Editore"s Note
Tilting at Windmills

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May 22, 2007
By: Kevin Drum

HEALTHCARE NON-DEBATE....Mark Schmitt and Jon Cohn are genteelly arguing about whether presidential candidates ought to release detailed healthcare plans during their campaigns. Jon says yes, Mark says no. Look what happened to Bill Bradley's healthcare plan, after all.

I am, roughly speaking, on Mark's side. Phone book plans are worthless at best, and probably even counterproductive in most cases. But then again, it turns out that Jon agrees. It's all a matter of what you mean by "detailed plan." This becomes clear when Mark describes what he does want to hear from a candidate:

Are they willing to challenge insurers? Are they willing to challenge those elements of the business lobby that will resist higher taxes or an employer mandate? Indeed, the key to health care is not designing the system, but figuring out what fights to pick and how to win them.

Jon follows up with this:

The basics will suffice. When you say universal coverage, do you mean everybody? If so, by when? Roughly what level of benefits do you consider adequate? Do you want to blow up the whole health care system or simply find a way to patch the holes in coverage? If it's the former, do you intend to create a single-payer system or craft a system that relies heavily on private insurance? If it's the latter, how do you intend to pay for your plan, since it probably won't save enough money to cover the extension of coverage?

It's hard to see a lot of daylight here. On Mark's side, I suspect that the questions he wants answered actually require a moderate amount of detail to answer. On Jon's side, it's obvious that this moderate amount of detail is roughly what he wants too. Kumbaya, brothers!

But I will say one thing: Details may not be all that important, but strong convictions are. Ronald Reagan might not have issued a 200-page tax plan during his campaign, but there was never the slightest question what he was going to try to do with taxes. Likewise, I don't need to know precisely which model of national healthcare a candidate supports, but I need to at least hear a strong dedication to the proposition that not one single person should ever find themselves without health insurance. After all, the public will never support this unless someone leads the way.

And I'll also repeat what I said earlier about Barack Obama: If you decide to go the generalities route, that's fine. But if you do offer details, they better be good ones. You can't have it both ways.

Kevin Drum 1:05 PM Permalink | Trackbacks | Comments (34)

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Comments

I like candidates who can make their case with broad strokes, and distrust mightily those who can't.

Here's an easy formulation: Single Payer. Alternatively, Medicare for All.

Not exactly a lot of detail, but it says just about everything you might want, and in a way voters can be made to understand.

Bold strokes are clear strokes. Details are for those who refuse to think big.

Posted by: frankly0 on May 22, 2007 at 1:16 PM | PERMALINK

If the candidate will aacknowledge that there is a problem, and commit to solve it, I'd be content to leave the details (and necessary political compromises)to later.

Right now, the people running the country think the biggest problem with health care is that we have too much insurance, and resulting "moral hazard." The first priority is a president who rejects that lunacy.

Posted by: rea on May 22, 2007 at 1:20 PM | PERMALINK

I agree with frankly0 and disagree with rea. Until a candidate at least gives a broad-brush picture of the solution, it isn't at all clear that s/he perceives the same problem(s) as the rest of us.

So I'm for some sort of skeletal outline of a solution. I don't need to see what color the tail feathers are, but I need to at least be able to see that it while it might or might not be a parrot, it's definitely not one of the Budweiser Clydesdales.

Posted by: low-tech cyclist (formerly RT) on May 22, 2007 at 1:25 PM | PERMALINK

We are going to need some bigass health care in the U.S. of A., since Bush is secretly surging up tp 200,000 soldiers into Iraq. The wounded will be coming home in droves soon.

There will be a "surge" soon in the number of blind, crippled amputees in the American health care system soon, thanks to George!!!

Posted by: The Conservative Deflator on May 22, 2007 at 1:27 PM | PERMALINK

Presidents don't get to enact detailed proposals. They go through Congress over an extended period, and they get amended.

Presidents can, however, commit to principles and can start with the skeleton of a plan. The principle should be that every American is covered, period. There are many differing successful models to choose from; the Canadian system is only one example.

