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Tilting at Windmills

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March 6, 2006
By: Kevin Drum

UNIVERSAL HEALTHCARE AND THE BLOGOSPHERE....I thought I had gotten this out of my system over the weekend, but I guess I didn't. I'm talking about the DLC's feeble and ridiculous 7-point plan to "move our health care system in the right direction." I read it on Friday and it had me fuming.

Look, I'm a pragmatic kind of guy. I'm so pragmatic that I even halfheartedly supported the Medicare prescription drug plan, which Bruce Bartlett, with some justice, calls "the worst legislation in history." But bad as it is, I figure it did one critical thing: it established the principle that Medicare should be responsible for providing access to prescription drugs. And it's a lot easier to fix a bad bill in the future than it is to get it passed in the first place.

That's how pragmatic I am. But I swear, the DLC's healthcare laundry list is the kind of thing that convinces me the DLC is trying to give pragmatism a bad name. Let's count the ways.

First off, it's hopelessly wonkish and unfocused. It's a 7-point plan, for God's sake. The worst aspect of Hillarycare was that it was so complex it scared people, and this plan learns nothing from that.

Second, it has no chance of becoming law. The big argument against fighting for universal healthcare is that it's politically infeasible, but the DLC's plan is dead on arrival too. What's the point of compromising if the compromise itself is just as big a nonstarter as the original goal?

And finally, it's far too timid about at least acknowledging that our eventual goal should be a full-fledged, single-payer national healthcare system. This means that it forfeits any chance of making a clear and easily understood statement about what the Democratic Party stands for. Instead it's just mush.

This last point is the most important one. Abortion opponents happily endorse incremental abortion restrictions all over the country, but there's never any doubt that a full-blown ban is their actual goal. Democrats, conversely, are still shell shocked over the events of 1994. That's understandable, but 1994 was over a decade ago. It's time to get back into the saddle.

Let me be clear: I don't underestimate the political difficulty of getting universal healthcare enacted. I don't underestimate how long it will take. But if there's anything the Democratic Party ought to be united on, it's the principle of loudly and enthusiastically endorsing universal healthcare as a goal.

So how about it, blogosphere? It's great that we endorse good candidates and help get them funding, but how about also making a difference in the policy arena and insisting that candidates publicly endorse universal healthcare if they want our help in the future? After all, not only is it a big, meaty, progressive goal, but it's one that we all agree on, not one that we fight over. We don't have to pick any particular plan, and we shouldn't expect anyone to commit electoral suicide over it. But we should at least insist that anyone who wants our help has to support simple, genuine, full-blown universal healthcare as a goal and that they do it publicly. That's how Grover Norquist turned the Republican Party into the "Tax Cuts Forever" Party, and it worked pretty well.

The reason that universal healthcare has failed in the past has been fear: fear of rationing, fear of lines, fear of bureaucracy. To win, we have to overcome that fear, and that's a public opinion campaign that will take years. The blogosphere can help by writing about what national healthcare systems in other countries are really like, and we can also help by insisting that candidates who want our support get on board the bandwagon. How about it?

Kevin Drum 11:06 PM Permalink | Trackbacks | Comments (84)

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Hastert!

Posted by: frist on March 6, 2006 at 11:15 PM | PERMALINK

What's this? Kevin Drum criticizing the Vichy Leadership Council?

Up next: the real significance of a 6.5% current account deficit and the wonders of "free" trade!

Posted by: alex on March 6, 2006 at 11:16 PM | PERMALINK

I suppose I should be in favor of single payer. It's probably the quickest way to get to individual health insurance policies, which is the only reasonable solution.

There's simply no way that the upper middle class and above will tolerate single payer. What's the point of making money if you can't pay for better care? No self-respecting insurance company or medical care provider will ignore the opportunity to sell these people something better. Over time, more and more people will buy their own policies and the "single payer" system will just be Medicaid all over again, as everyone else leaves it--and then questions why it should be funded.

The only way to prevent a private market from springing up would be to forbid it in the first place, and that just won't happen. Institute a care system that forces the rich to get the same care as the poor? Not in this country.

So I suppose I should be for it. Still, given how likely this development is, I can't for the life of me see why you're in such a hurry for single payer.

Posted by: Cal on March 6, 2006 at 11:19 PM | PERMALINK

five-year colon cancer survival rates:

US: 60% UK: 36%

five-year breast cancer survival rates:

US: 82% UK: 63%

That's a whole lotta dead Americans, Kevin.

Posted by: am on March 6, 2006 at 11:20 PM | PERMALINK

I agree 100% Kevin. The beautiful thing about making the Dems the party of "universal healthcare" is that it functions just like the GOPO making themselves the party of "national security" -- it puts your opponent on the permanent defensive, because how can they possibly be against such an obviously worthy goal?

Posted by: Nils on March 6, 2006 at 11:22 PM | PERMALINK

Cal: Universal healthcare doesn't eliminate private healthcare. People with enough money to afford private clinics can still use them if they want.

Posted by: Kevin Drum on March 6, 2006 at 11:23 PM | PERMALINK

Kevin says: The reason that universal healthcare has failed in the past has been fear: fear of rationing, fear of lines, fear of bureaucracy.

You forgot to mention the deep pockets of the health insurance industry. The only way to get universal care that isn't a big bureaucratic mess is to get rid of the insurance industry.

Posted by: MonkeyBoy on March 6, 2006 at 11:26 PM | PERMALINK
I'm so pragmatic that I even halfheartedly supported the Medicare prescription drug plan, which Bruce Bartlett, with some justice, calls "the worst legislation in history."

Bartlett's description is somewhat hyperbolic, but gets the right point across; I'm not sure, therefore, how supporting that legislation makes you "pragmatic" (though, among moderate Democrats, "willing to accept whatever festering garbage spews forth from the Republicans and support it because it nominally addresses a liberal concern" seems to a frequent, though quite bizarre, definition of "pragmatic" that might apply here.)

And it's a lot easier to fix a bad bill in the future than it is to get it passed in the first place.

I doubt that's true in this case, as fixing it will mostly consist of blowing it all away and starting from scratch; its a lot harder to build momentum to change a program already nominally in place; either the existing one will be spun successfully by defenders of the status quo as "good enough", along with the attempts to divert any problems with the existing program with fears that the change will be worse, or, on the other hand, the existing program will be so bad that it will discredit the idea of the government having a program to address the concern it nominally addresses. Either way, it gets in the way.

This is especially true when the functional details are complex and difficult to understand.

But I swear, the DLC's healthcare laundry list is the kind of thing that convinces me the DLC is trying to give pragmatism a bad name.

That's pretty typical of the DLC for the last dozen or so years.

First off, it's hopelessly wonkish and unfocused. It's a 7-point plan, for God's sake. The worst aspect of Hillarycare was that it was so complex it scared people, and this plan learns nothing from that.

Real wonks have focussed plans.

