Tonight I had the displeasure of watching on C-SPAN a broadcast from the "Center for American Progress Action" where Senator Baucus spoke to a small crowd followed by questions and a panel of experts on healthcare (Norm Ornstein, Karen Tumulty of Time Magazine, and Paul Begala, moderated by a professor of public policy from Georgetown whose name escapes me right now). It was very depressing to watch for a physician who works for single-payer and really for anyone who cares about how our political system works.
More beyond the jump.
Senator Baucus' speech actually included a refusal to take the "public option" off the table (right now anyway), which was a bit more than I expected from him. Having said that, he spent a good portion of his speech reassuring the audience that everybody, including the insurance companies, needed to be included in whatever final compromise was made, for sure including the insurance companies and the Republicans, and definitely don't forget the insurance companies have to be included. (You get the idea.) I won't go into his borderline inability to even read his speech; it actually occurred to me that perhaps he is struggling with some kind of medical issue himself. There was a fair amount of mouth-time spent on "keeping costs down"; good luck with that if you have the same fubar system we have now, just bigger. He also spent a good portion of time discussing the complexity of the problems of the health system and how difficult it is to fit all the moving parts together in a reform, which is actually sort of true. However, I felt that he spent very little time discussing what the best system imaginable might look like; that appeared to be much less important than how politically to get to a reformed state.
The expert panel afterward was perhaps even more infuriating. The panelists concerned themselves essentially the entire time with the poticial process by which a reform might happen, without commenting very much on what type of reform would actually have value and would work over the long run.
A facet of this discussion that came up repeatedly that I have not previously focused on is the idea that we need a "uniquely American solution" to the health care crisis. Baucus, the panelists, and several days ago Atul Gawande in the New Yorker have espoused this "need". First, this strikes me as utterly grandiose, the idea that we can and must develop some kind of unique solution that doesn't borrow from the experiences of other countries. Nonsense! We have models all around the world that work. Let's steal one from somewhere else, or parts from different ones. Hell, we already have working in our country right now some models for universal health care that are pretty similar to other countries (the VA system and Medicare). This demand for a "uniquely American solution" strikes me as an attempt to place the solution to our problems farther away and prevent the inevitable confrontation with the insurance industry.
Painfully, the expert panel seemed to basically agree that the "public option" was only being kept on the table for now as a bargaining chip, and that it would be bargained away at the last moment to get buy-in from one or another group, either the Republicans or the insurance companies. I support single-payer as the best option, but I can see that a good public option has at least the chance of forcing reform. Without at least that public option, I feel pretty sure that any "reform" will not be real at all, but will be vaporware that leaves us all poorer and with many not getting care or going broke.
One panelist (Tumulty) noted that she had covered Hilary Clinton's campaign and that at every stop Mrs. Clinton had outlined different types of health plans and asked people to raise hands for those they supported. Ms. Tumulty said that at every stop a majority of hands went up for single-payer. (This is in keeping with the 2003 Washington Post/ABC News poll of US citizens that found majority support for a single-payer system.) However, this was treated as a curiousity, not something that demanded action from elected officials.
One questioner from the audience was a "physician who had stopped practicing in order to work on health care reform". She pointed out that elected officials seem completely unwilling to respond to the obvious demand on the part of the populace for massive reform, such as single-payer solution, as evidenced in part by the story about the Clinton campaign. This woman got no significant answer from these "experts" on this central question. I mean, words came out of their mouths, but the words did not address the question directly at all. There was a brief shot of the woman as they answered, who appeared mildly distressed as she realized they had no intention of actually answering her question.
In fact, the most egregious aspect of the whole thing is that none of these people from Washington (Senator Baucus or the experts on the panel) appear to have any particular concern about doing what will actually help people or enacting a durable solution or even representing the desires of their constituents. The only concern appears to be to "get something done while the moment is hot".
Sad.
If I could speak to these people in Washington and the others getting ready to make these new reforms, I would say: guys, you can use any of the universal health care systems in the world as a model, or you can try to make up your own, but it is going to come down to confronting and controlling or minimizing or eliminating the private health insurance industry. You can do it now, or you can face the same question again 15 more years down the road. You can't go over it, you can't go under it, you can't go around it, you must go through it. It will be painful and hard, but just frakkin' do it, because people are dying and being hurt by the system as it is, and you should understand that blood is on your hands if you fail in this.
I'm going to sleep for a couple of hours, but will be back to respond to comments.