And politicians should have the guts to make enemies. The insurance industry is, literally, killing us ("murder by spreadsheet"). The head of my company's insurance provider is a self-made billionaire, meaning that he, personally, extracted over one billion dollars from premiums paid by his company's customers, and managed to put them into his own pocket instead of using them to pay doctors, hospitals, or drug companies.

We need someone with the guts to call a robber baron a robber baron. He or she will be accused of engaging in "class warfare" or "the politics of envy". Big deal.

Posted by: Joe Buck on May 22, 2007 at 1:34 PM | PERMALINK

This is essentially an ideology question.

Are they willing to stand up to the Insurance industry?

Or are they going to stand up FOR the Insurance industry?

It's an important question that each candidate MUST clearly answer, in order to honestly convey his or her intent on this matter.

I guarantee - not one single one of the top names is willing to clearly state this. Not a single one.

Posted by: osama_been_forgotten on May 22, 2007 at 1:38 PM | PERMALINK

Broad brush strokes would be fine by me. Along with attacks on any one who brings up the "do you want a government bureaucrat deciding" canard. After all, we wouldn't want to interfere with the private bureaucrat that denied a claim from a surgeon who reattached an arm that had been severed by a broken mirror. The insurance company wanted proof of medical necessity. For an arm.

Posted by: Tigershark on May 22, 2007 at 1:41 PM | PERMALINK

Kevin wrote -- ". . . I need to at least hear a strong dedication to the proposition that not one single person should ever find themselves without health insurance."

People need health care, not health insurance. The only reason the masses of uninsured in the U.S. are such an issue is that the healthcare system is set up so that most providers are paid by insurance companies. But it doesn't have to be that way. Access to health care is the key phrase that all candidates should be spouting.

Posted by: paul on May 22, 2007 at 1:44 PM | PERMALINK

Osma_been_forgotten:
Now you're talking about one of the secret, un-elected governments here in the fifty. The right person could name quite a few.

Posted by: slanted tom on May 22, 2007 at 1:46 PM | PERMALINK

I have an idea: other developed nations were not granted health care plans by divine fiat; those programs had to be crafted by democratically elected leaders at some point in the past too. (Germany, as we all know, was an exception; Japan and the Republic of Korea are too, although in different ways).

How did Aneurin Bevan create the NHS in the UK? How about PM Diefenbaker in Canada (back in 1957)? Diefenbaker was a Tory, I might add. In Canada, the process began with Saskatchewan's own provincial plan, spread to BC (both '46), then took a few years before going national. Did Diefenbaker campaign on this issue?

(Yes, I am aware of the fact that PMs are different from presidents and don't campaign in the same sense.)

Posted by: James R MacLean on May 22, 2007 at 1:46 PM | PERMALINK

The idea I had was to examine the political process by which those plans were created.

Incidently, see this post (Washington Monthly) referring to Ezra Klein's post on comparative systems; see also this one (Washington Monthly).

Both have excellent discussion threads, in addition to linking to very good initial articles.

Posted by: James R MacLean on May 22, 2007 at 1:53 PM | PERMALINK

I really wish a new Democratic President would by executive order open Medicare (just as it is) to everyone. And tell Congress to figure out how to pay for it.

Pre-emptive health care for everyone. Sort of like how we went to war.

We need a lot more than that -- but it would be a hell of a lot better than what we've got.

Posted by: katiebird on May 22, 2007 at 1:53 PM | PERMALINK

I agree with frankly0. If a candidate gets mired in low-level details it gives the opponents the chance to nit-pick some tangential point that isn't really crucial to the overall proposal. And the low-level details aren't going to survive the legislative process intact anyway.

I'd even rather it be stated in terms of the outcome that is the goal, rather than a particular mechanism like "single payer," along with a clear explanation for why that should be our goal.

In other words, the model should be more like Kennedy's goal of putting a man on the moon. He made a case for why it should be a national goal, and it had a clear outcome (put a man on the moon and bring him home safely), but he didn't try to stake out a position on solid fuel boosters vs. liquid fuel boosters or anything like that.

The candidate should try to keep the debate away from those details. The debate should be about what to do: provide basic healthcare to all Americans.

