The Center

In ongoing discussions about health care and the like, I feel like the conversation tends to trip over alternate conceptions of what it would mean to have a "left" versus a "center" view on these issues. For my part, in the abstract my views on health care are way to the left of what the major presidential candidates are putting out there. I'd reduce private insurers to a minor role around the margins, and would even try to do some experimenting with direct public provision of health care services along with the public provision of health insurance.

But then back in the world of sound political strategies for the immediate future, my view is to the right of what John Edwards has put out there, to the right of what Barack Obama put out yesterday, and quite possibly to the right of what Hillary Clinton will put out in the weeks to come. I don't think the political circumstances are ripe for dramatic alteration of the American health care system, and I don't want to see the next Democratic president's first term wracked on the shoals of health care reform. I'd like to see that box checked with a handful of small-or-medium sized initiatives that will make things better and, if successful, may build support for further public action down the road.

Comments

Sever the relationship between employment and health care - tell the Fortune 1000 that they are no longer responsible for the health care costs of their employees and that they no longer have that global competitive disadvantage - tell the 20 or 30 million small business owners in the U.S. that they will finally have health insurance - and just see how ripe the conditions get.

Posted by Brautigan | May 30, 2007 9:58 AM

But then back in the world of sound political strategies for the immediate future... I don't think the political circumstances are ripe for dramatic alteration of the American health care system, and I don't want to see the next Democratic president's first term wracked on the shoals of health care reform.

You've asserted this a number of times in a number of ways over the course of the past several weeks, but have you ever actually made an argument supporting this assertion? Neil Sinhababu, among others, has pointed out that the '09-'10 congress is likely to be the most Dem-friendly congress any Democratic president is going to get in the near future. If the time isn't ripe for health care reform then, it never will be.

Increasingly, I get the impression that you just don't pay all that much attention to domestic policy, and have accordingly allowed the importance of domestic issues to slip down your list of items to care about. Which is fine; as a commentator you're allowed to write about whatever interests you at the time. But don't mistake your priorities for the country's. Just because you haven't been paying attention to health care all that much doesn't mean that Americans are going to dismiss the chance to radically improve their lives on this score.

Posted by Christmas | May 30, 2007 10:11 AM

I'd love to hear provide some more reasoning behind your view of the prospective political situation in 2008. After the wreck of HillaryCare your political incremental view was the prevailing view of DC Dems including Ted Kennedy. But, if fifteen years later we still haven't moved the ball any further than CHIP, it would seem to undercut that particular political dialectic.

My view is simple if one thinks this is an important thing to do, one campaigns on it, then crams it through, or as much as one can get, alla the Bush tax cuts. If it goes through, and works, the political rewards could rival Social Security and Medicare.

Posted by AJ | May 30, 2007 10:12 AM

"I don't think the political circumstances are ripe for dramatic alteration of the American health care system"

That's because you don't understand politics.

Posted by Petey | May 30, 2007 10:14 AM

"I'd love to hear provide some more reasoning behind your view of the prospective political situation"

Here is Matt's reasoning.

Posted by Petey | May 30, 2007 10:17 AM

Touche, Petey. I don't think Mat will ever live down that picture.

Posted by Clark | May 30, 2007 10:19 AM

Petey- That's just wrong on some many levels, from ideological to hygenic.

Posted by AJ | May 30, 2007 10:22 AM

"Touche, Petey. I don't think Mat will ever live down that picture."

If he really holds such absurd views of the correct politics of health care reform, we ought to see if we can get him to pose in a cap and T-shirt that say "Vichy Dems for the Status Quo".

Posted by Petey | May 30, 2007 10:22 AM

I don't think the political circumstances are ripe for dramatic alteration of the American health care system, and I don't want to see the next Democratic president's first term wracked on the shoals of health care reform.

i don't know what Yglesias' agenda is, but let me speak plainly. I see little or no point to a Democratic administration unless there is massive health care reform.

And Mitt Romney has delivered on health care. His program has been criticised, but if the Democrats are not absolutely front and center serious about health care, then I will take what he has to offer.

Posted by Duncan Kinder | May 30, 2007 10:46 AM

Matt Yglesias: The Running Dog of Neoliberalism

Posted by LaFollette Progressive | May 30, 2007 10:54 AM

Petey - the political conditions do not allow for any dramatic changes - only marginal changes that won't really do anything to fix the system.

For example, Obama's speech calls for an electronic medical system that's inter-compatible - until one would have to ask proprietary code writers to share thier secrets with other for-profit companies. or get around pharma's pricing schemes. or etc., etc. etc.

Things can change dramatically through adjudication but not through the political process.