Second, it has no chance of becoming law. The big argument against fighting for universal healthcare is that it's politically infeasible, but the DLC's plan is dead on arrival too. What's the point of compromising if the compromise itself is just as big a nonstarter as the original goal?

The point is for the compromise to fail so that the DLC types can blame liberals for the compromise failing. The DLCs raison d'ètre seems to be to outdo the Republicans in blaming liberals, in the hopes that by doing so they can guarantee that, whoever wins the primaries, Republicans will have an advantage in the general elections with liberalism, and, by simplistic media extension, Democrats including the DLC types, will be preemptively discredited.

And finally, it's far too timid about at least acknowledging that our eventual goal should be a full-fledged, single-payer national healthcare system.

That's because the DLC types don't agree that that is the goal. The goal is defeating liberals, because every liberal that gets elected, and every liberal policy victory demonstrates that the cult of surrender that goes by the name "DLC" is fundamentally misguided.

This means that it forfeits any chance of making a clear and easily understood statement about what the Democratic Party stands for.

The DLC isn't for the Democratic Party having clear and easily understood statements of what it stands for. Because, if you had those statements, then you couldn't claim to be a Democrat and on most important issues just propose "What the Republicans want, but a little less."

But if there's anything the Democratic Party ought to be united on, it's the principle of loudly and enthusiastically endorsing universal healthcare as a goal.

It should be. Indeed, the Party should be really pushing to get the pending universal healthcare bills passed in California, to demonstrate that it works, and the world won't end if it is adopted.

Posted by: cmdicely on March 6, 2006 at 11:28 PM | PERMALINK

Kevin advocates for this: ... a full-fledged, single-payer national healthcare system.

Such a system will incorporate the many problems experienced by Canada, Britain, France, and other Western countries that have an NHS. Don't kid yourself: you're trading one substantial set of problems for another substantial set of problems.

As Cal notes, you would have to ban private markets -- Canada did this, and the Quebec Supreme Court just ordered that reversed? Why? Because the single-payer, single-provider system has failed Canada. The rest of Canada is going to figure that out.

Note that in Britain's last election, all three major parties agreed that the NHS was broken and required major reforms, which were going to cost billions of pounds to fix. Check the pages of the Guardian, and you'll see that problems continue with waste, with under-funded, bankrupt health care units, and with timely treatment.

France has similar problems: don't get heat stroke in August. The French health care workers are frequently on strike protesting various problems (of course, they're French so a strike is like a lunch-break -- and they still get their pay when on strike).

The Scandinavian countries have decent health care, and that's consuming their national budgets. Ditto the Low Countries. Germany's government is becoming increasingly constrained by health care costs. They can't do the many other things they need to do.

The point is simple: point to a single-payer NHS system in the world that provides first-class care without breaking the national budget. There isn't one. You can have second-class care (Britain), you have have a bankrupt system, you can have increasing delays (Canada), but you can't have everything you're trying to promise people.

Americans are a lot more impatient than most Europeans. Try to foist a system on them that bans private practice, that causes substantial waiting for necessary procedures, and that makes every hospital look like the old County hospital, and you'll have a revolution -- and not the one you progressives want, either.

In no way is the current American system perfect, or close to it. I work in it and I can point out plenty that is just plain stupid. But I wouldn't trade it for any NHS system I've seen anywhere in the world.

And any Democrat who trades to make that happen is going to have me voting against her/him.

Posted by: Steve White on March 6, 2006 at 11:29 PM | PERMALINK

Cal: Universal healthcare doesn't eliminate private healthcare. People with enough money to afford private clinics can still use them if they want.

That depends on the exact model of universal healthcare chosen; as I understand, the Canadian model does in fact prohibit private pay for services available under the national plan. I believe, though it is structured somewhat differently, the California SB840 proposal does, as well, or at least permits regulations that would do so, though I'd have to go reread the bill to be sure.

Of course, in the SB840 model and many other universal systems conceivable, nothing eliminates private healthcare, the universal part is the payment system, the providers may still be public or private.

Posted by: cmdicely on March 6, 2006 at 11:32 PM | PERMALINK

One could waste a liftime cleaning up troll poop, but according to the UK gov 5 year survival rates for breast cancer is 80% and for prostate cancer is about 50%

I didn't check the us figures

Posted by: Atrios on March 6, 2006 at 11:33 PM | PERMALINK

Check the pages of the Guardian, and you'll see that problems continue with waste, with under-funded, bankrupt health care units, and with timely treatment.

I see that all the time with US hospitals closing down, reducing emergency room beds so there is little coverage, etc.

I mean, if your going to point to a problem we are going to get, point to one that isn't present in the status quo system.

Posted by: cmdicely on March 6, 2006 at 11:34 PM | PERMALINK

I agree - universal healthcare should be one of the Dems' top planks, if not the top. And if Dems present it correctly, they should be able to convince people that it is not only the right thing to do, but it would be more efficient and result in better outcomes than the mess we have now.

You're right - blogs should be taking this issue up in force, but we need to agree on the basics - a simple, single-payer system that covers everyone. No compromises. No variations of the same, inefficient, for-profit system we have today.

Hillarycare tried to be all things to all people and failed miserably, and ended the push for real health care reform right through to today.

I think Dems are afraid of this issue because of the stigma of the S-word - socialized medicine. But who knows? If bloggers can push for single-payer hard enough, it might embolden some of the fainthearted Dem leadership.

Posted by: abi on March 6, 2006 at 11:38 PM | PERMALINK

In no way is the current American system perfect, or close to it. I work in it and I can point out plenty that is just plain stupid. But I wouldn't trade it for any NHS system I've seen anywhere in the world.

Let's just say I take you at your word. And before the rest of the "just say no" crowd show up and start shouting "moral hazard! waiting lists! free rider!" I just have to ask:

every time Kevin posts on this topic, we get the same "no no no" stuff. But the "no" crowd never says what they are for. Nobody can seriously tell me that we have the best of all possible worlds in this country, so let's hear it - if not some form of National health care, then what? Stop just saying "no" and tell us what you have in mind that is better than the current system, and also better than what Kevin and others keep proposing.

We're all ears...

Posted by: craigie on March 6, 2006 at 11:39 PM | PERMALINK

"Universal healthcare doesn't eliminate private healthcare. People with enough money to afford private clinics can still use them if they want."

Then all universal health care will do is eliminate employer funded health care (great) and replace it with lousy government funded health care--and create a market for individual insurance.

So why are you calling for "universal" health insurance if you know from the start that it won't be universal? That's crazy.

"Nobody can seriously tell me that we have the best of all possible worlds in this country, so let's hear it "

Individual policies. Mandated insurance--everyone has to buy some form of insurance. Government can subsidize expenses through tax deductions, and cover policy payments for the poor and the chronically ill--which will become less of a problem over time, if everyone has to be insured.

Posted by: Cal on March 6, 2006 at 11:42 PM | PERMALINK

"All Americans pay for the cost of medical treatment of people without health insurance. Government should pay for coverage for those who cannot afford insurance, but those who can afford it should be required to buy it."