And about why we must do it: our infant mortality rate is shameful, it is shameful that Americans die for lack of basic healthcare simply because there's no profit in providing that care, and it's shameful that the profit motive not only denies that basic healthcare to many hard-working Americans but also provides the care it provides in a monstrously inefficient fashion.

Posted by: bob0 on May 22, 2007 at 1:57 PM | PERMALINK

HC? , how bout a candidate that can articulate a plan to get us off oil and into alternative fuels so we can detach from the ME and let them have thier fun? As a corp worker with good HC, I don't have issues, but as a scho pumping $4 gas in my SUV, I'm feeling the pinch. Crickets, chrickets, just as I thought.

Posted by: The fake fake AL on May 22, 2007 at 2:02 PM | PERMALINK

Katiebird:

It can't be by executive order, but Lawrence O'Donnell once said that all Congress has to do is pass a law changing one line in Title 42. The age at which one becomes eligible for Medicare.

Posted by: Tigershark on May 22, 2007 at 2:06 PM | PERMALINK

The thing is that the good plans are all simple. Taxpayer-funded universal health care with a single payer. The only tricky parts are elective operations.

The details all arise from essentially telling the insurance companies and big Pharma that the party is over, and we want to have health care like the rest of OECD. Better care at half the price.

Posted by: jayackroyd on May 22, 2007 at 2:07 PM | PERMALINK

But I will say one thing: Details may not be all that important, but strong convictions are. Ronald Reagan might not have issued a 200-page tax plan during his campaign, but there was never the slightest question what he was going to try to do with taxes.

I want to hear some details--enough to indicate seriousness. But even more, and certainly first, I want to be convinced that any of these people's convictions on this topic are as strong as they should be. As others here have noted, we need somebody who's willing to make an enemy of the insurance industry. We haven't even begun to see a sign of that yet.

After all, the public will never support this unless someone leads the way.

This is one place where the electorate is out way ahead of elected officials. A solid majority of Americans supports universal health care. It's not the "public" we need to convince--it's the candidates who are going to need the stones to stand up to insurance, pharma, etc., as well as the minority of voters who like things just fine the way they are.

I just lost an extremely dear friend at least partly because he was temporarily without health insurance for the first time in his adult life, and was terrified of losing everything he had to unpaid medical bills. He made some bad decisions to delay some types of medical care for this reason--bad but understandable.

I am operating on high emotion at the moment and I'm okay with that. Change apparently will not come until enough people are thoroughly emotional--and thoroughly pissed off about 1 in 6 (then 1 in 5, 1 in 4, 1 in 3...) uninsured Americans, scores of millions more whose insurance runs out or refuses to pay, lack of preventive care ballooning into health crises, lost homes and life savings....and on and on and on. These stories aren't rare exceptions to the rule. These things happen every day to people just like everyone reading this blog. And I have fucking had enough of this. You?

Posted by: shortstop on May 22, 2007 at 2:08 PM | PERMALINK

As a corp worker with good HC, I don't have issues

Really? You mean your contribution hasn't gone up every year? Your copays haven't risen? You haven't found that you couldn't get the drugs your doctor prescribed because the insurance company disallowed the quantity? You haven't had a valid claim rejected?

IME, even people with coverage are getting an increasingly bad health care experience.

Posted by: jayackroyd on May 22, 2007 at 2:18 PM | PERMALINK

Kevin, you're misreading Mark's article. He says that the important thing is what fights a politician is willing to pick, but he clearly says that politicians should not be telling us about this until after they are elected. Just look at the two sentences after the ones you quoted:

"But it is folly to pick those fights before one is in a position to win them. A candidate is powerless; a president powerful."

He goes on to describe how we can't know the nature of the fight until after the election, and that you should first try to attract the support of groups like big business and only pick fights with them if after it becomes clear that you can't win their support (that is, after the election).

Posted by: anon on May 22, 2007 at 2:31 PM | PERMALINK

"I like candidates who can make their case with broad strokes, and distrust mightily those who can't.

Here's an easy formulation: Single Payer. Alternatively, Medicare for All."

