The Health Care Reform Moment

Paul Krugman has a really good column today about the consequences of the Democrats' victory on stopping Medicare cuts (Bush has vowed to veto, but the votes will in all likelihood be there to override) by halting the creeping privatization of the system. More than anything it was a tactical victory:

This year, the Democratic leadership decided, instead, to link the “doctor fix” to the fight against privatization and offered a bill that maintains doctors’ payments while reining in those expensive private fee-for-service plans. Last month, the Senate took up this bill — but Democrats failed by one vote to override a Republican filibuster. And that seemed to be that: soon after that vote, Senators Max Baucus and Charles Grassley had another bipartisan fudge all ready to go.

But then Democratic leaders decided to play brinkmanship. They let the doctors’ cuts stand for the Fourth of July holiday, daring Republicans to threaten the basic medical care of millions of Americans rather than give up subsidies to insurance companies. Over the recess period, there was an intense lobbying war between insurance companies and doctors.

And when the Senate came back in session, it turned out that the doctors — and the Democrats — had won: Senator Kennedy was there to cast the extra vote needed to break the filibuster, a number of Republicans switched sides and the bill passed with a veto-proof majority.

If the Democrats can win victories like this now, they should be able to put a definitive end to the privatization of Medicare next year, when they’re virtually certain to have a larger Congressional majority and will probably hold the White House.

More than that, however, advocates of universal health care, like Health Care for America Now, the new group headlined by Elizabeth Edwards, have to be very encouraged by this week’s events.

Absolutely, especially considering that HCAN will be in the exact attack dog position that the AMA was over the Fourth of July holiday. The AMA ran ads in Republican districts and broke them down to finally change their vote. As Ezra Klein notes, if physicians can be brought into a coalition on health care reform, that could be a tremendous asset.

Now there's been a lot of controversy to the launch of HCAN, particuarly from single-payer advocates who think that HCAN will perpetuate the for-profit insurance industry. Now, what they actually favor is a public option being given the ability to compete with private insurance, making gradual the transition to a national health care plan, along with strict regulation on insurers so they have to compete on price and quality. But overall, I think that these single-payer evangelists misunderstand HCAN's role, which is to relentlessly push back on insurance companies and wayward legislators rather than any kind of policy role. And the AMA/Medicare Advantage situation shows how that can work to reform the system in a progressive direction.

I thought Ezra's other post about the bind single-payer advocates are in was particularly good.

On the one hand, there will never be the political will for single payer without effective and determined advocacy. So single payer supporters need to engage in that advocacy, and point out problems in competing proposals. On the other hand, barring a seismic political shift, single payer isn't passing the US Senate any time soon, and so dogmatically insisting that the only way forward is single payer is basically dogmatically insisting that there won't be health reform because you'll oppose achievable compromises. At times, this attitude has killed health care reform, as when Democrats refused Nixon's proposal in the 70s -- a proposal far more radical than anything being offered today. So it's tricky. The policy is possible, and simply requires political will. The will is absent and requires advocacy. But the advocacy, if conducted too dogmatically, can stand in the way of reforms that would help the 47 million uninsured and get us a step closer to single payer.

I think that the goal ought to be single payer, but anything that helps 47 million people get health care is positive. And both Physicians for a National Health Care Plan and HCAN have roles to play in that goal, if they could only work together. But you have to acknowledge that tension.

UPDATE: Jon Cohn has more on the burgeoning coalition of Democrats and doctors.