As featured on p. 218 of "Bloggers on the Bus," under the name "a MyDD blogger."

Friday, October 19, 2007

Getting Ugly Over Health Care Non-Solutions

So after being peppered with criticism from both term limits groups and the California Nurses Association, the Speaker's office has chosen which group to strike back at: the nurses, of course, using the exact same standard of judgment that they called a "smear job" when it was used against Nuñez.

This is an argument over improving the delivery and cost of health care, and there's plenty of ideological rigidity to go around. What started as a promising "year of health care reform" has devolved into putative allies arguing about how much money the other spends on hotel rooms. Behind the mere gaining of political points is a serious debate about how to best allow all California citizens, not just the ones with full-time employment (us freelancers need health care too), the highest quality affordable health care they can manage. And the real truth of the matter, the one that nobody really wants to talk about, is that none of these state-based plans, by definition, have any hope of working and have serious potential consequences, besides. I think that's why everyone's getting so mad at one another, because it's easier to do so than to face the facts.

We’ve got all these great universal bills passing at the state level, and I’m here to tell you that, well, they are pretty great, but they’re not going to work. It didn’t work in Washington State, when they tried it, and the insurers first jacked up the premiums, and then moved out of the state in order to kill the model. It didn’t work in Hawaii, which saw an economic downturn move more people onto their subsidies exactly as the state’s revenues dropped. It didn’t work in Tennessee, where the Democratic governor, Phil Bredesen, upon killing off Tenncare and leaving 300,000 people uninsured, told his state that, "I say to you with a clear heart that I've tried everything. There is no big lump of federal money that will make the problem go away." Similar plans failed in Oregon, in Massachusetts, and many other states.

The plans fall for a few small reasons, and one big one. The big one is that states don’t have the fiscal stability to run universal health care. 49 of 50 states cant deficit spend. That means that when the state goes into recession and more people need subsidies and the revenues to give them don’t exist the state can’t borrow the money. So they dismantle the program. It’s happened time and time again -- in some states, like Oregon, more than once.

Moreover, you don’t really want this being a state-run solution. As a stopgap, increasing coverage through state plans is worthwhile, but health care reform is more than access – it’s actual reform to bring down costs, which are, at the end of the day, the biggest problem in the system. And the states don’t have the regulatory authority, the money, or, save in a few cases, the size to do that. I simply don’t trust them to fundamentally reform the system.

California is obviously one state that has the size, and certainly could float ever more bonds to spend the necessary money. But we're almost certainly on the cusp of a new recession, and the combination of massive debt passed on to grandkids and a pay-to-play system that still reigns supreme in Sacramento is unpalatable to reform.

I repsect the efforts of groups like Physicians for a Naitonal Health Plan, who have studied the issue and recommended some of the best possible solutions. But that word "national" is hard to get around; it's the only way to create the real economies of scale and managed risk necessary for a solution. I believe in health care for everyone, not simply in red states or blue states. As Ezra Klein notes,

You know, whenever you talk about the state reforms, you always hear the old Brandeis quote about the “laboratories of democracy.” But there’s another Brandeis saying that I think is more applicable: “If we would guide by the light of reason,” he said, “we must let our minds be bold.” And that’s what I’m asking: Be bold. Because nothing else will, in the long term, work.

UPDATE: I'll even give you a talking point: We want the same health care for every American that gives triple-bypass surgeries to members of Congress for virtually nothing. That'd be the simplistic version, but even with the details it's a bold, realizable goal.

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