A Sick System

I think at this point I'm deeply frustrated by all sides of the health care debate in California. You have the purity trolls who believe that anything to the right of single-payer healthcare is the work of the devil and are feeding into right-wing attacks on the Speaker (some of them completely well-deserved, we'll get to him in a moment) to advance their goals. You have dissemblers like Arnold and his Hoover Institute backers who will claim that their plan is universal health care "just like Hillary Clinton's" when it offers no cost controls on insurers and essentially just creates an expensive forced market. And then you have the "go-along-to-get-along" folks who talk about "expanding access" while driving us into the ditch of strengthening employer-based health care, applying a 1940s solution to a 21st-century problem.

Nobody's working together because nobody has the incentive to work together, and there's the safety valve of the ballot box which all sides see as a panacea. So nothing will advance in this special session, and remarkably, that's probably a good thing.

The Republican position on health care is that people have too much health insurance. They want to make lousy insurance cheaper so people will buy it and "be covered," but not be able to use it as much. As the insurance industry LOVES this approach, it's the only thing they'll ever champion, in the name of "universal health care." This is why I disagree with some in the lefty blogosphere who think that just getting people like John Boehner to address universal health care is a win. No, it devalues the word. They've already turned it into something deceptive like the forced market Schwarznegger has put forth in his failed bill. The end result is confusion, leading to blurring like "Arnold's strategy is the same as Hillary's." Actually, that's almost completely untrue.

I'm not immune to an incremental approach while we continue to build the coalition for the end to for-profit health care in California. Here are two small things you could put on a ballot tomorrow that would pass: guaranteed issue, which would eliminate the practice of denying health care to anyone based on a pre-existing condition; and community rating, mandating that all insurers provide their coverage to a community at the same price regardless of age or relative health. Those two steps alone would be vastly preferable than trying to jerry-rig an approach that will inevitably take steps backward rather than forward. The insurance industry is hated in this state and in this country, and nothing beyond the status quo or forcing a market to them will placate their concerns. So if you're going to have a vigorous opposition, at least have it be in service to something that makes sense.

UPDATE: Ezra preaches it:

On the micro level, a health crisis can leave you bankrupt if you lack insurance, have too little insurance, have too high a deductible, or your insurance decides not to cover the costs of your treatment. On the macro level, the spiraling cost of health care is a massive threat to our economy. Looking into the future, if we don't restrain the growth in health spending, effective GDP-per-person (i.e, what's left after health costs) will actually begin to go down (here's a graph!), and we'll all become poorer. And my hunch is that the only way to restrain health costs in a humane and politically palatable way will be through integrating the system, bargaining down prices, and rearranging consumer incentives so soft rationing -- i.e, ineffective drugs receive less reimbursement, and so aren't as often used -- becomes possible.

These should be the minimum requirements of a sound policy. The conservative position, again, is "people use too much health care." Why this can't be honed into a fine point is beyond me.