As we all know, Joe Lieberman said he would veto any bill that includes Medicare buy-in or the public option. Citing data that shows that leaving people uninsured will result in over 150,000 extra deaths over 10 years, Ezra Klein responded that Lieberman is willing to cause 150,00 deaths to satisfy his desire for revenge on liberals.
Klein was right, give or take some thousands of lives. But that's going to make your head explode, twice.
A premise of this argument is that being uninsured can kill. That's one natural reason to want universal healthcare, obviously. But it's not a reason that progressives here and elsewhere have been emphasizing at all. The reason is that it conflicts with the biggest narrative of health care reform: that health insurers don't "add value," that they sell "crap insurance" which isn't real, and that they kill people with denials by the thousands (though I've never seen a statistic on this). I've argued numerous times that it is absurd to claim insurers don't add value: if they didn't add value, no one would bother to buy health insurance or worry that they don't have it. As for crap insurance and denials of necessary care (as opposed to unwarranted care), they are real phenomena, but at the margins of the industry and not the centerpiece.
This is not at all to defend the way our health care system works now, or health insurance in particular. Massive reform is essential. But a pillar of the argument for that reform on the left flies in the face of reality, a reality that we all accept when we aren't focused on scapegoating insurers.
Now, for the second head explosion: Howard Dean says that Democrats should not pass the health care reform bill if the public option and Medicare buy-in are not included. As per the Urban Institute, the same 150,000 people will die without universal healthcare over 10 years as they would in Lieberman's case. So, by the same logic, Howard Dean is apparently willing to cause the deaths of 150,000 people to satisfy his desire for revenge. In Dean's case, the revenge would be on health insurers and conservadems instead of liberals.
My guess is that most people at this point will want to defend Dean by saying that actually Ezra Klein was wrong, and that a better reform is around the corner. But the prospects for reform aren't any higher if the current bill fails because liberals reject it, or if the bill fails because moderates reject it. The number of deaths isn't any less, and failure to pass is failure to pass, regardless of your motives. If this compromised bill can't pass, how can a more uncompromising bill that attacks the heart of powerful special interests pass, as Dean wants?
Like a lot of people, the direction of this debate on health care reform has got me angry, so this is an angry diary. I've written very detailed, carefully sourced diaries supporting my point of view in the past, for those who are interested in a debate.
Final note: I do think Dean has an "out" that Lieberman didn't have. Dean is not in the Senate, so he can oppose the bill but he can't threaten to withhold his vote. I volunteered full time for Dean in 2003/04, and I have enough respect for him now to think that he may actually be doing a very clever feint: becoming the visible face of liberal disappointment and opposition to the latest compromise. Given Lieberman's determination to oppose anything liberals embrace, Dean may be the symbolic opposition to this compromise in an attempt to get Lieberman and others to accept it and not ask for other concessions. I hope that is what Dean is doing. As I wrote a few months ago:
I don't pretend to know whether the public option will be included in a final bill, or if it does whether it will pass or will mean universal health care fails to become law. I'm happy to use the public option to draw fire away from other critical aspects of reform. If it is included in a final bill and passes, and the public option hasn't been eviscerated in the process, that will be some brilliant maneuvering and a great accomplishment.
But if it passes, it almost certainly will be weakened to the point of irrelevance in the short term because, at this stage of the game, nothing that cuts deeply into the bloat in our $3 trillion health care system will pass. The entire industry, and not just insurers, will see to that. So it would be a tragedy, if it comes down to it, to refuse to compromise on the public option, leaving millions uninsured for the next 4, 8 or more years.
Coverage reform now with minor cost reforms. That will set the stage for major cost reforms in 2-4 years.