Wednesday, August 19, 2009

Learning from the 1930s

With all the talk about the 1930s: comparing the Great Depression to the current one, wingnuts trying to compare Obama to Hitler, etc. something struck me as I was reading Ezra Klein's recent post on the public option:

Letting [the public option go] go will smooth the path to victory. But will it? The co-op plans, which were supposed to be the compromise to the public option, endured a blistering attack from the GOP yesterday. When Republicans are attacking the compromise of a compromise, it's worth wondering whether their opposition is based on a dislike of particular provisions or a desire to doom the whole bill. I'd say the evidence increasingly favors the latter.

Loudly letting go of the public option wouldn't necessarily secure additional votes so much as it would increase the confidence of opponents and depress supporters. If the forces arrayed against health-care reform could spend two weeks assailing end-of-life counseling, they can find another provision in the bill, too. Maybe the exchanges, Or the subsidies. Or MedPAC. They're committed to defeating Barack Obama and the Democrats, not erasing a particular section of the bill. Reform's advocates, however, are substantially -- maybe overly -- committed to the public option. Dropping it from the effort is likely to wound them while emboldening the opposition.

It struck me how similar the public option is to the Sudetenland in that giving it up gets the Democrats nothing from the Republicans, but it undermines the will of the left to fight for the rest of the health reform bill. The Democrats need to absorb the lessons of the 1938 Munich Agreement as far as dealing with implacable opponents goes. Appeasement doesn't work, and it's a very stupid idea when you have the upper hand.

If the Republicans aren't willing to negotiate in good faith then shut them out of the process until they're willing to start. Grassley said a couple days ago that he'd vote against the bill even if it contained everything he was asking for. How much more obvious does it need to get that there's no point in trying to talk to these people? It's time to focus on people who would conceivably vote for the bill like "moderate" democrats or the senators from Maine. At least there, concessions might actually buy you the votes you need to pass something mildly effective.

Thursday, August 13, 2009

An unhealthy attachment to the status quo

It seems that as time goes on more and more people turn against health reform. Although many people sense that the system as a whole is getting out of control and sympathize with the uninsured, they're not willing to pay the cost of reform or risk their own current coverage. They disbelieve the president's assurances that they can keep their coverage if they're happy with it. What they may not realize is that they might not be able to keep the coverage they have now even if no health reform passes.

Health insurance premiums are rising steadily. Every day additional businesses and individuals are priced out of the market. If costs are allowed to continue increasing, there's no guarantee that the benefits being promised today will be affordable or even available in a few years. Granted there's some debate over whether the proposals currently in Congress will achieve the sort of cost savings, which will be required. That's a reason to advocate for the proposals which do, not to reject all reform out of hand.

Besides the questionable overall capacity to sustain the current system, at an individual level good coverage nowadays is depended on one's employer. If you lose your job, you also lose your medical coverage. Even if their job is relatively secure, few people seem to realize that the medical conditions, for which they most need insurance, might also incapacitate them to the point of losing their job and therefore their insurance. Insurance that isn't there for you when you need it isn’t insurance.

Finally, a disturbing trend over the last few years has surfaced: faced with the decision whether or not to pay out large claims, many insurance companies are deciding to terminate people's coverage instead. (See this post.) While this does not really apply to employer-based coverage, it means that those of us with no access to such coverage may not really be able to purchase insurance at all, even if we can purchase "insurance."

Thus, it's unfair to compare potential healthcare proposals with the best insurance plans currently available, because they are not representing the majority of cases and they are and not sustainable. If we do nothing, it will get much worse for all of us.