When it comes to healthcare policy, people don’t care about the API, they care about the GUI. In English, that means if the end product isn’t liked, it doesn’t matter if the wonky details are nerdvana. Or as we often say around here, people have to like this crap.
So, Sen. Bernie Sanders released a healthcare proposal. I’m going to go Full Metal Slatepitch and argue that not including the funding mechanism is smart–and remember that the pundits who are saying it’s a flaw completely whiffed on the 2016 election. These are the same august solons who fail to realize that Democrats can now say, “Republicans want to give the rich a tax cut, we want to make sure you will never lose your healthcare.” That’s not bad. And the upside of Republican willingness to demonize Democrats no matter what they do, means they might as well propose something good. So, when you hear all the wonky criticism, remember what a relative in the newspaper bidness used to say, “Consider the source.”
Anyway… First, it’s important to lay out what a good healthcare system would look like. Think about all of the previous healthcare discussions: they never started from the premise of “what healthcare services do people need?” Not “what insurance mechanism could work”, which is about how can we help people buy into a mediocre, overpriced system. Second, most voters don’t care about the mechanisms; they just want a system that’s affordable, available regardless of employment status, and easy to use. That’s what people think of when they say “single-payer.” As some asshole with a blog put it ten years ago about incremental healthcare plans:
What I’ve never understood about the entire healthcare debate is the need to invent completely new plans. My take on this is ultimately pragmatic: find a system that provides universal coverage and good healthcare and institute it. Much of Europe–including the dreaded French–have very good healthcare. Translate the damn documentation, slap a big ol’ U.S. of A. flag on it, and you have some healthcare. If other countries can do that, it’s not impossible, or even impractical.
Then DeLong, realizing that his program won’t be passed, veers in the other direction by supporting the Democratic candidates’ programs because they would be better than what currently exists (which is probably correct). But, at this stage, I still don’t understand why Democratic candidates feel the need to develop complex plans (any plan would be complex) that wouldn’t be as good as some of the EU plans. There’s no international copyright on government programs, and if you’re going to go through all of the legislative trouble anyway, why not use a better plan?
So I’m not ideologically wedded to single-payer, though it seems like a good starting point–and at least the single payer advocates are stepping up with specific outcomes rather than chanting healthcare insurance policy-related phrases like they’re performing an exorcism to cast out democratic socialist spirits (“The Dutch System. The French System. Socialist Demons Begone!”). From a public health perspective, single payer has the advantage of being able to more easily track what is happening to patients (e.g., antimicrobial resistance surveillance) because it is a single system. The key thing is that it should have a good healthcare system–and we need to define what that means. Third, I don’t think single-payer is the political death knell many pundits make it out to be, especially in Michigan and Wisconsin–where people are close to Canada and are aware of what the Canadian healthcare system actually does. Former Montana Senator Max Baucus–not exactly a liberal, by a long-shot–made this very point.
And if you’re a pundit who is saying, well, “what about problem X?”, let’s revisit that topic:
Single-payer advocates, the hardcore socialists aside, want what other countries have: portable, affordable healthcare that is easy to use (and gain access to in the first place) and that isn’t contingent on your job. Personally, I don’t care if it’s a hybrid system or more like Medicaid-for-all (that’s not a typo), or flat-out Canadian-style healthcare (AAAIIIEEE!!!!). But such a system, whatever the details are, is not like trying to make cold fusion work or going to Mars. Other countries have already done this, so this is not impossible, by a long shot.
By the way, the Budget Control Act, which enforces artificial austerity, expires in 2021. Wonks should know that.
These problems can be solved. It’s not like going to Mars at all, just to any number of other countries.