And the malpractice courts system sounded very good.

But its more fun pushing for a takeover of a huge industry so go for it!!!!!

You get fulfilment, the Republicans get victory, the world economy is well guarded.

Posted by: Mca on March 6, 2006 at 11:43 PM | PERMALINK

Mandated insurance--everyone has to buy some form of insurance.

Well, that's the "univeral" proposal that the head of, IIRC, Blue Cross suggested; with selective subsidies to increase the market clearing price for insurance.

But it doesn't address any of the costs drivers, so its a really bad idea.

Posted by: cmdicely on March 6, 2006 at 11:50 PM | PERMALINK

Mandated insurance--everyone has to buy some form of insurance.

Safe Auto gets into the medical insurance business. Oy vey.

Posted by: Dustbin Of History on March 6, 2006 at 11:55 PM | PERMALINK

Alex writes:

There's simply no way that the upper middle class and above will tolerate single payer. >>

I don't know who makes up the upper middle class these days, but if they have health insurance they surely all have jobs with large corporations. The only other way to be covered is to be filthy rich. Otherwise you are seriously out of luck.

I worked for about 15 years as a freelance editor specializing in nuclear topics. I was paid very, very well, with monthly income in the 5-digti range, but I had a problem. While I was healthy, my spouse, Jim, had a rapidly deteriorating heart. Part of the reason his heart went south was that we couldn't afford the cholestrol-inhibiting drugs, which were hellishly expensive when they first came out, on a regular basis. He was certainly doing everything else right -- exercise, good diet, etc.

Of course, once Jim had his first heart attack, there was no way that we could afford private insurance that would cover him. Thus, we lived many years in the same manner as other junkies -- figuring out just how to cover his monthly drug costs.

Eventually, I got a state job, one of the few types of job that offer full coverage (after a 6-month waiting period) for family preexisiting conditions. That was a bit raise, as Jim's drugs cost about a thousand dollars a month.

And thus, when Jim finally crashed and burned, we had insurance to cover the full week he was in ICU -- $60,000 (that's just the hospital charges -- the doctors who had treated him for years didn't send bills).

I didn't push to keep him alive a minute longer than I thought he could come back as more or less himself (he'd have killed me if I'd let him come back a mess), but he was fairly young and strong and didn't want to die just then. So he held on for a full week.

A little money for Lipitor might have given him many more years. When we had the money we never stinted spending it on drugs, but there were many, many months when he bought just the drugs that would keep his angina at bay.

I'm not sure this generalizes to the American public. Maybe not. People are prone to continue on in habits that will kill them sooner rather than later. But my husband did all the right things (except being born in a family with decent hearts). Maybe it's not worth reforming the health care system to keep people like him alive. He was only 62 when he died, but maybe people that age are expendable.

I must say that it irritated me beyond belief when I found that our VP has a squad of medics that travel with him. I suppose that's just a personal thing; after all, the VP is a really important person, and my husband wasn't.

Marie

Posted by: Marie on March 6, 2006 at 11:55 PM | PERMALINK

I don't even like the use of the word "insurance" in this context. It applies to some things, like emergency treatment if I get hit by a bus, but where is the "insurance" element in standard preventative care? Even if nothing is wrong with me, for example, I'm going to the dentist twice a year. I don't need "insurance" for that - I know it's going to happen.

This is true of some pretty big ticket items. Having a baby, for example, is pretty expensive, even if nothing goes wrong. But calling it "insurance" when two people say "hurrah! we're pregnant!" seems daft. It's plain old medical care.

Sorry, there's no punchline here. I'm just in a harrumph sort of mood.

Posted by: craigie on March 6, 2006 at 11:58 PM | PERMALINK

This issue could be a big election winner ...for the repugnant ones.
Because all they have to do is frame it as more ' Tax-and-spend' big gooberment and socialism by stealth by the Lib-rul traitors.
So until Dem Donkee's become the party of ' small-is-beautiful', ' less-is-more' smaller lower leaner grass-roots goverment for the people ( not the Corpses )then they will obviously remain the comfortable flabby professional losers that they so patently are.
I live in Au where a major operation cost me nothing and you live in a shithole nation where poor people die for lack of health care. This could be easily fixed by an Au style system and even Libertarian Party members could vote for it PROVIDED the overall size of the state was shrunk in some area - say, Start wars?
The Party that campaigns for universal free health cover AND smaller government could be on a winner.
There is no party like that in the USSA - the closest one is actually the Trotsky-cons.
The Democratic party are losers, losers, losers. If they asked for 13 they'd get a 31. Pragmatic = loser. No ambit claims - no politics worth spit.

Posted by: professor rat on March 7, 2006 at 12:04 AM | PERMALINK

Mandated insurance--everyone has to buy some form of insurance.

At first blush, this seems reasonable. It's certainly occurred to me.

But mandating the buying of insurance is (sort of) easy. Mandating the selling of it is something else. I have a tough time believing that insurance companies wouldn't find a way to dump all the people who actually require medical care onto the government anyway, leaving themselves in the business of banking premiums and doing little else. Kind of like now.

And if you're going to do that, you might as well capture the money pissed away to "insurance" companies who are never paying anyone's medical bills.

Posted by: craigie on March 7, 2006 at 12:09 AM | PERMALINK

The Scandinavian countries have decent health care, and that's consuming their national budgets. Ditto the Low Countries.

Strange, when the US spends the highest proportion of its budget on healthcare.

Germany's government is becoming increasingly constrained by health care costs. They can't do the many other things they need to do.

Yeah, like spend a huge huge proportion of their GDP over more than a decade rebuilding half their country and their national capital.

How does that sclerotic German economy manage it? I mean, the US rebuilt New Orleans so quickly and all...

Posted by: floopmeister on March 7, 2006 at 12:12 AM | PERMALINK

Lets look at the plan:

1.) Restrain costs by improving quality. Paying doctors and hospitals according to the health results they achieve, rather than the quantity of services they provide, could make the entire system vastly more efficient and effective. The federal government should spur regional efforts, backed by the combined purchasing power of employers, insurance companies, and government programs, to push for this "quality revolution," through such means as provider comparison report cards, a focus on health promotion and disease prevention, and greater use of evidence-based medicine.

Okay, so the government controls what health providers get paid, but not based on providing services, but some kind of outcome based regime that will encourage gaming the system to guarantee that the cases they handle are the ones that are most likely to give good numbers on the outcome measures that get invented.

1.) Restrain costs by improving quality. Paying doctors and hospitals according to the health results they achieve, rather than the quantity of services they provide, could make the entire system vastly more efficient and effective. The federal government should spur regional efforts, backed by the combined purchasing power of employers, insurance companies, and government programs, to push for this "quality revolution," through such means as provider comparison report cards, a focus on health promotion and disease prevention, and greater use of evidence-based medicine.

Well, as I understand it, FEHB is just a huge group that purchases private health coverage and negotiates for good prices; essentially, this is universally subsidized private insurance.

