'Sick' author Cohn at TPMCafe

Jonathan Cohn's new book, Sick, is this week's book club item over at TPMCafe. Jacob Hacker, Ezra Klein, Matthew Holt, Robin Podolsky, Don McCanne, Roger Hickey, Maggie Mahar and Joseph Paduda will debate Cohn on the options: single-payer, hybrid, or social Darwinism.

Cohn writes, "One of the most striking things about the hybrid crowd is how many of them actually believe, in their hearts, that single-payer is better. For these people, endorsing a hybrid is all about political calculation: Single-payer won't pass, so it's better to get behind a workable compromise."

He thinks that's a mistake: "For one thing, a discussion about changing public policy ought to start with a discussion about which policy would actually work best, whatever the politics."

Cohn refers to his NYT Magazine interview with Safeway CEO Steve Burd, who joined with Andy Stern of SEIU and Sen. Ron Wyden (D-OR) to call for universal healthcare. Burd didn't want to look to government. First he pushed personal responsibility in the form of forcing employees to cover more of their own costs, and then he pushed personal responsibility in the form of employees adopting healthy habits. But it's not enough, is it?

In conversations around the Bay Area, [Burd] heard over and over from hospital administrators about the financial burden the uninsured were placing on their facilities — a burden that eventually rippled through the insurance system and showed up on Safeway’s bottom line as inflated health premiums.

Burd’s first effort to trim costs and keep Safeway competitive involved cutting back on health benefits. Then he tried encouraging his workers to be healthier. Could nationwide universal health care simply be the next step? As long as there were large numbers of uninsured, Burd reasoned, there would be no solution to his company’s — or the country’s — problems with affordable care. And that, he says, is when it finally dawned on him: Maybe this was a problem the company couldn’t solve on its own. If he wanted relief from employee health costs, the government would have to help.

It was not an idea that came easily to Burd, a self-described conservative and Republican...

It's striking how many of the comments to Cohn's TPM piece push the free market mantra. Of course it can push down costs...

Well then why hasn't it? Or more to the point, why has single-payer kept costs down wherever it exists? As it covers everyone? Why hasn't "moral hazard" shot their costs out of the ballpark? Why have their outcomes remained as good or better than ours? For half the cost?

Lastly, how is the health insurance market different than a protection racket? Wouldn't it be better, in the long run, to set up a police department rather than relying on the Sopranos?