First, let me begin by apologizing for the lack of posts in the last few months. I am completing a second MA and working on my thesis. In conversation recently, I’ve had occasion to formulate some thoughts on the ever-widening division of stance between the right and the left when it comes to health insurance reform. As I’ve been sharply critical of those on the left for being unable to step out of their own shoes and try to see things from a different perspective (and question their fundamental assumptions…heck, who am I kidding…recognize their fundamental assumptions), I’ve decided to take the opportunity to do just that, and try to see the deadlock as an outsider.
I think the issue that feeds the rancor, and prevents any kind of progress being made is that we have begun to disagree about the fundamental principles governing our attempt to solve the problem. At no point has the government seriously stopped to ask (no, not even yesterday) “What exactly is the problem we need to solve?” The end result is that (like the stimulus and the Iraq war) the objectives have shifted several times, and while people may have been largely in agreement with the first set, as the definition of the problem itself has drifted into new territory it garners less and less support and more and more concern that it will continue to mutate into the future to become an excuse for the government doing anything it wants.
So what is it both sides actually agree on? That the cost of health care services (including drugs) is so high that most in the middle class must have health insurance in order to be able to pay for it, but the cost of health insurance is so high that most cannot afford more than the most basic plans unless the cost is shared by their employers.
Both sides actually agree, at least in theory, that the solution to this is “choice and competition” (at least that’s what they keep saying).
By limiting the attempts at reform (at least at this stage) to that in which we are in agreement, meaningful reform could be implemented rather quickly.
Both sides disagree about how to fix that, but that is what the debate should be about. Personally, I favor starting with repeal of the McCarran-Fergueson Act (and any other impediments to interstate trade of plans), which would have the effect of giving everyone in the country access to almost two thousand choices without costing anything for the taxpayer. That kind of meaningful competition would drive down costs the most effective of any solutions hitherto proposed. I mean, if we’re in agreement about “choice and competition,” why not begin with the simplest, no-cost solution that achieves the agreed-upon ends (stimulating competition and offering more choices) to the greatest degree (two thousand more choices instead of one more).
From there we can bolster gains in the cost reduction department, identify the underlying principles behind other problems (and there are other problems) and develop solutions.
There are also things we do not agree on, and that is why meaningful debate is necessary. For instance, are those who choose to remain uninsured a drain on the system? Proponents say yes; opponents say no (if you are not insured; you are billed. If you had been choosing to remain uninsured, a calculated risk on your part, you have assets that could be seized if you default on your bill). Are doctors prescribing needless tests because they are milking the insurance system, or is it because they are covering their asses due to the ease of filing malpractice suits? Are prescriptions so expensive because pharmaceutical companies are greedy, or because the FDA regulations are so onerous that the cost is driven up sharply? Are those too poor to afford their own health insurance (and without it from their employer) left to die, or do they already qualify for free services and government assistance? What other issues may exist there? How can those issues be solved in a sensible way? etc, etc
That is what it means to debate the issues, and that debate was never allowed to occur either in our legislative chambers or in the media (if you think it was, then you are completely in the dark about the “opposition’s” ideas and principles).
A very good and well reasoned post, but…
Whilst that does appear (to an outsider) to be a very good summary of the issues that surround the problem of healthcare, it unfortunately doesn’t seem to me to have much to do with the questions under discussion both by the administration and the country – and it never really has had.
What most of the more vocal elements throughout the US seem to be arguing about are matters involving highly bigoted ideology on both sides (mainly on the subject of politics rather than healthcare) that is fuelled by huge vested interests (to do with protevting enormous profits rather than healthcare), none of which has any intention of backing down. It’s an old style gunslingers’ stand-off and the only thing missing is the “O-K Corral”
Repeal of the act and forcing an “open market” is, as you point out, both vital and obvious and needs to be done before any other discussion even begins and it should be done without delay and regardless of any other debate or reform.
However, the very fact that the McCarran-Fergueson Act and, as you describe them, other impediments to interstate trade of insurance plans ever came into existence at all in the first place must surely speak volumes. In a country that talks about fair, open trade and professes to believe in market forces, that is the most heinous piece of crap imaginable. How can you have market forces without a bloody market? It’s downright crooked and the ordinary American people – almost all of them – are the victims of massive fraud here.
It seems to me that there is currently no debate to be had here at all, because those involved who have the power to change things are not even concerned with the subject of healthcare, but rather with their own private (and frequently disgustingly greedy) agendas and none of those involved is ever going to agree about what day of the week it is, let alone healthcare, which they don’t give a sh*t about.
They won’t ever genuinely discuss healthcare because that is not a subject that concerns them in the least.
Well, as far as market interference is concerned, we have the FDR attitude to thank for that.
I would say, however, that “protecting ‘massive’ profits” (which turn out not to be nearly as ‘massive’ as touted) is a mischaracterization of the Republican side. Only one party refuses to entertain opening the interstate market (the Democrats), but opening the markets breaks monopolies (or near monopolies), which would actually have the effect of driving *down* profits due to increased competition.
So it seems we have a battle line drawn. On one side is a party that seeks to introduce massive competition (which interstate trade of plans would do) and all that entails (including profits shrunk due to competition – not as an end in itself), and the other side that wants to socialize the whole industry to death.
I’m sorry, but I only see a clear benefit to the poor and middle class on one side of that equation, and it isn’t the one that ends in more regulations, a public option or single payer system.