No you can’t always get what you want
But if you try some time, you might find
You get what you need. -
The Rolling Stones
So several times in the past two weeks, when the topic of health care reform is broached, my conservative family and friends have offered some familiar personal advice:
“You, [Strawman Blogger], are just another socialist.”
Now, I take no offense. If there’s one thing your intrepid blogger enjoys, its being considerately labeled a no-good-red-commie-Mao-loving-Trotskyite. But unlike that time we were caught with the minister’s daughter, these allegations are without a shred of truth. So very shortly, and with damning finality, I shall clear my name.
But before I begin, we need to know what the bill is. And for that, we’ll need a shorter version of the bill in question. If only I had one lying around …
The Awful, Terrible, No Good Socialist Health Care Proposal: A Shorter Version
So this is how the bill works:
Each state sets up an exchange, where individuals who are uninsured (or uninsurable) are allowed to buy insurance from private companies, such as the ever-caring Blue Cross/Blue Shield. The individuals benefit from purchasing insurance at cheap group rates, and the insurers benefit from access to new customers.
In order to be listed on the exchanges, insurers have to meet some minimum qualifications. They have to qualify in price – their policies must be cheap enough. And they have to qualify in quality – they have to provide a basic level of health care service. In return, individuals are allowed to rate their level of satisfaction with their insurance, and these ratings must be made public by the insurers – the community rating system.
But what does the government do? In short, not much. The government provides subsidies to purchase insurance to the mostly poor (people earning up to about 300% the federal poverty line, or around $32,000 for an individual). They also help set up the exchanges.
But, as far as reform goes, that’s it. The government doesn’t employ any doctors, and they don’t tell you what policy to buy. And they don’t insure a single person.
If this all seems terribly conservative, well, it is. It’s so conservative that it’s basically identical to the proposals endorsed by Bob Dole and Tom Daschle. It’s so conservative that some basic elements, like a selling insurance across state lines, were suggested by McCain on the campaign trail. It’s vastly more conservative than the health-care plan advanced by Richard Nixon, and it’s conservative in part because over 160 amendments were accepted from Republicans in the Senate HELP committee.
A Brief, Irritated Aside
Oh. And the end-of-life counseling provision, the late and unlamented father of the death panel rumours? It was included in the GOP’s 2003 Medicare prescription drug bill.
And Back to Our Original Point
So I hope you can understand the uncomfortable position of your Strawman Blogger. Here I stand, accused of all types of nefarious socialism, for the crime of being slightly further to the right than Richard Nixon.
And we’ve sacrificed along the way. We’ve given up on the strong public option on a federal exchange, the federal exchange, the strong public option on a state exchange, the weak public option on a state exchange and, finally, the public option all together. We’ve given up stronger subsidies, on ending the employer-tax exclusion, on Medicare-for-all. We’ve given it all up in a hopeless effort to get a single Republican vote, and now have lost it all, all because a Massachusetts politician doesn’t see the value in shaking hands outside of Fenway Park.
And for this, you accuse me of being a socialist. For shame.
Back to the Future
So where does this leave us? It’s very simple.
Health care is broken. It’s broken enough that we spend 40% more than any other country, but rank 32nd in health outcomes. It’s broken enough that it will bankrupt the country by 2070. It is, in immortal words of Steven Pinkner, well and truly unsu-fucking-stainable.
Of course, if something cannot go on forever, it stops.
Solution #1 – Like Our Sex Life in High-School: We Do Nothing
This, ignorant louts that you are, is the option you’ve chosen. We continue merrily on our present course, while each year health care costs increase, and each year more and more people will be denied, or will be unable to afford, insurance. Eventually this will increase to the point where the system of private insurance will be, for all intents and purposes, broken.
Solution #2 – Like Our Sex Life in College: We Do Something, Anything, At All
There are options for fixing health insurance. Hell, we’re the only country who can’t do it right. We can squeeze insurers and providers with a public option. We can set up a risk-equalization pool. We can nationalize the whole bloody system. But these are all much, much more liberal than the proposal you’ve just rejected.
So this leaves me in a confused position – I am left defending a conservative health care proposal from the conservatives who invented it, when the status quo doesn’t work and all the other options are deeply, terribly more liberal.
Just what is your better idea?
