Ideology Vs. Progress, Take 4

Returning to health care for a moment, there's a big debate over whether to engage in an incremental approach to health care that would be universal, or to go for broke with a single-payer system. Again, single-payer is probably the best opportunity to keep down costs and cover everyone successfully. But I tend to agree with Paul Krugman on this issue:

The generic Demoplan, which basically follows the template laid down by John Edwards, involves four moving pieces: community rating, requiring that insurance companies offer insurance to everyone at the same rate regardless of medical history; a mandate, requiring that everyone have insurance; subsidies to help lower-income people pay for insurance; and public-private competition, in which people have the option of buying into a plan run by the government.

The alternative would be single-payer, aka Medicare for all: a payroll tax on everyone, and a government insurance program for everyone. Wouldn’t that be simpler, easier to administer, and more efficient?

Yes, it would. I myself described the Schwarzenegger plan in California, which contains all these elements except the public-private competition, as a “Rube Goldberg device — a complicated, indirect way of achieving what a single-payer system would accomplish simply and directly. “

But there are very good political reasons for going with the Demoplan: basically, it looks like something that could actually happen early in the next administration, while enacting a single-payer plan like the Conyers plan or the PNHP plan, excellent though those plans are, might take a very long time.

The public-private competition in the Demoplan is crucial, by the way, because it means that the Demoplan isn’t locked into the inefficiency of the private insurance system – it could evolve into single-payer over time.

I agree that the public option is what sways me in the direction of getting this achievable system in place. (By the way, Arnold's plan does not have community rating in the sense that it does not spell out the baseline floor for care, or the ceiling for costs). And it's also why it's ridiculous to suggest that Hillary Clinton's plan is the same as Mitt Romney's. First of all, Romney doesn't have a plan. The MassCare option was the result of the state Legislature, and Romney's official plan contains none of the MassCare parts, and essentially offers grants to states that do what they want, as well as giving tax breaks that ultimately favor the rich. The Massaschusetts plan also did not have the cost controls of the Clinton plan (which is why costs have exploded in the first year), nor did it have a public option in competition with private insurers. That's a key difference.

I do worry about how you enforce an individual mandate - do people that don't buy health insurance go to jail? Get fined? But the positives of a mandate-and-subsidize, private-vs.-public plan are significant, and people shouldn't be quite so ideologically rigid when discussing this issue.