Schwarzenegger of California and former Gov. Mitt Romney of Massachusetts, who’s just left his post to become a (mean old) Republican presidential candidate in 2008.

The name's Wyden, Ron Wyden. And Ted Kennedy. And John Edwards. And Barack Obama. And Ed Rendell, who's moving forward with his own health care plan in Pennsylvania, which (while marginally similar to Schwarzenegger's in California) actually addresses cost-containment and quality of care, frankly the only issues that are going to make health care more affordable and more desirable.

So if you agree that the broad cross-section of the public, and the broad cross-section of the political spectrum want universal care (though the Democrats have been waiting for the Republicans to get there since 1994), it behooves you to actually take a look at the plans, and not give them a free pass because they kinda sorta seem like they want to help people. Which is how Mitt Romney got so much praise for getting a plan through in Massachusetts that actually will slowly begin to bankrupt the uninsured:

Uninsured residents will have to shell out a quite a bit more than originally expected to get mandated health-care coverage, according to the group charged with introducing the coverage.
Monthly premiums to meet the state's minimum coverage under last year's universal health-care law would cost $380 on average and could cost up to $580 for a 56-year-old.

The plans are meant for roughly 200,000 uninsured Massachusetts residents who aren't eligible for publicly subsidized insurance programs, said Bob Carey, director of planning and development at the Health Care Connector Authority. The group sent out requests for proposals to health insurance companies asking for the cost if they provided 60 percent of the benefits from an above-average health insurance plan. The cost ended up $100 higher than expected.

"This is bad news," said member Jon Gruber. "We used to think it was going to cost $260."

So it's not enough to come up with some magical way to insure everybody. Content matters, and some fundamental principles must be preserved. I believe health care is a right and not a privilege for those who can afford it. I believe in the importance of covering all children regardless of any other factor because it's cheap, it promotes wellness throughout life, and it can prevent diseases which are more serious in children than adults. I believe that trying to partner with the private insurance industry is like making a deal with the devil, and that the only market-oriented solutions that make any sense include things like guaranteed issue and community rating, so nobody is discriminated against for health care based on who they are. I believe in baseline minimums for basic care that are far above what is typically considered in these plans. I believe that forcing a marketplace through an individual mandate that doesn't include a "Medicare for All" option does nothing but subsidize for-profit industry. I believe that health care with a huge deductible and giant co-payments is not health care. And I believe that single-payer is the best way to keep down costs and keep the system efficient, and that anyone who studies the issue will come to the same conclusion. Failing that I like Jacob Hacker's solution from the Agenda for Shared Priorities.

A far better alternative was recently proposed by Yale Professor Jacob Hacker and the Economic Policy Institute. Employers would either have to provide good insurance, or pay a tax of six percent of payroll. People without insurance could buy into a public program much like Medicare, on a sliding scale. That same program would enroll people whose employers elected to pay the tax instead of providing insurance.

Hacker estimates about half of all Americans would soon be in the universal pool. Over time, the superior efficiencies of the public program would attract more people. The private health insurance industry, as a superfluous and inefficient middleman, would gradually dwindle. We'd eventually get universal and public coverage without the fragmentation.

Of course, the people who brought us HMOs will fiercely oppose it, but that's not necessarily bad. Harry and Louise, the stars of the insurance industry commercials that helped kill the Clinton plan, have a lot less credibility these days. Reformers seeking universal coverage should recognize that the private insurance industry is less a credible partner than the prime obstacle.

For the Beltway punditocracy, their bretheren in the states, and people who don't pay a lot of attention, having a health care plan means that you are a beneficent soul trying to improve people's lives. I don't begrudge motives, but it's not enough just to be FOR the general principle. You have to support something that'll actually work.

UPDATE: Wouldn't you know it, Ezra Klein wrote an almost identical piece, albeit from a slightly different perspective, at TAPPED. It's very much worth a read.