From this morning's
NYT - Matt Miller, covering MoDo's gossip beat while she's on book leave, has this to say about health care reform:
President Bush - who, with 51 percent of the vote, has set 100 percent of the agenda - has taken a pass. And the terms of the debate remain surreal. After all, Margaret Thatcher would have been driven from office if she'd proposed anything as radically conservative as Bill Clinton's health plan, which would have left millions uncovered and had private doctors deliver the care.
Is there hope? Maybe. But only if America's chief executives exercise their "nuclear option."
The CEO "nuclear option?" Corporate CEOs lead the charge on a national health care system.
Click here for the whole scoop, before the Times limits on-line access to its editorial page to those who are willing to pay for it.
Is this really the way we want health care reform to occur? Probing questions and refreshing diet beverages after the flip.
Before I begin in earnest, I need to make it clear that at this point, because of the abyssmal state of the health care delivery system in this country, I'll take a national health care plan any way I can get it. If corporate CEO's will do the heavy lifting, then I am down with that.
However, I'm not at all enthralled by this scenario. Let me pose two questions to illustrate.
Question #1: What incentive do corporate executives have to push for the Thatcher-esque national health care plan that Miller proposes as the most conservative option? Miller does offer us a pretty compelling argument:
Here's my version of the script: A dozen marquee C.E.O.'s would convene a "Manhattan Project"-style effort on the future of health care. They'd propose a new goal: instead of health costs rising from today's 15 percent of G.D.P. to 20 percent by around 2020, as is now projected, the nation should shave two to three percentage points of G.D.P. (or more) off projected growth in ways that improve quality, even as we extend coverage to the 45 million uninsured.
Our chief executives would explain that this is doable because today's system costs too much and delivers too little.
(Quick review: We spend 15 percent of G.D.P. on health. Other rich nations spend 10 percent or less, but they manage to insure everyone - and have equal or better public health outcomes. And we have huge variations in practice patterns and medical spending that bear no relation to quality. Bottom line: radical inefficiency.)
Our C.E.O.'s would add that a new health strategy would get excess costs off businesses' backs - costs that competitors don't face in countries where governments pick up the tab. It would re-engineer the delivery of care so governments would have cash left for other purposes. And it would cope with the political reality that every dollar of health care "waste" is somebody's dollar of income.
The massive portion (15%) of our GDP spent on an inefficient health care system (the health care administrative sector is growing at 3 times the rate of the rest of the industry), the argument goes, is a drag on business (just ask the Big 3 automakers, who estimate that health care benefits add over $1000 to the cost of each manufacture automobile). Making the system more efficient under a single payer would relieve this burden.
I would argue that the 15% of the GDP spent on health care is precisely the reason why CEOs won't push health care reform. Whaaaa...? The reasoning behind this lies in how tightly interconnected the ownership and managerial classes of the United States are (for a really fascinating and infuriating look at the extent of these interconnections, check out UC Santa Cruz sociologist Bill Domhoff's book, Who Rules America?).
Take, for example GM's Board of Directors. Notice the other corporations represented on the Board, most notably Pfizer, represented by Vice Chairman of Pfizer Inc., Karen Katen. Similarly, look at the range of corporate interests represented on the boards of Pfizer and Eli Lilly. Given the financial interests that the medical-industrial complex and its ancillary industries have in maintaining the current, mostly privatized system of care, as well as the interpenetration of the medical-industrial complex and its ancillaries with the rest of corporate America, I am skeptical, to put it mildly, that any corporate CEO would have any sort of inclination to challenge this cash cow.
Question #2:Is this how we want health care reform to occur? Again, let me emphasize, if Miller's proposal is how we arrive at single-payer health care, I'm all for it. But, this plan perpetuates something that those of us on the Left time and time again rail against - the corporate influence over our politics. Now, I know that the corporate levers are what moves the agenda in D.C., but do we want to continue to reinforce what is increasingly becoming a corporate state (never mind the the theocratic element)?
Let me suggest an alternative: The history of the United States has never failed to demonstrate that most business and government leaders do not, out of altruism and the kindness of their hearts, put a high priority on the well-being of the People (their workers and/or constituents). Rather, these institutions are forced to concede to the public interest after citizens struggle to achieve these ends. This model is our guide to achieving health care reform.
We already have in place massive grass- and net-root organizations that have demonstrated their ability to rally over 50 million voters around John Kerry last fall. Now, the health care crisis is one of the American people's top priorities - the perfect platform for groups like MoveOn.org and ACT to achieve a broad bipartisan appeal while simultaneously allowing them to mobilize millions in support of health care reform. And the coup de grace? An American public united across partisan lines, defying, for a moment, at least, the wedge politics that the extreme Right has used to foist their agenda on the country (while ignoring the public's).
Pie in the sky? Maybe. But who's up for some rabble-rousing?
cross-posted at jScoop