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.