Now, employer group plans are in part kept affordable by the fact that employable people are, on average, healthier than non-employable ones. So, prices of insurance will go up, even before you consider the effects of the subsidies.

3.) Require shared responsibility for the cost of coverage. All Americans pay for the cost of medical treatment of people without health insurance. Government should pay for coverage for those who cannot afford insurance, but those who can afford it should be required to buy it.

See notes above; less and less people are going to be able to afford insurance, and more and more are going to be subsidized. That's not, itself, bad, but maintain the network of private insurers does nothing to constrain cost drivers. This is, essentially, a license for the insurance oligopoly to print money.

4.) Advance the use of information technology through a health information network. Bringing the health care system fully into the digital age could enormously reduce medical errors, spread medical "best practices" throughout the system, and reduce costs. But only the federal government is in the position to create a national network for exchanging health information electronically, giving patients the ability to give providers access to medical records without sacrificing privacy.

HIPAA may have substantially improved medical privacy; but I don't think anyone would agree that, the promise dangled by the common data formats notwithstanding, it has been cheap for providers to comply with. If anything, I'd bet its been a big cost driver, even ignoring the privacy rules, in terms of compliance with the data related rules. Expanding the governments dictation of how providers, insurers, etc., communicate -- often with mandates that don't meet very well the needs of some segments of the field that already have well-established communication protocols -- is going to drive costs up. But it, like HIPAA before it, will be a bonanza for IT contractors.

5.) Create health courts for fair and reliable justice in malpractice cases. The real scandal of medical malpractice is not large jury awards, but how few injured patients receive timely compensation, and how little the system encourages better medicine and fewer life-threatening errors. Congress should create a national network of specialized "health courts" similar to those that handle workers' compensation claims.

Health courts may be a good idea, but in a system which doesn't federalize health law (except, apparently in communication and mandating purchase of insurance), I don't see how they are a federal responsibility, as malpractice isn't generally a matter of federal law.

6.) Reform Medicare and Medicaid by creating accountability and choice. Today the two biggest public providers of health insurance are reactive regulators and paymasters for health services, not proactive managers responsible for improving health care quality and access while restraining costs. The key principle for Medicare and Medicaid reform is to make that change in role decisively, while giving beneficiaries real choices in health plans and access to services tailored to their individual health conditions, while making cost-conscious decisions.

There's a lot of vague glittering language in here, but no substance as to what it really entails.

7.) Create a National Cure Center to speed medical breakthroughs. Finding and deploying cures or effective treatments for widespread chronic diseases like diabetes could have an enormous impact on health care costs while saving lives and creating a healthier America. Congress should adopt Sen. Joe Lieberman's proposal to establish, within the Institutes of Health, a National Cure Center whose mission is to accelerate breakthrough medical research, and speed its implementation among medical practitioners.

That's a nice mission; how would it acheive it? But nice of the DLC to endorse Lieberman by name -- its almost as if this was part of his campaign effort. Really, this plank sounds like a better soundbite than substantive policy, and its not even a great soundbite.

Crap. Absolute, total crap. And not, as Kevin says, wonkish at all. I like wonkish. I live for wonkish. This is just crap, and largely looks like it was written by a combination of the RNC and the insurance industry (federalizing malpractice claims? Handouts to insurance companies? Vague plans for "choice" in Medicare and Medicaid?)

The DLC -- The Other Republican Party

Posted by: cmdicely on March 7, 2006 at 12:17 AM | PERMALINK
Strange, when the US spends the highest proportion of its budget on healthcare.

And, it should be added since the US budget is small compared to GDP, also the the largest proportion of its GDP.

Posted by: cmdicely on March 7, 2006 at 12:19 AM | PERMALINK

cmdicely: Damn, and I thought I was playing Mr Pedant today ;)

Enjoyed the grammar lesson on the previous thread, too...

Posted by: floopmeister on March 7, 2006 at 12:23 AM | PERMALINK

The real problem is that people of both parties want more health care than they are willing to pay for. Any reasonable health care debate has to start with the question - how much does it cost to provide health care for the average citizen? Truth about the real cost will guide us out of the current conundrum.

I really believe good basic health care could be provided if:

1. Basic health care consisted only of catastrophic care.
2. Catastrophic care had an agreed upon upper limit.
3. Things like regular check ups, regular dental visits, regular exams were paid for by cash. The old fashioned way.
4. People would stop fretting that the rich get better health care. Who cares??? Those who have money will always find a way to get better health care - let them do it on their own dime.
Concentrate more on giving a good basic level of service to all who can't afford the private doctors, rather than trying to make it "fair"!

Maybe then it would get support even from the right side of the aisle.

Posted by: John Hansen on March 7, 2006 at 12:25 AM | PERMALINK

The Dems should EMBRACE rationing, and just admit that it will happen.

Here's how: Each American, at birth, get 1000 hours of physician time, 30 days in the ER and drugs up to a given limit. Once you run out, you buy a policy to cover more. If you play sports for instance, you will buy a temporary policy to cover more.

At the end of your life, if you have had good health, you have a lot in the bank, and can prolong your life. If you have run out, you pay out of pocket, or take an assisted suicide pill.

A little cold I know, but it addresses the issue: it does not avoid rationing, but does make you think carefully about medical care.

Posted by: dataguy on March 7, 2006 at 12:26 AM | PERMALINK

"There's simply no way that the upper middle class and above will tolerate single payer."

I'm going out on a limb hear and saying that the upper middle class WILL approve of a single payer system (SPS) because it will boost their US stock holdings. The best part about this option is that US business is already asking for it. The first party to step up to the plate and say they support SPS to level the playing field for our old-line industries with Europe and Asia will win.

This is so obviously pro-business, the Republicans should be all over it, and if the Dems wait long enough it will be! If the Democrats don't come out with the strongest possible statement of support for SPS and universal care, it will leave the door open for the Repubs to come out stronger and take the issue away. Once they see that it is a winner with voters, they will!

This is not just pro-business (although that's enough). It is also very worker friendly, even at the UMC level. It means that every worker in America would no longer be tied to their employer by Health Insurance handcuffs. Who wouldn't vote for that? I believe there are tremendous implications for the workforce under such a program, too. But I'll leave that for another time.

Posted by: mezon on March 7, 2006 at 12:36 AM | PERMALINK

Up next: the real significance of a 6.5% current account deficit and the wonders of "free" trade!

Thank your lucky stars Kevin doesn't know anything about Doha accords.

Posted by: lib on March 7, 2006 at 12:37 AM | PERMALINK


Democrats, conversely, are still shell shocked over the events of 1994. That's understandable, but 1994 was over a decade ago.

Conventional wisdom has it that the GOP avalanche in '94 was driven by aversion to Hillarycare.

Not being one for conventional wisdom, and having been busy talking to a lot of wingnuts at the time, I would aver that the biggest single reason the GOP base turned out massively in 1994 was... gays in the military.

It's a profoundly irrational issue upon which to stake control of the Congress, but no one has ever plausibly accused the American electorate of rational conduct.

