The following is a part of the TPMCafe Book Club group discussion of the new book “Sick: The Untold Story of America’s Health Care Crisis — and the People Who Pay the Price” by Jonathan Cohn
Several participants have rightly insisted on focusing us on a large order question: what kinds of fundamental reforms are necessary to get a health care system that will cover everyone, improve health and make the health care system much more efficient?
And the big debate is over the role of the private health insurance industry: can we regulate and “incentivise” big health insurers to get them to achieve these goals, even though their business model has produced many of the very problems the public wants solved?
A few others have plaintively insisted that all this talk about systemic change and the model of single-payer is politically unrealistic and therefore irrelevant.
Mark Schmitt and others rightly ask if we can combine our long-term vision with a constructive participation in the messy realities of the political process.
As I noted earlier in this conversation, the public has signaled to the politicians that health care is a priority issue, and the politicians (at least on the Democratic side of the presidential race) have responded with a generalized pledge: “I will make sure that everyone is covered by the end of my (first or second) term.”
Since they are all scrambling to figure out how to do that, we have an enormous opportunity before us.
I submit that one of the best things we on the “progressive” side of this debate can do this year is to engage the nation—and the politicians—in a public discussion about the private health insurance industry: about the many ways the industry deforms and cripples our health care system—and about how they actually kill people.
Former Sen. John Edwards was of course, specific and eloquent, embarrassing Illinois Sen. Barack Obama for lacking details. But Clinton firmly took out after the health insurance industry. Take a look at this short excerpt and tell me it doesn’t sound like she’s getting ready to cut private health insurance completely out of her health care plan:
I am in favor of universal health care coverage. [And a system] that begins to guarantee coverage to people who already have insurance, because, let’s not kid ourselves, there are a lot of people who think they have insurance except when they need it. [She tells a story about a woman excluded from insurance because of a pre-existing condition.]
Now, I don’t want to wait until I’m president to begin. I’m going to introduce legislation while I’m in the Senate to end insurance discrimination. Guaranteed coverage. No more cherry picking.
You cannot eliminate people on the basis of preexisting conditions, because that’s what we need insurance for. And, you know, we’ve now met the human gene. We’re going to find out we’re all susceptible to something.
So, none of us are going to be insurable if we don’t change this system. And I think we need to start now in order to make sense out of it and get people the coverage they deserve to have.
Now this kind of populist rhetoric is also useful if she is planning to go for a wimpy and dangerous plan like that of Sen. Ron Wyden, D-Ore., that essentially gives all our public subsidies to the insurance companies—while pretending to regulate them. The point is that Hillary is aware of the public anger at insurance companies among the voters, and she is determined to make it work for her.
We should be doing the same thing—but with the goal of channeling that anger to some productive conclusions:
• Insurance companies distort our health care system at great cost, and therefore:
• We should demand politicians tell us how they would make insurance companies change their business model—now based on insuring the well and the wealthy. or
• We should build our health-care-for-all vision around a public system—like Jacob Hacker’s Health Care for America —not the private insurance companies.
Even if you are one of those who believe the next president will have to capitulate to the insurance industry in order to get anything passed, you’ve got to see that having the companies publicly on the defensive—explaining that they don’t want to cut off peoples’ insurance or charge outrageous premiums—has got to give us an advantage even if our goal is getting a plan for America that is marginally better than Massachusetts or California.
But millions of Americans are telling the politicians that we can do better. Edwards deserves the praise he’s been getting (including from me) for the way he’s detailed a plan that bites the bullet on paying for coverage in a progressive way and for requiring employers to “pay or play.”
But on the role of the private insurance companies, Edwards essentially splits the difference. His plan is a cross between California Gov. Arnold Schwarzenegger and Hacker (the Hackernator?).
Obama is now on the spot. He’s got to decide whether he advances a plan (or at least principles) that are more progressive than Edwards—by limiting the role of the private insurance companies. And as we all know, the grass roots and the progressive bloggers have some influence on the policy decisions of Democratic candidates trying to excite the Democratic base.
Many of the participants in this conversation are very good at explaining and detailing the many ways in which the health insurance companies have helped to create our dysfunctional health care system. We at the Campaign for America’s Future are eager to work with you to turn that explanation into a grass roots campaign for change.
And then, of course, we need a positive plan to cover everyone in America. One of the things we learned last time around is that Americans want a vision for health care that they can understand—and a solution to big problems of costs and coverage that proceed from an understandable diagnosis of why we face those problems.
What we do over the next few months can help shape the proposals the 2008 Democratic presidential candidates offer to the nation on health care. And what we do over the next several years can help shape how those proposals evolve—and whether they have a chance of succeeding in our lifetimes.
This forum helped clarify the challenge we face. And, as motivation, I leave you with Matthew Holt’s description of the outcome he fears. (It’s a pretty good description of my fears about our legacy if we don’t rise to the challenge.):
My essential fear though, is that we’ll only get to some kind of compromised quasi-universal coverage system that doesn’t really cover everybody, keeps a role for a private insurance industry operating under the wrong incentives, and looks like welfare for the poor.
In that case this whole cycle will start again, and in about 15-20 years when we go into a more violent collapse—then we will end up with Soviet-style rather than Danish-style socialized medicine. And we ought to be able to do much better than that.