Some Quick Thoughts On Health Care

• In California, Arnold Schwarzenegger hasn't gotten around to mentioning that his plan for expanding access to health care calls for the federal government just giving him $3.7 billion dollars. Arnold has been extremely unsuccessful in getting so much as a penny out of the feds, so I'd say his plan is a plan in the same way that the Underpants Gnomes have a business plan.

Collect Underpants
???
Profit!

Maybe this is why the Governor isn't writing a bill and can't even seem to get a legislator to introduce his plan as a bill, either.

• Republicans in the California State Senate, meanwhile, have come up with their own plan, called CalCare. Their plan, essentially, gives tax shelters to the rich while trying to eliminate wellness plans for children under 5. Oh, and giving insurance companies tax credits to be efficient. It's a REAL GOOD HEALTH CARE PLAN, it is.

• Meanwhile, other states are pushing forward with their own universal health care plans, like New Jersey and Maryland. Both states are controlled by Democrats, so it should be interesting to see what they'll come up with. And Massachusetts, even former Governor Romney, needs to be credited with getting this ball rolling (even if their plan looks to be incredibly steep for many inviduals to pay).

• Harry Reid looks to understand the crucial issue, that a for-profit insurance industry is the enemy of access and universal health care.

The problem is that the insurance industry is the enemy of most everything we do today. They have an anti-trust exemption from the Depression era that was supposed to last only a few years (the McCarran-Ferguson Act) but is still with us today. This exemption allows the industry to do harmful things to the country. They are fixing prices, which would ordinarily be a violation of the Sherman Anti-Trust Act, but there is nothing we can do.

This is why Edwards' plan represents something very new, allowing public plans to compete with private insurers, to break this stranglehold they have, where for-profit companies can get in the way of quality health care and saving lives.

• Gov. Tom Vilsack, running for President, answered my questions to him about health care in this Kos thread:

We clearly need universal access to health care for all citizens. Our system is wasteful and immoral. The uninsured either don’t get coverage or get care in expensive emergency rooms.

But there is more to the debate than coverage, and it has to do with lowering costs and increasing quality.

We need focus on prevention and wellness, we need to cure currently incurable diseases with a coordinated national effort, and we need long term (he trailed off -ed.)

As Governor, Iowa was only one of two states to decrease the uninsured last year and we have covered over 92% of the children in Iowa with Health Insurance.

Cost containment is certainly very important, as is prevention and wellness. I think those things end up improving, however, when you stop forcing the uninsured to only use the emergency room as a last resort and sign them up for full treatment and care.

• There have been several posts about the strategy for changing the health care system. Matthew Yglesias counsels a go-slow approach, with incremental ideas like lowering the age for Medicare, or expanding the CHIP program to cover more and more kids, rather than building some compromised but comprehensive system that keeps the for-profit insurance system or the employer-based system locked in place.

To put it another way, compromising on the quantitative aspects of single-payer health care means taking small steps to the social democratic utopia of tomorrow. Compromising on the qualitative aspects, by contrast, risks locking a bad system in place forever.

• Meanwhile, Mark Schmitt thinks Presidential candidates should stop giving detailed health care plans altogether, as someone will focus in on the inevitable negative detail and blow it out of the water. (Well, yeah, but won't that happen anyway? Isn't it better to try and get elected on something specific?)

• And Ezra Klein is righteously pissed that the Edwards plan is significant to the Beltway media only because it raises taxes (I mentioned this, too).

But if the problem with the New York Times and Washington Post story was that it failed to clearly or seriously explain the plan's features, much of the media hasn't even bothered to fail at the substantive task. They, instead, have been mainly interested in Edwards' willingness to raise revenues to fund the plan. This, of course, is a no-go, a non-starter, political suicide, evidence of unelectable extremism. On the other hand, all of these reporters would happily tell you, in private, that taxes need to be raised. Most all of them support health reform. They universally loathe the politician's tendency to avoid tough questions like revenue increases. But when a politician steps up, they rush in with the very narratives and reporting style that encourages such irresponsible rhetoric. If the framing were that Edwards was willing to speak the hard truths about how to pay for his, and the country's, expressed priorities, maybe other politicians wouldn't fear honest utterances.

But if there wasn't conventional wisdom, the Beltway wouldn't have any wisdom at all!

• Shum from the CNA is a single-payer evangelist, and important to the debate. I don't agree with him about Edwards' plan, however. Having competition between public and private plans will test the "single-payer is the only solution" hypothesis and force for-profit industry to either provide good service or be left behind. You're not going to overturn the entire insurance industry in a day. You can try, you can yell about it a lot, but it's not going to happen. But breaking their monopoly, chipping away at Medicare rates (lowering the age at which you can join), these things will legislate the insurance industry right out of business. Edwards is so far the only major legislator to add that component (community rating has the potential of doing the same thing, but these competitive health markets will get there faster).