It was also a disastrously bad signature issue for Clinton to take up in his first term. Whenever I hear Democrats reminiscing about the Big Dog's supposed "political genius", I try to keep that particular clownish misstep in mind.

--

Posted by: marquer on March 7, 2006 at 12:48 AM | PERMALINK
Not being one for conventional wisdom, and having been busy talking to a lot of wingnuts at the time, I would aver that the biggest single reason the GOP base turned out massively in 1994 was... gays in the military.

I think the swingable middle was turned off by the infighting of the Democrats, and impressed by the appearance of principle and purpose in the Contract with America.

Gays in the military may have helped energize the Republican base I think a demobilized Democratic base and an impression by the middle that Democrats, particularly in Congress, couldn't get anything done and lacked vision really made the biggest difference.

And I think the DLCs main function has become to perpetuate that disadvantage.

Posted by: cmdicely on March 7, 2006 at 12:52 AM | PERMALINK

" I have a tough time believing that insurance companies wouldn't find a way to dump all the people who actually require medical care onto the government anyway, leaving themselves in the business of banking premiums and doing little else"

Mandatory insurance would hand a great deal of money to insurance companies, and there would be strings attached. We can't mandate insurance without also mandating coverage. It would probably have a fair amount of regulation.

"But calling it "insurance" when two people say "hurrah! we're pregnant!" seems daft. It's plain old medical care."

Exactly. We're talking insurance, not health care (I think John Hansen made a similar point).

We'd be paying for our own health care out of pocket, and it would be more than we currently pay. We'd become more cost conscious. And most of us would hate it.

However, Bush's current policies are pointing us in this direction anyway. I think if we started with some big tax incentives--remove the 7.5%basement on medical expenses, for example--and ensured that catastrophic coverage was comprehensive, it's at least a possibility.

Posted by: Cal on March 7, 2006 at 1:01 AM | PERMALINK

It's backing those progressive candidates Kevin, via funding, via talk, etc, that will allow us to put in power leaders and officials who don't have that fear and are able, honest and courageous enough to articulate universal healthcare as a goal.

Posted by: MNPundit on March 7, 2006 at 1:03 AM | PERMALINK

"And most of us would hate it. "

Correction: most of us would hate the idea of it. I don't think it's politically doable, because so many people expect a free ride through government subsidies of employer insurance.

The tax overhaul commission suggested taxing insurance premiums, and it's really too bad that the Bush administration didn't put this on the table. That would have been something worth arguing about, unlike Social Security private accounts.

Posted by: Cal on March 7, 2006 at 1:04 AM | PERMALINK

The idea of mandating insurance sounds logical, until you consider what happens to your car insurance premiums if you have an accident. Say you have a fender bender; your rates/premiums are likely to go up a couple of hundred bucks a year (at least mine did with USAA).

Now say there's mandatory health insurance. Then say you are suddenly diagnosed with diabetes. What happens to your insurance premium? Right. It goes up. A lot.

So then what? You still end up with uninsured people, just like there are uninsured motorists. But when the uninsured sick person goes into the hospital, you can't just tack a fine on like you would when the uninsured motorist is ticketed; the sick person's likely already pretty broke, or will be by the time he/she gets out of the hospital.

Better idea, please.

Posted by: Linkmeister on March 7, 2006 at 1:05 AM | PERMALINK

The easiest way to get universal health care is to write a bill that provides universal health care for children under 16.

Who can argue that children, who have no choice about whether their parents have health care and cannot get a job themselves, should not have health care?

Then, once this is passed, children will grow up under universal health care and will wonder why the system that works for them is being taken away. Parents will wonder why what's good for the kids isn't good enough for them.

Posted by: J on March 7, 2006 at 1:07 AM | PERMALINK

The reason that universal healthcare has failed in the past has been fear: fear of rationing, fear of lines, fear of bureaucracy. To win, we have to overcome that fear, and that's a public opinion campaign that will take years.

According to ABC News, it should take approximately -3 (yes, that's minus 3) years to get 62% of America to prefer universal health care coverage, even though most Americans are insured and most insured Americans are content with current costs and quality. If you don't have limited doctor choice (e.g., you go with an SB840-like plan which allows you to seek care from any licensed provider in the state) and you don't create government-managed waiting lists for routine care (which would not seem to be a feature of the SB840 plan, which relies on providers to handle scheduling, just as in the status quo), the public is already there.

All we need to be able to do is counter the insurance industry attempts to scare them out of what they already support.

Posted by: cmdicely on March 7, 2006 at 1:08 AM | PERMALINK

"Then say you are suddenly diagnosed with diabetes. What happens to your insurance premium? Right. It goes up. A lot."

Wrong. The insurance companies would be pretty heavily regulated--and even in car insurance, accidents don't necessarily increase your insurance.

And you wouldn't be able to be uninsured.

The idea would be to give people choice about their insurance based on what they could afford, with a basement and government protection for premiums in times of unemployment as well as subsidies for chronic health problems.

But those who are employed would pay a lot more for the health care that they enjoy now. Given that they enjoy it based on unequal government subsidies, that's fair. They won't think so, though.

Posted by: Cal on March 7, 2006 at 1:11 AM | PERMALINK

God bless ya, Kevin! Here's a what what!, a hallelujah!, and a word!

Please keep blogging about health care for the next three years.

The Dems need your wonkish insights on healthcare and we also need an issue that will bring you around as the real Democrats plunge the knife into the corrupt and feeble Lieberman wing of the party.

UHC is our major rallying cry, as well as real social security reform (i.e., reform that protects the program instead of destroying it).

Rock on, Kevin. Your fire is much appreciated.

Sean

Posted by: Sean on March 7, 2006 at 1:11 AM | PERMALINK

Now y'all are pissing me off. Just read this article about two-tiered health care systems and get back to me later:

Two-tier health care is a form of national health care system that is used in most developed countries. It is a system in which a guaranteed public health care system exists, but where a private system operates in parallel. The private system has the benefit of shorter waiting times and more luxurious treatment, but costs far more than the public one for patients. Thus there are two tiers of health care, one for the public at large and another for those who can afford to pay for better care.

Oh, and y'all make sure that you visit the Canadian and American health care systems compared page on Wikipedia as well.

Mandated insurance...Jesus. Get your collective heads out of you collective asses...

Posted by: grape_crush on March 7, 2006 at 1:12 AM | PERMALINK

We have mandated car insurance. And the accident rate is really high, what with everyone's head up their asses. Hard to see.

Posted by: Cal on March 7, 2006 at 1:15 AM | PERMALINK

grape_crush,

Why don't you ask one of the 45 million Americans without health insurances if there is a two-tier system of healthcare in the United States currently?

I'm sure those people choose to be uninsured, right?

Who's got their head up their ass again? You'll want some insurance for that...

Posted by: Sean on March 7, 2006 at 1:30 AM | PERMALINK

As a conservative Republican, I have to admit that the DLC plan, and Senator Clinton's health plan, deserve a look at. Drum is silly and immature not to recognize these realistic plans are more doable than silly pie-in-the-sky socialized medicine.