The best example I can think of is here in New Orleans. Post-Katrina, essentially 5 free clinics took up much of the indigent care as the Charity system had shut down. Well, in the vacuum of post-hurricane, where there was no infrastructure at all (electricity, computers, etc.), each of the 5 clinics now runs non-interoperable computer systems, information is not shared, collaboration is byzantine and patients still float around the system.

I argue that in post-Katrina new orleans the conditions existed for a complete overhaul of the health care system - but the process still didn't allow for this (due to an idiotic public health infrastructure, private hospital demands, patient ignorance, etc). Extrapolating to a larger system, where there exist multiple players with independent motives, I cannot see how any major changes can be made.

Posted by Adi Nadimpalli | May 30, 2007 10:59 AM

"Matt Yglesias: The Running Dog of Neoliberalism"

Don't give neoliberalism an undeserved bad name.

-----

I've got nothing against realism in achieving political goals. But what annoys me is when folks argue for trimming sails when the wind is at our backs on a particular issue.

If Matthew doesn't think something as modest as the Edwards healthcare plan is achievable in the '09-'10 Congress, he really doesn't have a clue.

Posted by Petey | May 30, 2007 11:05 AM

I don't think the political circumstances are ripe for dramatic alteration of the American health care system

Isn't this precisely the kind of appeal to political feasibility/possibility that you've attacked in the past?

Posted by Freddie | May 30, 2007 11:05 AM

Yes Mathew. Spoken like a true 25 year old with health insurance.

Posted by devo | May 30, 2007 11:57 AM

I've got nothing against realism in achieving political goals. But what annoys me is when folks argue for trimming sails when the wind is at our backs on a particular issue. - Petey

Right. This is, in fact, the ONLY moment for massive health care reform; it's critical that health care reform be placed on the agenda at the same moment as we're pulling out of Iraq, or in the aftermath. It is the Iraq debacle that has delegitimized conservatism and created a massive political groundswell for health care reform, more or less the same way Kennedy's assassination made the Voting Rights Act and Medicare/Medicaid possible for Johnson. THIS is the moment. It's not the moment for a few small palliative reforms which will "create support for further changes down the road". It's the moment for the one big push that gets universal health care over the hill.

Posted by mattsteinglass | May 30, 2007 12:09 PM

"This is, in fact, the ONLY moment for massive health care reform; it's critical that health care reform be placed on the agenda at the same moment as we're pulling out of Iraq, or in the aftermath. It is the Iraq debacle that has delegitimized conservatism and created a massive political groundswell for health care reform, more or less the same way Kennedy's assassination made the Voting Rights Act and Medicare/Medicaid possible for Johnson. THIS is the moment. It's not the moment for a few small palliative reforms which will "create support for further changes down the road". It's the moment for the one big push that gets universal health care over the hill."

Hear, hear!

Your analysis of the political big picture is quite similar to mine.

If Matthew can't see how the '09-'10 Congress is our best shot for passing a left-leaning healthcare bill, he really needs to rethink the whole topic.

We're unlikely to see a more fertile moment anytime soon.

Posted by Petey | May 30, 2007 12:14 PM

What Petey said. For all their lobbying dollars, Big Insurance and Big Pharma are setting themselves up for a kicking that would be cheered on by the public.

Posted by pseudonymous in nc | May 30, 2007 12:29 PM

My left-wing healthcare strategy would be to eliminate drug patents and break the power of the professional licensing cartels. The problem now is that patents and cartel pricing of professional services make some things artificially lucrative, and then the standard model of care gravitates toward the money.

Posted by Kevin Carson | May 30, 2007 12:57 PM

Petey to Matt,

That's because you don't understand politics.

I'd say you're the one who doesn't understand politics. HillaryCare was a much, much less drastic reform of the nation's health care system than the utopian single-payer fantasies of the far left, and even that went down in flames despite the fact that the Democrats controlled the White House and both chambers of congress. When single-payer health care was put to the voters in California and Oregon, it was defeated by a 2-to-1 margin in both places. If you cannot even come close to passing single-payer health care in two of the bluest states in the country, you have absolutely no chance of enacting it at the national level. You have your head buried in the sand. Matt is exactly right. Single-payer health care reform is a political fantasy. I think it will always be a political fantasy. I wonder how long it will take you to realize that.

Posted by Seamus | May 30, 2007 1:09 PM

Re: Extrapolating to a larger system, where there exist multiple players with independent motives, I cannot see how any major changes can be made.

People have made that point about everything from E-Commerce (too many different O/S and software systems, and way too much computer illiteracy for it to work) to the interstate highway system (too many local and state road authorities to work through and around). But guess what: when a better idea really does come along, and someone is willing to push it hard, all those conflicting interests either fall into line or are steam-rolled right over.
By the way, I wonder if the source of the pessimism (Matt's and some others here) is the fact that single payer probably is out of reach, and therefore they are loathe to see any major reform.

