17 April 2007

Single-Payer: Go for it!

Roger Hickey, co-director of the Campaign for America's Future, "an organization launched by 100 prominent Americans to expand the national debate about America's economic future," has a terrific post at TPMCafe on healthcare reform.

He makes the excellent point that even if you believe that single-payer isn't realistic, we should still go for it. That tactic puts the insurance companies on the defensive, where they'll be more amenable to a modicum of justice, less arrogantly certain that greed should be unlimited when it comes to their own profits.

Hickey quotes Clinton, saying it sounds to him as though she's figured out that the American public is outraged by the health insurance industry, and that she won't suffer politically by going after them (except, of course, in the all-important race for cash). "Now this kind of populist rhetoric is also useful if she is planning to go for a wimpy and dangerous Wyden-style plan that essentially gives all our public subsidies to the insurance companies – while pretending to regulate them," he cautions.

Hickey likes Jacob Hacker's plan, which takes us to single-payer in stages, as I understand it. I haven't read the plan, but I have read The Great Risk Shift, an important book worth the time.

Hickey also quotes Matthew Holt, from an earlier post on the discussion at TPMCafe:
My essential fear though, is that we’ll only get to some kind of compromised quasi-universal coverage system that doesn't really cover everybody, keeps a role for a private insurance industry operating under the wrong incentives, and looks like welfare for the poor. In that case this whole cycle will start again, and in about 15-20 years when we go into a more violent collapse—then we will end up with Soviet-style rather than Danish style socialized medicine. And we ought to be able to do much better than that.
Well said.

There are a number of posts on healthcare reform through the TPMCafe's book club discussion on Jonathan Cohn's new book, Sick.

One of the best is a comment to Cohn's post, "Un-compromising Positions." Cohn also praises Hacker's plan, although he caveats, "One risk in embracing such a compromise plan is that it will let stand a wasteful, poorly designed system that will keep generating unnecessarily high costs. But I’m not sure that, politically speaking, we can cover everybody and deal with the system’s inefficiencies all at once."

Which is probably why I haven't read the plan. I keep hearing it's a compromise, and if we begin with a compromise we'll be compromised.

Here's much of that great comment to Cohn's post:
... if you went car shopping and found...

Volkswagon Jetta - $20,000
Toyota Camry - $15,500
Volvo S40 - $18,250
Chevy Impala - $44,800

...you would say 'What a rip-off for the Chevy Impala!' and look on the invoice and laugh at all the comically overpriced features and poor relative performance and choose ANY of the others - even though the others are very different.

Now substitute OECD per capita health care costs (2003).

Germany - $2,938
Japan - $2,249
Sweden - $2,745
United States - $6,711

That's the same price spread the cars. The US has fewer doctors, fewer nurses, fewer hospital beds, higher infant mortality, lower life expectancy, and more uninsured people than Germany, Japan, and Sweden and we spend more than twice as much.
There are so many other good posts and comments to this discussion that it's hard to read them all — or find them all. Don McCanne had a good one last week that I wanted to link to, and now I can't find it. If TPMCafe has all the connected stories in one place, it's a place I don't know about.

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