Posted by: TYmbrimi on March 7, 2006 at 1:58 AM | PERMALINK

Oh, and y'all make sure that you visit the Canadian and American health care systems compared page on Wikipedia as well.

Posted by: grape_crush on March 7, 2006 at 1:12 AM | PERMALINK

And read the big disputed banner.

Posted by: McA on March 7, 2006 at 1:58 AM | PERMALINK

Marie at 11:55 p.m. --

That was a very powerful comment. It certainly does help expose the fundamental perversity of the trolls who post here, with their relentless -- religious -- hatred of all things government. Thanks for sharing with us.

Posted by: Roger Keeling on March 7, 2006 at 2:30 AM | PERMALINK

What does single payer have to do with not being able to pay for what you want?

If what you need is paid for - annuals, checkups, emergency care...

...How does that stop you from getting teeth whitening, breast enhancement, melanin removal, etc?

Every time I step in to say, 'Hey, isn't your post also kinda long for the point?' there's someone whinging about something entirely tangental, irrelevent, or plain missing from the entry.

Sheesh.

Posted by: Crissa on March 7, 2006 at 4:47 AM | PERMALINK

We'd be paying for our own health care out of pocket, and it would be more than we currently pay. We'd become more cost conscious. And most of us would hate it.

We?

We who?

What percentage of the US is covered by private plans? (That, by the way, is smaller than the number who are 'insured')

Honestly, I pay out of the pocket, and 'cost conscious' is the last thing I want to hear from people when it comes to my health!

Posted by: Crissa on March 7, 2006 at 4:58 AM | PERMALINK

Re: http://en.wikipedia.org/wiki/Talk:Canadian_and_American_health_care_systems_compared

And read the big disputed banner. - Mc A

...Yeah, it seems to lead to seven complaints about the tone of the article, and only two complaints about verifying data.

None of the disputes actually... Disputes anything in the article. Which I would rather expect.

What, none of them could even bother to google up a contrary fact?

Posted by: Crissa on March 7, 2006 at 5:06 AM | PERMALINK

I wouldn't trade it for any NHS system I've seen anywhere in the world.

Anywhere in the world? The only place where you'll find an 'NHS system' is the UK. Try again.

Of course, if you really are a MD, you'll need your mouth stuffed with gold first.

Posted by: ahem on March 7, 2006 at 6:41 AM | PERMALINK

Check the pages of the Guardian, and you'll see that problems continue with waste, with under-funded, bankrupt health care units, and with timely treatment.

When the UK Tories did their policy review after losing in 2001, they went to lots of foreign countries to see what they could learn about healthcare.

They didn't bother going to the US, because the lessons are all too clear. And absolutely unacceptable for British voters.

If you were to start from scratch in Britain, you might introduce something akin to the French system. You certainly wouldn't introduce something akin to the American system.

Posted by: ahem on March 7, 2006 at 6:51 AM | PERMALINK

Boy, the DLC is exactly what gives Democrats a bad name. This plan they advance creates completely unnecessary wings of government for no reason at all. We do not need a national health care computer system -- it would be super expensive and take the place of one hospital calling another for a file or information.

Health courts? What idiot thought of this? The current court system does an excellent job of providing for torts inflicted by malpractice. Two things on this: As Kevin recently pointed out, the cost of insurance has nothing to do with health care litigation -- Second, as the Washington Monthly magazine pointed out recently, most lawsuits in America are filed by corporations, not individuals. The "health court" proposal is tantamount to saying that the Republicans are right -- we need tort reform. They are wrong and we do not.

A great deal of the DLC plan is just spending for spending sake, and the creation of needless bureaucracy -- just teh thing that gives Dems a bad name. When will be rid of the wonkish, useless, mealy-mouthed DLC?

Posted by: Tom Burka on March 7, 2006 at 6:57 AM | PERMALINK

> Americans are a lot more impatient than most
> Europeans. Try to foist a system on them that bans
> private practice, that causes substantial waiting
> for necessary procedures, and that makes every
> hospital look like the old County hospital, and
> you'll have a revolution -- and not the one you
> progressives want, either.

Can you provide some references to show that that is the situation in France and Germany? Becuase no one I know who has had occasion to use the health care system in those countries, including my American, German, and French co-workers, has reported anything like that. The UK, yes. Unhappiness in Canada, yes. That is why the model is Germany, not the UK.

Cranky

Posted by: Cranky Observer on March 7, 2006 at 7:00 AM | PERMALINK

For once, an incredibly complex problem has a simple answer that will work: extend Medicare and the Veterans healthcare system to cover everyone. They are successful and are extremely popular with their beneficiaries. Don't let the Republicans attack some incredibly complex system that no one understands: make them attack the healthcare plan that is loved by their parents and by their relatives who have served their country.

Posted by: xtalguy on March 7, 2006 at 8:09 AM | PERMALINK

Heres an even simpler answer to the complex problem of healthcare--

Americans should demand access to (and on the same terms) the healthcare plan that Congress has.
Its good enough for them why not us???
Sit back and watch their heads explode

Posted by: Larry on March 7, 2006 at 8:40 AM | PERMALINK

Want to watch heads explode? All you have to do is take out that lousy bit of social engineering via the Tax Code by which company paid insurance premiums are tax free to employees.

This is what supports our current system wherein $.25 of every 'health care' dollar goes directly to the insurance industry.

That passes the cost off to taxpayers as a whole and most particularly to taxpayers who do not have employer provided insurance. The non-insured subsidize the insured who then complain that those without insurance 'drive up costs' when in fact it's precisely the other way around.

Posted by: CFShep on March 7, 2006 at 8:59 AM | PERMALINK

Is universal healthcare the same as single-payer?

Posted by: John H. on March 7, 2006 at 9:01 AM | PERMALINK

CFShep.....Thanks....I never recognized that single fact for its cause and effect.

Posted by: Larry on March 7, 2006 at 9:13 AM | PERMALINK

Cal said: What's the point of making money if you can't pay for better care?

Um, buying iPods?

Posted by: Adam Piontek on March 7, 2006 at 9:19 AM | PERMALINK

Way too much wonking going on here.

For the average 'Merican, health insurance, and therefore health care, is dependent on employment.

The average 'Merican understands this, and knows that losing a job, or being unemployed for a stretch of time, means no health care.

Say to this average 'Merican that they can get health care apart from having a job. Tell him that he and his family will be covered, regardless of employment status.

Let the wonkosphere worry about the details of the plan. And consider that you can market universal health care as a boost to small businesses, by removing that burden from them. Hell, you can tell people, "this could be your chance to start your own business - the government is taking away a big f*ing expense."

But, at a f*ing mimimum, tell that average 'Merican guy that you are working on getting health care for him and his family.

Posted by: Lame Man on March 7, 2006 at 9:24 AM | PERMALINK

The Dems should EMBRACE rationing, and just admit that it will happen.

