Tuesday, September 8, 2009

What Will We Get?

Josh Marshall wonders if the compromise healthcare reform trial balloon being floated isn’t a disaster waiting to happen.

Am I the only one who thinks that if the Dems pass a bill with mandates and subsidies for poor and moderate income people to purchase it but no public option or competition with the insurers, that it will be pretty much a catastrophe for the Democrats in political terms?

You ‘solve’ the problem of the uninsured by passing a law forcing them to buy health insurance which, by definition, most a) cannot afford or b) are gambling they won’t need because they’re young and healthy. Either you end up with low subsidies which still leave it onerous to buy, thus creating a lot of disgruntled people, or you get generous subsidies, which cost a lot of money.

It’s sort of like reform with all the cool political downsides but none of the reform.

Of course, political terms are not the only calculus on which to evaluate these questions. And the model I’m describing sounds more or less like the system they have in Switzerland and Massachusetts, which many health care experts I have a lot of respect for still believe would be a big improvement over the current situation. But I do wonder whether, if the details are not thought through carefully, you might not end up with a system less effective at driving down costs than driving down the number of Democrats serving in Congress.

I am hoping that the compromise being talked about is just that — talk. I hope that the Democrats, with a majority in both the Senate and the House and with a president in the White House could come up with a bill that will not just get affordable insurance to everyone, get the costs down, improve the efficiency, and provide a sense of peace of mind to those who can least afford to be without health insurance, but what they’re talking about doesn’t sound a hell of a lot different than what we have now; just some nice new shiny bells and whistles on the outside.

I still don’t think the folks working out this deal get the idea that no matter what they come up with, the Republicans will be against it for one reason, and it has nothing whatsoever to do with healthcare. It has to do with the simple fact that if the Democrats deliver real healthcare reform — lower costs, availability for everyone, no pre-existing condition exclusions — it will be immensely popular with the American public. The Republicans cannot allow that, and they will do anything they can to undermine it. Compromise, bipartisanship, or whatever waters it down, will accomplish that for them. So if that’s what we get — old medicine in new bottles — then the Democrats will get what they deserve.