Democrats & Liberals Archives

Centrist (sensible) Health Care Ideas

The mislabeling of support for meaningful health care system reform as coming from “The Left” has reached epidemic levels in the United States. The conservatives of any other western democracy which enjoys universal, no hassle, coverage, must be puzzled by our political debate.

Single payer coverage which is the standard in many democracies, apparently is only supported by "the far left" if you believe the mainstream media, while even support for a very modest and watered down public option is decried as "Socialist" by the demagogues of right-wing radio.

The facts are otherwise. Both single-payer systems, and robust public options, draw support from thoughtful thinkers of many different political stripes from liberal to conservative. Anyone who has been screwed over by health insurance companies driven by Wall Street expectations instead of concern over the health of their customers might be on the single-payer bandwagon.

This whole debate and process has been pretty disappointing. Though I certainly don't know the whole of the various plans currently being considered, I fear my support is lukewarm at best. The ideological screaming from those who have either a vested interest in some piece of the current system, or a knee-jerk reaction against some element of an alternative hasn't helped.

The debate that I wish we would have, is an honest one about what our health care system ought to look like in 10 or 15 years - decide on that - and then figure out the transition. Those who want to implement a single payer system tomorrow, aren't being honest about the impact of putting 90% of the health insurance industry out of work in the middle of our low-employment crisis. Those who scream that any government run plan is tantamount to a takeover, are being dishonest and feeding hysteria, not real debate.

The key elements of the system I would like to see in place in 15 years are:

1) NOT employer based
2) 100% universal
3) massive reduction in paperwork
4) immediate and transparent access to medical records
5) incentives or mandates which keep pricing competitive
6) elimination of coverage dropping or denial based on pre-existing conditions

Number 6 we are going to get no matter how flawed whatever bill moves forward.

Number 5 is the biggest challenge in a single-payer system, but is clearly a huge problem in our current system as well.

Numbers 3 & 4 should be accomplished over time, by the industry itself, and charges that the current Medicare system is the biggest roadblock toward implementation, probably have merit.

The value and merit of number 2 should be obvious, but Republican, Libertarian, and insurance industry interests seem to be doing everything in their power to prevent it.

Number 1 is the unfortunate victim of a pragmatic concession by Obama and many Democrats, in an attempt to allay the fears of many currently covered by employers and afraid of change. Number 1 may have to wait, but we need to stop pretending that employer coverage is any kind of permanent answer.

What I would like to see is a healthy debate between supporters of a single-payer eventual solution, and some more libertarian, but serious, solution, such as that proposed by David Goldhill in a September Atlantic Monthly article. Goldhill's solution strikes me as overly reliant on middle class consumers being sensible about getting the necessary catastrophic coverage and planning for the added expenses of significant but non-catastrophic care. Given human nature, I'd rather see a public option for coverage which includes basic and preventative care, but perhaps an opt-out option for those who choose to get private catastrophic coverage, and pay their own way for everything else. Perhaps that pool of people could help create the market incentive for price competitiveness.

For all his rhetoric about "getting it done", I hope our President realizes that the bill he signs, whatever it may be, is really only Step 1.

Posted by Walker Willingham at October 8, 2009 10:49 AM
Comment #289046

Implementing a single payer system would be easy. Next year Medicare covers people 60 and older. The next year it goes down to 55 and so on. What would be hard to deal with are the corporations that are used to 20% more profit than last year. Their pool would shrink at the same speed.

Posted by: Mike the Cynic at October 8, 2009 5:49 PM
Comment #289104


I truly think a single payer system is the only system that has any real hope of reducing costs significantly. That is exactly why it cannot pass yet. Moneyed interests won’t surrender their cash cows easily.

It is my hope that whatever is passed, will cause the light to remain focused on how it is working. Ultimately, transparency is what will cause a single payer system to come about. Continued rising costs will focus more and more attention on the robber barons.

Posted by: gergle at October 9, 2009 11:34 PM
Comment #289215

Walker, I think there is a psychological difference between a sizable portion of Americans and the peoples in those other nations with universal health insurance underwritten by their government. Europe for example, was ravaged by the Italians and Germans in WWII, and Germans again in WW1. They now know the perils of each person or nation being on their own, and the enormous wisdom of strength through unity and interdependence.

In America, there is a significant minority who still believe in Old West rugged individualism, more a product of dime novels and Hollywood than the reality of collective strength demonstrated by Colonialists and the original 13 colonies ratifying the Constitution. They fear collective arrangements or co-dependent arrangements outside their nuclear or extended family, and focus like a laser on the costs of collective arrangements while discounting and dismissing the strengths and benefits.

