It seems like some of us might have "missed the memo". Health care reform is no longer even on the table. Just listen to the President: at issue is "health insurance reform". Health care reform is so 1993. The main point now is simply that everyone must have government-regulated health insurance. The progressive rallying cry is to allow us at least the option of buying it from the government.
But is health insurance really health care?
It turns out that it's a lot easier to achieve "universal health insurance" than it would be for universal health care. With health care you would have to actually provide it; with health insurance, you can just require everyone to buy it. In all of the back and forth about the public option, I've not seen any debate about "mandates", which is weird because during the Democratic primaries, it seemed like mandates were the only health care reform issue worth debating. I remember my candidate catching a lot of flak from Hillary Clinton and Paul Krugman for saying this:
“Their essential argument is the only way to get everybody covered is if the government forces you to buy health insurance. If you don’t buy it, then you’ll be penalized in some way. What I have said repeatedly is that the reason people don’t have health insurance isn’t because they don’t want it, it’s because they can’t afford it.”
-- Barack Obama, Nov. 24, 2007
I haven't heard Obama say anything even remotely like that lately. And while everyone seems to be in total agreement with respect to making everyone buy health insurance, no one at all seems to be interested in talking about how much people will have to pay for it. Controlling that, of course, would be "socialism", or at the very least "government price controls". But how much do you think health insurance premiums, already going up 20% a year, are going to be when we are required by law to purchase it, with no limit on the price?
Yes, I do realize that those of us who are "lucky" enough to be deemed sufficiently poor already will only be forced to pay what we can "afford", with the rest coming out of our tax dollars. In many cases, however, what we will be deemed able to afford will still be more than we're paying now, and "now" for a lot of us already involves trade-offs between food and rent, much less health care.
And yes, of course, I 100% agree that if we are to be forced into buying health insurance at whatever exorbitant rates the health insurance companies and the federal government deem appropriate, then the least that we should ask for is that any excess that we generate above and beyond our own needs be contributed to the public weal, as opposed to further lining the pockets of insurance company CEO's and shareholders in the process.
But will the public option reduce premiums, deductibles and co-pays? Will a co-op? It all seems to depend on what's actually written into the law, but clearly there every reason to doubt that either a public option or a co-op will be allowed to undercut private insurance.
Most fundamentally, however, are we really working from the assumption that having health insurance means that you'll get the health care that you need when that has never been the case in the past.
Even if HR3200, surely to be the progressive outlier amongst the various proposals, was enacted into law completely as is, would that be progressive? Am I really supposed to go out to a town hall meeting and scream and shout that I should be forced to buy health insurance at whatever price and quality industry and government deem appropriate?
I've tip'd and rec'd every single one of your and slinkerwink's diaries that I've come across, emailed my Congresswoman, written letters and comments to various entities, but I'm truly not seeing anything progressive being considered.
I'm not one of those purists who allege that Medicare-for-all is the only solution. I'd support that, but if the nation is not ready for Single Payer, then why not leave the for-profit health care sector in place as is, and instead focus on building and improving our public and nonprofit health care delivery systems that treat everyone regardless of insurance, and only recoup a fraction of their costs. Isn't it the proper role of progressive government to directly care for those who fall through the cracks in the private market by itself, as opposed to relying on the private sector to do so, at a profit?
Isn't that what most other countries that have universal health care do such as Britain with its National Health Service? Isn't that what we do for our own veterans through the Veteran's Health Administration? The point is that people should be guaranteed basic health care whether they can afford it or not. If the government is not going to automatically provide everyone with health insurance such as they do the over-65 with Medicare, then why not focus on providing quality health care whether or not people have health insurance.
There was a comment to slinkerwink's diary ealier today that asked a question that I'd like to also see answered:
Why do we need to change the way we deliver health insurance to 100% of all of America when the key point being pressed by the President is the need to deliver health insurance to the 15% of Americans who are uninsured?
I haven't seen a good answer to that question. I accept that forcing the private insurance market to provide (mostly) universal health care is one way to do it, but is it the best way?
An alternative proposal would be to stitch together all of the existing public and nonprofit medical facilities around the country into a public HMO similar to Kaiser or the VA that would automatically treat and enroll anyone who needed health care, regardless of whether they have insurance or not, and charge them only what they can afford. You could even start out revenue-neutral by simply formalizing all of the government-funded and/or un-reimbursed care that takes place today. You could just give everyone who comes in to our current public "system" a membership "card" for no other purpose other than keeping track of their medical records.
Is this even more socialistic than what's being proposed. Not necessarily. The 85% who currently have health insurance would not be affected unless they wanted to be. It would only affect those who for whatever reason don't want to or can't get what they need through the for-profit medical system. That would include the 15% who don't have insurance, and then maybe also a smaller number of others whose insurance proves inadequate to their needs. Rates and charges could be established strictly based on ability pay up until the "at cost" level was reached. But there would be no need for any new regulations on private insurers. That system could remain in place, untouched, for those who "like their current health care insurer" (who, by the way according to the polls, constitute the vast majority of those with health insurance).
A small tax on the for-profit sector could even be assessed to help build the quality of the public health system given the given the literally trillions of dollars that pass through their hands every year.
I just don't get it. Take care of the people who need it; leave the others alone. Copy what's been done successfully in other countries, and by ourselves with respect to veterans. It seems like good politics and good policy. Why are we forcing this huge bureaucratic system on everyone instead of just addressing the needs?