Tuesday, March 31, 2009

Why We Never Get What We Want

Avedon Carol made an astute observation yesterday on why "pragmatism" is just not a useful tool, especially when it comes to such important issues as universal access to health care:

If you are only acting in a "pragmatic" fashion instead of asking for at least what you really want (better to ask for twice as much), you are not gonna get what you want. I want Nye Bevan's healthcare system - you know, "socialized medicine". And maybe if I keep talking about it, at least people will know the difference between single-payer and "socialized medicine". You want single-payer? Maybe if you ask for socialized medicine, they will compromise by giving you single-payer.


Liberals never get what we want because we always come to the bargaining table convinced that what we want is too radical a change, so we have to settle for far less. That's a defeatist bargaining stance, one that guarantees that we will fail at even a baby step towards our goal. It's clear that even the most clear sighted amongst us have been conditioned to this approach, especially on the issue of health care, by all the forces of the market place. From "Harry and Louise" commercials to the editorial pages of major newspapers, the debate has already been framed for us, and we accept that frame.

Sadly, the Sacramento Bee, one of my favorite newspapers (especially on California issues), published an excellent example of that framing. Perhaps the best clue to how the reform of health care access will be treated is given by the title of the op-ed piece: "Should health care reform include the choice of a public insurance plan?"

Not "Should we have a single payer plan," which would mean everyone would be enrolled in a Medicare type system, but rather, "Should this be an option." Right off the bat you know that at least as far as the Bee's editorial board is concerned, that's the most we can hope for.

To further that stance, three viewpoints on that limited approach are presented. The first is authored by Jacob Hacker, professor, University of California, Berkeley, and it details every reason why a single payer system is far preferable to anything else:

Public plan choice simply means making a public health insurance plan modeled roughly after Medicare available to anyone – on the same terms under which other plans are available. The case for public plan choice is simple. First, public health insurance outperforms private insurance in controlling costs while maintaining access and benefits. Second, public insurance has also made major strides in quality improvement, and a new public plan working with Medicare alongside private plans would be able to make much greater strides in the future. Third, a competing public plan is essential to set a benchmark for private plans, providing a "check and balance" to ensure that private plans, as well as the public plan, uphold high standards.

To be "fair and balanced", the piece then presents a response to such a plan: an excerpt of a letter sent to President Obama by Republican Sens. Mitch McConnell of Kentucky, Orrin Hatch of Utah, Charles Grassley of Iowa, Mike Enzi of Wyoming and Judd Gregg of New Hampshire.

Washington-run programs undermine market-based competition through their ability to impose price controls and shift costs to other purchasers. Forcing free-market plans to compete with these government-run programs would create an un-level playing field and inevitably doom true competition. Ultimately, we would be left with a single government-run program controlling all of the market.

And that, my friends, would be a bad thing. After all, the profit motive has served this nation so well in other fields, let's complete the destruction by ginning up the health insurance companies' bottom line.

To complete the cycle, the op-ed then provides what apparently is the favored answer, which is an excerpt from a Len Nichols and John Bertko proposal published at The New America Foundation: "A Modest Proposal for a Competing Public Health Plan".

It is possible to structure a new insurance marketplace so that public and private health plans compete on a level playing field. This will require separating the oversight of the public plan from that of the managers of the marketplace. It will also require that all rules of the marketplace – benefit package requirements, insurance regulations and risk adjustment processes – apply to all plans equally, whether public or private. Finally, this model requires that we address cost growth containment systemically and avoid relying heavily on the public plan's potential market power. In turn, this will require a commitment on the part of policymakers to acquire a health information infrastructure, develop best practice information and encourage realigned incentives that promote high-quality, efficient care for all.

Sure it will. And then I will be able to see a doctor about the sudden eruption of monkeys flying out of my posterior.

Look, the very best plan would be the "socialized medicine" that Avedon prefers, and she's right: that's what we should be demanding, or, at the very least, asking for. We don't have to buy into the frame that we can't exclude private insurers because, um, that would be bad and possibly unAmerican. When people tell us that a single payer program won't work, all we have to do is point to Medicare, which for all of its alleged problems is still more efficient and better run than any private insurance plan.

Enough of this caving before we even sit down to negotiate.


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Blogger Woody (Tokin Librul/Rogue Scholar/ Helluvafella!) said...

"We" lose because we send people to the bargaining table who, like "thePrez," have already determined to negotiate away what they know "we" want, as a bargaining chip, to make them look 'bipartisan.'

8:09 AM  
Blogger Cosa Nostradamus said...

This has to be the worst group of negotiators in American political history. Either that, or they're getting exactly what they set out to get: Nothing.

Let's see how they do on food safety.

Hm. Salmonella poisoning causes arthritis. We learn something new & painful every day. Thanks, Dubya!

6:41 PM  
Anonymous larry, dfh said...

In the movie 'Sicko", Michael Moore interviewed Tony Benn, former PM of Britain. He stated outright that the British govt, even under thatcher, couldn't remove socialized medicine because the govt was AFRAID of the populace, wheras here, the populace is afraid of the govt. While I agree completely with this, it seems ironic that the British govt is afraid of a practiaclly unarmed public, whereas the public in the U.S. is armed to the teeth, yet cowering in fear from their govt.

7:50 PM  

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