Our corporations and media and a fair number of politicians and political pundits have learned how to exploit this minority to garner support for their corporation, media, or politics - which is why fear is always a basic ingredient to efforts by the powerful who happen to be in a minority position. Though corporations have also learned the strength of oligopolies (collective monopolism) when it serves their interests.

However, our national debt and failures to address long term challenges when they are still inexpensive and easier to solve years or decades ahead of time, are catching up to Americans, and the price is already extremely high and going to get a whole lot higher and far more personal, as the hold outs and secessionists make their last stand to oppose America catching up with those other nation’s wisdom and strengths, insisting any action which limits individual choice is too high a price to be paid regardless of the national and future benefit for the greater good of all.

We are facing a potential 20 trillion dollar national debt which is, as far as I can see, bankrupting of the nation. If the hold outs succeed in delaying and frustrating successful changes in the direction on a host of issues from health care costs to environmental protection to cheap sustainable renewable self-produced energy, our nation’s future will implode under the weight of these unsolved challenges and the costs of retaining our status quo approach until emergencies overwhelm us and our resources to deal with them.

Grasping this bigger picture is beyond either the time and energy resources or educational resources of far too many Americans, making them dupes for the special interests. Perfect example is the Health Insurance Industry’s bought and paid for research depicting current reform legislation as costing Americans a thousand to several thousand dollars more per year in premiums if passed. As many as 45% of Americans will latch hold of that clearly self-interested and biased so-called ‘research’ as ammunition to fight the very reforms they will individually desperately need in the years ahead to avoid their own bankruptcy or loss of family savings, or worse. And they will never realize they were duped into being pawns in the high stakes profits game of the oligopoly of private health insurers who have doubled customers premiums in the last 10 years and increased their profits by more than 400%. This speaks volumes about America’s education system and cries out for education reform louder than almost any other issue I know of. The difference between selfish and greed and enlightened self-interest is a Grand Canyon wide and deep. Yet, most Americans could not tell there is much difference between the terms at all.

Where would our nation be today if our educational system in every state and county required high school students to read and largely comprehend Adam Smith’s Theory of Moral Sentiments? I don’t think there is any doubt but we would be the preeminent nation on this earth in nearly every way and area of expertise and implementation.

Posted by: David R. Remer at October 12, 2009 3:13 PM
Comment #289269

While I generally agree that Americans are manipulated by the idea of individualism and the the insurance industry along with hospital corporations are abusing their role in society, I disagree this has it’s genesis in dime store novels.

The country’s founders managed a sophisticated campaign to manipulate the populace to rise up in revolt against the Royal British empire and the taxes they were levying.

The myth they created was the idea of a government of the people, when in fact what they created was a government of the elite. The ideas were big and bold, but also soon discovered to be a lie during the whiskey rebellion.

These ideas have taken hold in the American psyche and since the World War Two domination of the globe by the US, with rising expectations.

Now we find these ideas in conflict. Rising expectations require an efficiency that doesn’t exist in a democracy. We continue to be a global power looking for a means to continue our upward rise. When Manifest Destiny was used to annihilate the Native Americans and steal their land, as well as fight off the French, British and Spanish claims, the conflicts were relatively easy to extinguish. The domination of African Slaves died hard. As Germany found, global domination is a bit more tricky.

I don’t believe the Libertarians have it all wrong, but they don’t seem to be in touch with the reality of the American psyche.

Ceding power to government to gain efficiency in healthcare will increase government power over our lives. The truth is that the biggest value in American society is the freedom of speech. At this point in our nation we need large government to counter big business(echos of feudalism) interests. That doesn’t seem to be going so well, because of the myth of individualism. Americans generally don’t admit to the power grabs of Manifest Destiny and WWII. It doesn’t fit with their sense of rugged individuals who are led by small government. We aren’t. We haven’t been in a long time. Waking up to that fact is necessary to see realistic solutions to our problems, and may deflate the arrogance of America’s self image. Which politician is going to lead that charge?

Posted by: gergle at October 13, 2009 9:51 AM
Comment #289986

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Posted by: Gary Gao at October 29, 2009 4:00 AM
Comment #290435

Harvard completed a study which said around 50,000 people a year choose to die rather than run up huge medical bills and ruin their families financially.
That is the only fact we need in our arsenal.

Posted by: Brian at November 7, 2009 9:00 PM
Comment #309820

What about allowing insurance companies to compete across state lines? That to me seems just obvious. I don’t see how it could be controversial, even if it perhaps is poison to a few politicians.

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Posted by: Miki at October 6, 2010 2:27 PM
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