Health care insurance mandates? How about something more socialist?
The American health insurance regime is a mess. Many of us have seen Michael Moore’s Sicko, which focuses on the greed and cruelty of the insurance industry — specifically the ways in which companies screw policy holders by denying coverage for critical procedures and squirreling out of payments.
Sicko doesn’t touch on another more boring but equally troubling problem, “adverse selection”. Under our current system, the healthy, the young and the cash-strapped often gamble with their health by either not buying insurance or buying crappy insurance. Obviously, these folks are screwed if they fall ill or are injured. But the fact that these healthy people aren’t participating in the risk pool also makes health insurance all the more expensive for everyone else, including the less healthy.
Plans for health care reform are now en vogue with liberal wonk types and this is a good thing. Following John Edwards’ lead, the major Democratic presidential candidates are all peddling plans (mostly modeled on the Edwards’ plan) that are supposed to move the country toward a system universal health insurance. A key feature of the Edwards plan is the personal mandates component, which would require adult individuals to buy health insurance (with government and/or employer support) just as car owners are required to buy auto insurance. This would effectively eliminate the adverse selection problem. People would be allowed to choose between a variety of insurance providers including a public plan based on Medicare. Edwards campaign material reads: “Families and individuals will choose the plan that works best for them. This American solution will reward the sector that offers the best care at the best price. Over time, the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan” (the hope, of course, is that is does).
But isn’t this needlessly complicated? The fact that it would become illegal not to buy insurance will be spun as statist authoritarianism and the transitional phase, in which private plans would be competing with the Medicare-type plan, would give the right a long window of opportunity to derail and sabotage the plan.
For both ideological and practical reasons, I think progressives should push for the existing health insurance system to be replaced by a single-payer system in one fell swoop. Ideally, monthly premiums would be eliminated and we would pay for this universal insurance through progressive taxation. Liberals who think this is too radical need to understand that right-wing opposition to any reform will be no-holds-barred and that we might as well stake out the most progressive position before considering any compromise. That’s a key strategic principle of bargaining, isn’t it? After all, the left has a very strong hand on this issue and there’s no reason to underplay it.
It should come as no surprise that the first North American universal health care system was a socialist accomplishment. Canadian Medicare (that’s what they call it up there) is modeled on the plan implemented by the Cooperative Commonwealth Federation/New Democratic Party government of Saskatchewan in the early 1960s. Those poor Canadian pinkos had to fight the great Saskatchewan doctors’ strike, an AMA-backed rebellion of medical professionals. The history of that struggle should give us some sense of the steely resolve it will take to win health care for all in the United States.
Right on: mandates suck big time. And this is definitely a situation where people on the left need to be saying “singlepayersinglepayersinglepayer” as often as possible, so we can try to move the debate leftwards. Right now the wonks and politicians seem to have decided that the choice is either fake-universal health care in the form of mandates, or a plan that doesn’t even pretend to be universal.
The real problem, as you note, is that successful health care reform is impossible unless you see the elimination of the private insurers as your long term goal. On the other hand, I think you slightly misread the implications of private plans competing with Medicare. As long as the government is really allowed to compete on a level playing field, the evidence strongly suggests that the public plan will win out. So short of single payer, I think that letting the government compete directly against the private insurers is the key to a progressive health care reform. And it’s the part that the the insurers will fight hardest against. Because if that gets taken out, what we’ll end up with is just a bunch of subsidies to insurance companies.
The public plan will definitely win out if allowed to compete with private insurers. The Edwards people see this as a way of sneaking in a single payer system…I just think it’s risky. Instead, I think we should charge in through the main gate, red banners blazing.
Yeah, it sounds all nice and socialist-like to immediately go to single-payer, but really that’s just as unrealistic.
“But isn’t this needlessly complicated? The fact that it would become illegal not to buy insurance will be spun as statist authoritarianism and the transitional phase, in which private plans would be competing with the Medicare-type plan, would give the right a long window of opportunity to derail and sabotage the plan.
For both ideological and practical reasons, I think progressives should push for the existing health insurance system to be replaced by a single-payer system in one fell swoop. ”
How wouldn’t a single-payer system be subject to the same opportunity for the right to swoop in and do the same thing? I think the good thing about a slower plan is that it gives more time to fight against the right’s smears. If the winning candidate came out with a single-payer plan immediately, you’d see the same backlash/mobilization that you saw against Hillary in 1994.
I think Bernie Sanders had something really good to say about this. We shouldn’t just throw up single payer in one fell swoop. It will mobilize the right just as quickly as you can put up the plan. Look at how quckly they struck down the last immigration plan this summer. Instead, put a plan in place that allows for everyone to have access to coverage. Then, mobilize mobilize mobilize at the state level. All politics is local, and this is where groups like us should excel. Get single-payer in your state. Movements are on for this in some states already. Once some states prove that single-payer works, gradually switch the whole nation over in the way that the Edward’s plan hopes to eventually push towards single-payer. We can’t be “revolutionary” when so many powerful forces are against us and the popular front has yet to mobilize. Going slower allows us to mobilize a larger majority for single-payer and create a lasting program by gaining the trust of the public, instead of charging in and getting mowed down by the already mobilized right and its partners in industry.
Well I don’t really disagree with Andrew. But Bernie Sanders, God love him, is a politician who has to deal with the day-to-day realities of Washington. As citizen advocates we are mercifully free to make all kinds of unreasonable demands.
Even the relatively mainstream Physicians for a National Health Program has refrained from endorsing the Edwards-style health care proposals and is sticking to its guns on single-payer in one blow. As socialists, our modest contribution to American politics should be staking out a radical position and putting the Edwards plan where it properly belongs, in the sensible center. When Fox News pundits call John Edwards a “far left” candidate, the left clearly isn’t doing its job.
Incidentally, I think we should be as noisy and obnoxious as possible in lobbying for actual socialized medicine, maybe starting with free pediatric clinics in every school district. Of course it’s not realistic at the moment, but who but us will dream the dream? If we really think a goal as modest as public clinics is impossible, we have no business calling ourselves socialists.
But is not first accepting the “sensible center” a movement toward single-payer that will give more time to fight the right’s rhetoric with proof that a movement in this direction is a good thing? Your free clinic idea is a reasonable demand. Going to single-payer in one fell swoop would be reasonable as well, if not for the right’s noise machines and the fact that plenty of average americans who could be accepting this sort of program if not for this misinformation are too trusting of their opinions. It will take a long time to counter those to win popular support, which is a must if you want to hold a national program of this magnitude together.
“It should come as no surprise that the first North American universal health care system was a socialist accomplishment. Canadian Medicare (that’s what they call it up there) is modeled on the plan implemented by the Cooperative Commonwealth Federation/New Democratic Party government of Saskatchewan in the early 1960s. Those poor Canadian pinkos had to fight the great Saskatchewan doctors’ strike, an AMA-backed rebellion of medical professionals. The history of that struggle should give us some sense of the steely resolve it will take to win health care for all in the United States.”
This is the sort of movement towards single payer I’m talking about. If we were able to help push through single-payer in, say, New York, it would be a HUGE move towards proving to the nation (outside of the left) that such a program is possible.