Posted by: frankly0 on May 22, 2007 at 1:16 PM

Agree with the concept and the solution. Keep it simple. Look what happened to the EU "constitution". Way too wordy. People don't want a fucking encyclopedia. Policital Poetry is needed now more than ever.

Posted by: Doc at the Radar Station on May 22, 2007 at 2:32 PM | PERMALINK
Agree with the concept and the solution. Keep it simple. Look what happened to the EU "constitution". Way too wordy. People don't want a fucking encyclopedia. Policital Poetry is needed now more than ever.

Yeah, but...

Clinton's healthcare idea was popular at the slogan level, but the vested interests it threatened got ahead of the debate on the implementation and destroyed it.

Which is why I think that, yeah, slogans are nice, but I'm not going to have a lot of faith in any candidate being able to deliver unless they can demonstrate that they can get ahead and sell the public on more than the highest-level slogans.

I don't want a candidate who would like to have universal healthcare, I want one who can deliver.

Posted by: cmdicely on May 22, 2007 at 2:39 PM | PERMALINK

Health care is a huge strength for Romney. The other candidates can only talk about it. He actually implemented a universal health care plan in Mass.

Posted by: ex-liberal on May 22, 2007 at 2:40 PM | PERMALINK

Health care is a huge strength for Romney. The other candidates can only talk about it. He actually implemented a universal health care plan in Mass.

Posted by: ex-liberal on May 22, 2007 at 2:40 PM | PERMALINK

Yes, ex-, but the real question is;
Under Romney's plan, will all three of my wives be covered on my policy? Or just my first? And will my third wife, who is 13, also be covered under her fathers policy?

Posted by: osama_been_forgotten on May 22, 2007 at 2:45 PM | PERMALINK

Tigershark, changing that one line would work for me too. I mean all these other plans are great. But they never happen. And I'm afraid they never will.

But, if we just change that one line, we can gradually add to what is covered or refine how it is managed.

In the meantime, everyone would be covered at least to the extent that senior citizens are covered now.

Posted by: katiebird on May 22, 2007 at 3:19 PM | PERMALINK

osama_been_forgotten wrote: Yes, ex-, but the real question is;
Under Romney's plan, will all three of my wives be covered on my policy? Or just my first? And will my third wife, who is 13, also be covered under her fathers policy?

Why is bigotry against Mormons acceptible in polite company? Kevin would delete a comparable comment about Muslims or Catholics or Jews. Or about African Americans or Hispanics. It's most unlikely that any poster would be gauche enough to commit such an infraction against good taste.

Why is it OK to attack Romney's religion? I think the answer is that when it comes to attacking Republicans, anything goes. If o_b_f had posted the same comment about Harry Reid, s/he would have been prooperly chastised. But, insulting Clarence Thomas's intelligence is no problem. Attacking Condolleezza Rice's guessed-at lesbianism is no problem. Conservatives deserve whatever they get!

In short, for many liberals, defeating conservatives and feeling superior to them are more important than the liberal principles of behavior that they espouse.

Posted by: ex-liberal on May 22, 2007 at 5:32 PM | PERMALINK

Why is it OK to attack Romney's religion? I think the answer is that when it comes to attacking Republicans, anything goes. If o_b_f had posted the same comment about Harry Reid, s/he would have been prooperly chastised. But, insulting Clarence Thomas's intelligence is no problem. Attacking Condolleezza Rice's guessed-at lesbianism is no problem. Conservatives deserve whatever they get!

What planet do you live on? Because on earth, where I live, it's a routine component of rightwing political discourse to make ad hominem attacks. In fact, Romney's main obstacle to getting the GOP nomination will, in fact, be conservative attacks on his Mormon faith. Seriously.

Ever heard of Amanda Marcotte? The allegedly anti-Catholic Roman Catholic blogger who resigned from the Edwards Campaign? Guess who led the foaming-at-the-mouth brigade? William Donahue, a fanatic of Hogarthian proportions. Never mind the fact that the Roman Catholic hierarchy and the patriarchy of the Latter Day Saints are potent political actors.

And Islam? It's almost de rigeur to spew slander about it. The stupidest and most ignorant fucktards have a monopoly on discourse on the subject. It's a disgrace.

