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This is not the health care reform battle. This only one important battle for health care reform. A well-designed, quality, universal health care system will not be passed with a single massive piece of legislation. If that is your goal in this fight, you will never win. Knowing that, it is important to focus on winning this battle as a strong foundation for the next battle.
This first battle is not about creating a workable health care system. It is also clearly not about really bringing down costs. It is about expanding coverage and making a commitment as a society that we will try to provide health insurance to all our citizens. Committing to at least not completely bankrupt people with health care costs. Getting that commitment embedded in our unspoken social contract will be a big deal. This fight is also about how we will get to insure universal coverage. Public programs, public/private partnerships, non-profit networks, highly regulated markets, massive subsidies to loosely controled private industries, etc. It is about what will be the foundation that the future of our system will be built on.
If a health care reform bill passes this year, there will be at least two more legislative battles before progressives could turn it into a quality universal health care system. The next battle will happen just before or soon after reform starts in 2013. It will be a fight to fix many of the unintended or overlooked problems with this bill. This battle will look very different than the one playing out in Congress now. Instead it is likely to be a series of skirmishes at the state and federal level about implementation, risk adjustment, and tweaks to regulation. In many ways this battle could be more important but because of the low level intensity of the action, it will make it hard to rally the grassroots supports around.
Once the current reform plan is finally “worked out,” the next battle will be several years later as a result of the impending crash. Our current health care system is on a completely unsustainable course. Some of the reform will help, but will not be nearly enough. I know the system is heading for a breakdown, I just don’t know how. It could be a mass dropping of coverage by employers. It could be a popular clamoring for access to the public option. It could be a major outcry by employers that something needs to be done about the cost of health insurance. It could be another economic downturn. It could be a looming problem related to government debt. How ever the third battle is started, it will not be pretty. Importantly, we will not get to this third battle unless the country first makes a commitment to try to cover everyone. Otherwise, the financial safety valve will always be just to put more Americans in the uninsured column.
It will be a battle (or series of battles) about really cutting cost and trying to rein in the big health industry players. Progressives need to have a proven public option and public health insurance programs in place to use as tools to push this third battle in the direction they want. This fight about reducing costs will probably be over whether to provide less care to many people versus using more government and regulation to really squeeze waste out of the system. The public option should ideally be the proof progressives will need to show that when it comes to reducing costs in health care, the government really is the solution.
Looking around the world at different health care systems, we know this is true. The goal is to lay the groundwork to be able to prove it to the American people at the moment progressives will need to. This is what PhRMA fears, what terrifies the private insurance companies, scares the Republicans, and worries the Democrats who rely on health industry donations.
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I’m going to go ahead and stick my neck out here and ask a simple question that I’m sure you or Scarecrow or Jason can easily clear up for me… Why can’t we simply open up Medicare to everyone? Say over a decade allowing people who wish to sign up for it to enroll, lowering the age threshold a few years at a time until everyone has that option. Why would a massive piece of legislation be needed for that? Would that not constitute a well-designed, universal health care system? My question is sincere. I genuinely don’t get why this isn’t the path of least resistance.
Another question that your post raises is: how did other countries achieve their systems (whether Swiss, French, British, etc.)? Did they manage it all at once or did they also have to take the piecemeal route? Again, it is a sincere question. I really don’t know and am curious how they managed to achieve what we have not.
It does not have the votes. Single payer currently has about 90 votes in the House and maybe 19 in the Senate. What stands in the way of Medicare for all is a general Republican myth of the government being bad and most importantly money. There is lots and lots of money interest that don’t want Medicare for all.
British system did sorta get put in place all at once but that was right after WWII and their health care system, country, and economy was completely decimated by the war. They were rebuild how cities from nothing. And of course that changed a lot over time
Most systems like French’s slowly morphed over decades.
even if this is true (and t.r. reid iirc says stuff like jumping halfway across the chasm doesn’t get you any closer to the other side), the real question is: “what are the steps we need to take, and does the current bill help or hinder that process?”
i’m going to go with hinder. for folks committed to the incrementalist approach, a process of state (or regional for small states) experimentation makes much more sense to me.
personally, i think we should attempt to take on the special interests. popular social movements have accomplished similar large changes. the insider deecee approach is, imo, ineffective wrt those special interests without such a social movement (either by attempting small or large steps)
Wyden added an amendment which would let states experiment with doing there own thing with the money as long as the could provide care at a better price or better coverage. These are the “foundation” things we need to make sure are in the bill. What states really need is that money stream to do these things.
thanks jon! i thought i vaguely remembered reading about some problem with the wyden amendment (that would not give states the ok to try single payer)…. but maybe i’m misremembering? i sure hope so!
There is a lot of state freedom depend how things shape out. For example It is likely states will be able to take over a state based exchange and make it open to all people and business right away. So say Vermont could give everyone in the state access to the public option that way. Of course they can only do these things if they have the ground work in place to do them, like a public option.
Once the current reform plan is finally “worked out,” the next battle will be several years later as a result of the impending crash. Our current health care system is on a completely unsustainable course. Some of the reform will help, but will not be nearly enough. I know the system is heading for a breakdown, I just don’t know how. It could be a mass dropping of coverage by employers. It could be a popular clamoring for access to the public option. It could be a major outcry by employers that something needs to be done about the cost of health insurance. It could be another economic downturn. It could be a looming problem related to government debt. How ever the third battle is started, it will not be pretty. Importantly, we will not get to this third battle unless the country first makes a commitment to try to cover everyone. Otherwise, the financial safety valve will always be just to put more Americans in the uninsured column
From where I sit all the scenarios are in place for your “third battle” already.
The problem is that there is not universal coverage. Currently we have all the problems for the third battle but there is the safety valve of just making more people uninsured. Until you remove that safety valve the pot will not boil over.