The GOP apologists should just admit that rationing is already happening, and in an enormously inefficient manner at that.

Posted by: Gregory on March 7, 2006 at 9:31 AM | PERMALINK

Rep. Jim McDermott has provided the talking points to shred Bushs idiotic HSA giveaway to the wealthy. Every Democrat should memorize it. We dont need a 7 point plan, we need a one-point plan universal health coverage for everyone, funded by repealing every one of Bushs tax cuts.

You bet its socialism! But, it sure beats the fascist plan Bush is proposing!!!

Posted by: Stephen Kriz on March 7, 2006 at 9:51 AM | PERMALINK

Cal on March 7, 2006 at 1:15 AM:

We have mandated car insurance.

Which is completely irrelevent, 'cause last time I checked, I'm not a car. If I get drunk and ram into you, you won't end up having to learn how to walk again. Also see craigie's earlier point on March 7, 2006 at 12:09 AM about getting insurance companies to sell to everyone.

Sean on March 7, 2006 at 1:30 AM:

Why don't you ask one of the 45 million Americans without health insurances if there is a two-tier system of healthcare in the United States currently?

Up until about a month ago, I was one of them. Actually, there is a nasty form of two-tier healtcare here in the US: Those who can afford to pay if they get sick and those who can afford to pray if they get sick.

I'm sure those people choose to be uninsured, right?

I didn't choose to be uninsured; COBRA is just too damn expensive...And I think you got the gist of my post wrong; instead of some cockamamie scheme like Universal Healthcare Vouchers (thanks, Kevin for subjecting me to that one) or mandated insurance, go with something that has been shown to work.

Who's got their head up their ass again?

I'd have to say that's you, Sean; a possible reaction to a severe knee-jerking episode.

McA on March 7, 2006 at 1:58 AM

And read the big disputed banner.

Apparently that's the only thing you did read...The article needs a little work, but it did survive a deletion vote (wasn't even close)...Accuracy and Non-Point Of View disputes are apparently fairly common things over at Wikipedia.

Posted by: grape_crush on March 7, 2006 at 9:55 AM | PERMALINK

@Alex

Speaking of the current account deficit and health care, Bill Gross's new column is pretty good.
http://www.pimco.com/LeftNav/Late+Breaking+Commentary/IO/2006/IO+March+2006.htm

Posted by: Zach on March 7, 2006 at 9:56 AM | PERMALINK

To the fears you listed, Kevin, add the fear of additional costs. People who are already paying for insurance - and that's a majority of people in this country - don't want to have to pay any more than they are paying now.

Posted by: DBL on March 7, 2006 at 10:02 AM | PERMALINK

What historic reasons are there for the health care system as it exists in the US today? Part of it comes out of an earlier need of corporations to bind workers, especially those workers that were costly to replace. It imposed a penalty on workers that quit. Even today, workers typically have to stay in place for X years for their pensions to vest and may even have to wait a few months before the health care kicks in.

Modern corporations in the US enjoy a good supply of non-union, highly fungible labor, so the number of persons that need to be tied to the firm is relatively smaller. It makes no sense to provide health care to fungible workers; indeed, some service-sector models such as Wal-Mart and MacDonald's already build the "churn" into their operating model.

The irony here is that earlier US companies benefited from the absence of universal health care because it gave them greater leverage in tying workers to them. Today the benefit from the savings from not funding health care through business models that limit the pool of core workers that need binding and rely on abundant low-skill labor supplies, either locally in services, or internationally (say, China or India) in the case of goods manufacture. The world has changed, but US companies still have no incentive to support universal health care.

Posted by: kostya on March 7, 2006 at 10:04 AM | PERMALINK

Hee! Last week you were saying Health Care reform was the one thing we could all agree upon, yes? Unfortunately, the only thing we can agree upon is that we don't like the current system. We don't all even dislike it for the same reasons, and we certainly don't all support the same fixes.

But you're right, this isn't a plan, it's a self-contradictory laundry list of interest group agendas.

Posted by: Boring on March 7, 2006 at 10:28 AM | PERMALINK

The GOP apologists should just admit that rationing is already happening
Of course it is Gregory. We're not the ones trying to lie to ourselves. Rationing happens in every system. Even socialized medicine.

All you have to do is convince the US voting public that having politicians doing the rationing is the best way to do rationing. Good luck.

Posted by: conspiracy nut on March 7, 2006 at 10:37 AM | PERMALINK

Right on, brother!

Posted by: hoipolloi on March 7, 2006 at 10:40 AM | PERMALINK

But you're right, this isn't a plan, it's a self-contradictory laundry list of interest group agendas.
Posted by: Boring

I concur.

Posted by: CFShep on March 7, 2006 at 10:43 AM | PERMALINK

While I personally have no huge problem with the concept of a universal coverage health care system, I think it will be very difficult to enact in America.

The goal we are trying to achieve is affordable health care coverage for everyone. I dont take it at face value that this cant be accomplished in the private sector (albeit via regulation that requires it).

What regulations you ask,
1) No cherry picking. There is one and only one pool of individuals. If youre an American (or you just live here) you can buy insurance regardless without regard to any pre-existing condition (this addresses the healthy people pay little while sick people pay a lot problem). As a corollary, if employers decide to provide insurance as a benefit, large employers will get no discount on premiums. We need to allow small businesses to be able to compete with Mega-Companies. If a Mega-Company decides to self-insure, the regulations must ensure they dont have an advantage over small businesses.
2) There is a basic coverage level that must be provided. Insurance companies would be allowed to sell-up for some additional/optional coverage.
3) The government would be involved as necessary to help individuals pay for the premiums as needed.
4) This is the key point, while Im no lover of the insurance industry, it wouldnt be fair (I cant believe I just used that word) to allow individuals to skate by without insurance waiting until they eventually needed it. To deal with this, I would REQUIRE EVERYONE to have insurance. If you own a car, you are required by law to have insurance. Its the same thing. For those who cant provide proof of health insurance at tax time, there would be a tax penalty that exceeds the normal cost of health insurance premiums. For those who are indigent and refuse to use the government aid to purchase the insurance, well, I cant see how wed be any worse off than we are now.

I realize that by REQUIREING people to purchase insurance its basically that same thing as TAXING but there is (I believe) a huge symbolic difference to people if we require them to purchase insurance from the private sector versus government providing health insurance.

Posted by: rmp on March 7, 2006 at 10:55 AM | PERMALINK

All you have to do is convince the US voting public that having politicians doing the rationing is the best way to do rationing.

which is easy:

"If you don't like the way your elected government official is rationing health care, you can vote him out of office. Can you do that to the CEO of Blue Cross/Blue Shield?"

Posted by: tam1MI on March 7, 2006 at 11:03 AM | PERMALINK
Apparently that's the only thing you did read...The article needs a little work, but it did survive a deletion vote (wasn't even close)...Accuracy and Non-Point Of View disputes are apparently fairly common things over at Wikipedia.