I could go on, but seriously, there's a reason people are rather acerbic when you say things like this.

Jokes about polygamy in the LDS? OK, if one wants to be nasty, how about its exclusion of African Americans to 1971? Or non-Morman parents at wedding ceremonies? Being a human imposes a certain decent consideration for the opinions of mankind. If someone violates those, ribbing will follow. At best.

Posted by: James R MacLean on May 22, 2007 at 6:58 PM | PERMALINK

On this issue, I would be unusually demanding. Tell us where you want to take us - and tell us what the obstacles are and how you mean to navigate around them.

The alternative is at best nebulous good intention without good prospects ... just another go-round, and another 10 or 15 years to recover our courage and try again.

The alternative at worst is deepening our investment in the obstacles themselves.

Posted by: RonK, Seattle on May 22, 2007 at 7:03 PM | PERMALINK

Look what happened to the EU "constitution". Way too wordy. People don't want a fucking encyclopedia. Policital Poetry is needed now more than ever.

The problem with the EU constitution was that it proposed to entrench the neoliberal political climate that was momentarily holding the reins of power. The political left in Europe stumbled, coalitions split, and the right suddenly pops up and says, "Let's make this state of affairs everlasting."

Constitutions are supposed to provide a framework for political action, not a straitjacket for all future time. The proposed EU constitution sought to settle every political decision forever and enshrine that decision in a constition. That's why the French and the Dutch electorate opposed it,not because it was "wordy."

Posted by: James R MacLean on May 22, 2007 at 7:05 PM | PERMALINK

Hey Kevin,

You're a smart guy. So, could you please begin to differentiate between candidate's "healthcare" plans, which is what your wrote your post was about, and "healthcare insurance" plans?

Part of the HUGE problem with this issue is that the average Joe *likes* our healthcare system - doctors, hospitals, etc., but abhors our heathcare insurance.

If pundits, bloggers, politicians, and technical experts don't start talking about universal insurance we will never solve this issue, I think.

People I talk to really think that lefties want to somehow federalize all the healthcare in the country, when all we really want to do is extend Medicare to everyone down to age zero. When you put it like that to people they get it - immediately.

Keep it simple and clear.

Posted by: rc on May 22, 2007 at 7:20 PM | PERMALINK

Basically what has to happen is that the smart money becomes convinced that the party is over and we won't let the private insurance industry feed off our healthcare needs any more. When the smart money has moved out of the healthcare insurance sector, they won't oppose universal single-payer any more.

In order to do that we need to hammer the public with the basic facts- we pay 5% more of our GDP for less coverage with worse outcomes. We need to get as smart as Europe, and that probably starts by booting private insurers into a strictly auxiliary role.

When anybody asks how we do that, we just say, well if they can do it, we can do it- we're not that dumb.

What the Democrats will do in legislatures is pass laws that require everyone to buy insurance and provide some financial help to the poor. Republicans will be happy to vote for plans that shower private insurance companies with windfall profits.

I dunno, maybe we are that dumb.

Remember, we don't elect leaders, we elect representatives.

Posted by: serial catowner on May 22, 2007 at 7:54 PM | PERMALINK
Bold strokes are clear strokes. Details are for those who refuse to think big. Posted by: frankly0 on May 22, 2007 at 1:16 PM

Sorry frankly0, but I have to vehemently disagree.

In fact, I'll go as far as to say that's a load of unmitigated bullshit.

"Bold strokes" are soundbites. Semantic empty calories for empty minds to munch on.

The devils in the details, if you don't have the details then you don't have a plan.

And without a plan, your useless.

Because you can't fix anything without a blueprint and soundbites aren't blueprints, their marketing tools.

Posted by: Dr. Morpheus on May 22, 2007 at 10:44 PM | PERMALINK

National security, the economy and health care will be important issues in the 2008 elections, no doubt, but thanks to Republican stubborness on prolonging the Iraq War, the war alone will continue to be Issue No. 1.

And, folks, if you believe the self-serving media and thus feel the enormous increase in the price of gasoline at the pump is not hurting and hurting badly, you have another think coming. The bills are just starting to come in and already it's shaping up to be an out-and-out disaster.

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