Katrina health care

I'm fairly confident that if Medicare was universalized tomorrow--if, say, Dennis Kucinich, were king and he could do that sort of thing--it would be a huge disaster. I think critics ignore Kucinich's plan not just because he's so far back in the polls, and not just because his idea isn't politically feasible, but because it's also not a very good idea. Yet.

Starting from here, though, one can take the position that the bureaucracy should be fixed so that, in the longer-term, government is providing all people with health care, or one can take the position that the federal government shouldn't be any more involved than it already is in peoples' lives. This is, I think, the essential difference between John Edwards and Mitt Romney on health care. Edwards' idea is that Medicare should be allowed to compete with private insurers in a mixed public-private system that will almost surely see Medicare slowly grow and outperform its competitors (and then draw in more people, etc.) That is a good way to prime Medicare and wary citizens for its eventual universality. And the flip side is that if Medicare happens to perform terribly when it's expanded, then, hey, to the spoils will go the victors in the market. Everybody will still be insured, but only the suckers (and old people) will have Medicare.

Romney, by contrast, doesn't see a role for expanding Medicare at all. And as a Republican, you can't count out the possibility that he'll at some point try to actually scale it back. These are important differences. And I think they explain where the two men are coming from when they use this rhetoric. Via Benen:

• Edwards: "Do you think the American people want the same people who responded to Hurricane Katrina to run their health-care system?"

• Romney: "I don't want the guys who ran the Katrina cleanup running my health care system."

These statements, it turns out, are completely consistent with both men's philosophies on expanding  access to health care. The difference is that Edwards wants to see the federal bureaucracy, the Katrina bureaucracy, mature to such a degree that it can handle 300,000,000 people on its Medicare roles. Romney, by contrast, sees the federal bureaucracy degraded to the FEMA level and thinks that's just fine as long as the private sector steps in to pick up the slack.

Comments

[JimPortlandOR]

You've found the correct buttons to diagnose our current national attitudes. Disgusted with government performance (thanks to 30 years of drowning attempts by the GOP), but welcoming the concept of universal access to health insurance - even if provided by the Gov't/Medicare.

The private sector health insurance biz is a dead horse (flies are buzzing, and bugs are eating their fill of the carcass) as far as public support is concerned, but the GOP will ride that horse again and again because it is the horse they rode into town upon (and rotten meat is their regular diet).

Of all the variant health insurance plans that pretend to universality somehow, someday, Edwards seems the most likely to succeed if tried: a mixed private/public set of options, with the insured making a choice over time which is for them. But some steps need to be taken first.

Any one-step plan to single-payer, national health insurance would be a frightful political fight with a predictable outcome - there is too much money at stake by private insurers and those who have fattened on the current (non)system. Private profits are so deeply embedded now that I can't imagine just eliminating all those companies, and their employees in one fell swoop.

The first step is to level the playing field. No premium subsidies for the private insurers. Requirements on all providers for community rating, non-cancellability, electronic records, and portability. And some kind of public appeal of insurers decisions on covering a treatment (and not an insurer-dominated arbitration system).

No national solution should be attempted until the reforms above are in place for 2-3 years to weed out those private firms that can't take a level field. I'm afraid that health care will become the next Wall Street bubble now that technology and housing have burst - and we need to cut that off at the pass.

Confidence in Medicare is very high among retirees, but largely an unknown for those in pre-retirement - particularly those now served (almost acceptably) but large company employer-selected plans. They will need great reassurance (and some actual historical performance) before they jump willingly to a Medicare-like plan.