The article pretty clearly doesn't meet Wikipedia quality standards (particularly, quite a lot of the claims are subjective, not factual, unsourced, and unverifiable), and quite clearly has, at least POV problems.

That's clear on the face from reading the article, and more clear from reading the discussion page. Surviving a VfD doesn't mean that its a good reference, it means that its not absolute garbage that is only redeemable by blowing it away and starting over, or a subject inappropriate for an encyclopedia in the first place (though, actually, I'm surprised this particular comparison wasn't deleted for the latter reason.)

That's not to say that I disagree with anything in the article. But its clearly not a good source to point to as any kind of substantial reference.

Posted by: cmdicely on March 7, 2006 at 11:05 AM | PERMALINK

We have a society with two versions of the Right. Both used to understand that the Right is about helping the cake get big and making sure the less-advantaged have chance and opportunity to make it to the top. The Republicans have sulked since FDR because they did not notice he had persuaded the country that only the Democratic Party believed that premise.

The Republican Party absolutely has not the balls to do this, and sadly I expect the Dem Party does not, either.

Socialize health by taking responsibilty for sharing the cost away from private industry.

The Netherlands has, I believe, the most efficient healthcare system, SO................................
Hire the best Dutchman and team we can pay for:
set a limit on what the providers can charge:
set a limit as to the percentage of cost permitted for 'administration':
titivate around the Dutch and German choices.

In case readers do not know ----- "over there" in Europe, they have longer life expectancies, MUCH cheaper costs, faster turn-round times etc. etc. etc. Their healthcare is better than ours, all round, and costs their countries less than ours does. Oh, BTW, they really are developed countries, because their healthcare is Universal --- everyone has it!


Posted by: maunga on March 7, 2006 at 11:20 AM | PERMALINK

As Howard Dean said in '04, single-payer makes the most sense and would be the cheapest route, but people are too easily scared. So, expand Medicare, and offer people a plan essentially the same as what Congress gets. Everyone pays 7 percent of their income, and the start-up investment (follow Arnie's usage and distinguish between spending and investment) comes in under the first year costs of the war in Iraq, while paying dividends far into the future.
And where are the so-called Christians? Followers of the Way should know what it means to care for the less fortunate.

Posted by: Cassandro on March 7, 2006 at 11:24 AM | PERMALINK

A lot of insurance salesmen must be Democrats.

Posted by: deejaays on March 7, 2006 at 11:31 AM | PERMALINK

RMP's proposal is the same thing I suggested, and I agree. It makes the most sense.

"Want to watch heads explode? All you have to do is take out that lousy bit of social engineering via the Tax Code by which company paid insurance premiums are tax free to employees."

I mentioned that, as well. The tax overhaul commission did recommend it and the White House buried the idea quickly because heads would explode. Yet it's an excellent idea.

Posted by: Cal on March 7, 2006 at 11:50 AM | PERMALINK

The Democrats could have a good start if they would try to combine all present government run systems into one single system. That would be MEDICARE, MEDICAID, VA, Government employees and add health care for people earning up to lets say $80.000 for an affordable premium, including prescription drugs. The MEDICARE system already excists.

People earning more than $80.000 are willcome to take all the private insurance the want.Unemployed people should be covered for a small premium also.

The system should co-operate with all Dr. and hospitals. Families should have family physicians.


We can be sure the insurance industrie will fight it. I think it would be a good start.

Posted by: renate on March 7, 2006 at 12:07 PM | PERMALINK

sorry, i did not read all the comments and may have repeated some.

one thing, did anyone ever calculate the expense to our economy of NOT having a good healthcare system?

Posted by: Renate on March 7, 2006 at 12:26 PM | PERMALINK

I mentioned that, as well. The tax overhaul commission did recommend it and the White House buried the idea quickly because heads would explode. Yet it's an excellent idea.
Posted by: Cal

Indeed. It's the single largest tax expenditure, dwarfing even that other big middle class entitlement the mortgage deduction, and is also regressive as hell.

Posted by: CFShep on March 7, 2006 at 12:35 PM | PERMALINK

cmdicely on March 7, 2006 at 11:05 AM:

The article pretty clearly doesn't meet Wikipedia quality standards and quite clearly has, at least POV problems.

As noted in the comments, more essay-like than encyclopedic...'tho one commenter noted that it's hard not to sound like a cheerleader when comparing the two.

That's clear on the face from reading the article, and more clear from reading the discussion page.

POV is in the eye of the beholder.

Surviving a VfD doesn't mean that its a good reference,

Just that it's not an invalid reference, I understand.

(though, actually, I'm surprised this particular comparison wasn't deleted for the latter reason.)

That was debated...Wiki actually has several comparison-type entries.

But its clearly not a good source to point to as any kind of substantial reference.

Can anything on Wiki really be considered a 'substantial reference'? To me, Wikipedia is a good, quick reference that can lead to further exploration of a topic. If you are looking for something more all-encompassing and thoroughly vetted by all perspectives, good luck finding it...and finding it for the same price.

Don't let the perfect be the enemy of the good...

Posted by: grape_crush on March 7, 2006 at 12:35 PM | PERMALINK
Can anything on Wiki really be considered a 'substantial reference'?

Plenty of things on Wikipedia are fairly free of editorializing, verifiable, and well-sourced, which makes them reasonably good, at least as intermediate sources. The article at issue seems to fall short of that in several regards.

Its better than the average WSJ op-ed, though.

Posted by: cmdicely on March 7, 2006 at 12:45 PM | PERMALINK

"I really believe good basic health care could be provided if:

1. Basic health care consisted only of catastrophic care.
2. Catastrophic care had an agreed upon upper limit.
3. Things like regular check ups, regular dental visits, regular exams were paid for by cash. The old fashioned way.
..."

The problem with this is that healthcare doesn't work much like most products.

Giving everyone in the country free reccomended preventative care + catastrophic care is expected (by healthcare experts) to be cheaper than giving everyone in the country free catastrophic care. This is because earlier treatment for illness is vastly cheaper than later treatment. The current US system is fairly bad at providing early and preventative treatment which is the most effective kind both in terms of outcomes and cost, it is very good at focusing fantastic resources on a person who may die very soon anyway.

Posted by: jefff on March 7, 2006 at 1:13 PM | PERMALINK

cmdicely on March 7, 2006 at 12:45 PM:

Plenty of things on Wikipedia are fairly free of editorializing, verifiable, and well-sourced

Agree.

The article at issue seems to fall short of that in several regards.

Nah; if you look in the various comments, you'll see that the author hasn't verified a couple of his statements, and from a few points of view seems to be cheerleading the Canadian system...

Its better than the average WSJ op-ed, though.

Agree with that sentiment, disagree with the characterization of the reference as an op-ed (with the exception of that very first paragraph).

Understand that I added that reference because it does contain useful, verifiable information comparing health statistics in Canada and the US...

Posted by: grape_crush on March 7, 2006 at 1:34 PM | PERMALINK




 

 

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