Posted by JonF | May 30, 2007 1:13 PM

"You have your head buried in the sand. Matt is exactly right. Single-payer health care reform is a political fantasy."

Tellingly, your use of the phrase "single-payer" marks the first time it's been used on this thread. Neither Matt nor any previous commenter has mentioned it.

If a thread isn't about your particular mania, just pretend it is.

-----

FWIW, the Edwards plan is designed to be enactable by making the single-payer option voluntary rather than mandatory.

Posted by Petey | May 30, 2007 1:17 PM

"By the way, I wonder if the source of the pessimism (Matt's and some others here)..."

Matt has a congenitally bad political sensibility. He generally tends to get the politics of any given issue wrong.

Combine that with a certain economic royalism that permeates his thought, and you have an incorrect timidity on the prospects for enacting a modest left-leaning universal healthcare plan like John Edwards has proposed.

"...the fact that single payer probably is out of reach"

The Edwards plan is enactable in the next Congress, and will create a slow but steady migration to single payer.

Single payer is only out of reach if you're not paying close enough attention.

Posted by Petey | May 30, 2007 1:23 PM

Neither Matt nor any previous commenter has mentioned it.

Matt described his unattainable "abstract" goal as follows: "I'd reduce private insurers to a minor role around the margins, and would even try to do some experimenting with direct public provision of health care services along with the public provision of health insurance." That's the far-left fantasy.

As for Edwards' plan, it doesn't even provide for universal coverage, let alone single-payer. None of the serious Democratic candidates has offered a health care reform plan that comes remotely close to what you "progressives" want. None of them are proposing single-payer. None of them are proposing to eliminate or dramatically reduce the role of private insurers. None of them are proposing to sever the link between health insurance and employment. None of them are proposing anything like equal access to health care for all. The most ambitious plan on offer amounts to minor tinkering with the existing system.

And this is probably as good as you're going to get. The plans on offer now are designed to appeal primarily to Democratic primary voters. After the primaries, the winner will doubtless feel pressure to "conservatize" his proposal to attract support from centrist Democrats and Republicans.

Posted by Seamus | May 30, 2007 1:33 PM

"As for Edwards' plan, it doesn't even provide for universal coverage..."

You, sir, are ill-informed or a liar.

The Edwards plan unquestionably provides for universal coverage.

"...let alone single-payer"

Addressed above. It provides a single-payer option right off the bat, and should provide a slow but steady migration to single-payer.

"None of the serious Democratic candidates has offered a health care reform plan that comes remotely close to what you "progressives" want."

If the Democratic field was limited to Clinton and Obama, you'd be correct.

-----

"After the primaries, the winner will doubtless feel pressure to "conservatize" his proposal to attract support from centrist Democrats and Republicans."

The median voter stands with me on this issue, Seamus, not with you.

Posted by Petey | May 30, 2007 1:39 PM

Petey,

The Edwards plan unquestionably provides for universal coverage.

No it doesn't. It provides for a continuation of the current fragmented, patchwork system of public and private programs and funding that leaves millions of people without coverage. It proposes expanding eligibility for Medicaid and SCHIP, ignoring the fact that millions of people already eligible for these programs simply fail to enroll in them and hence have no coverage.

The median voter stands with me on this issue, Seamus, not with you.

Ha ha ha ha! Yeah, right. That's why not even the most "progressive" of the Democratic candidates has proposed anything remotely close to the kind of dramatic reform you seek. You are truly living in a fantasy world.

Posted by Seamus | May 30, 2007 1:50 PM

Well, it's been said a few different ways already on this thread, but I'll say it again: Matt is wrong, wrong, wrong, wrong, wrongwrongwrongwrong on the politics here. Half-assed half-measures that "check the box" squander political capital on small-bore changes that don't affect many people's lives, get fought just as vigorously as more radical changes would be (see HillaryCare) for political points, and confuse the public.

Posted by Antid Oto | May 30, 2007 1:52 PM

"(the Edwards plan) ... leaves millions of people without coverage."

Liar.

"That's why not even the most "progressive" of the Democratic candidates has proposed anything remotely close to the kind of dramatic reform you seek."

John Edwards has proposed a plan that achieves what I seek, and which can be enacted in the next Congress.

Posted by Petey | May 30, 2007 1:55 PM

It provides a single-payer option right off the bat

There's no such thing as a single-payer "option." Either there is a single payer, or there are multiple payers. In the Edwards plan, there are multiple payers. The sole reference to "single-payer" in Edwards' proposal is the statement that "over time" the system "may evolve" "toward" a single-payer "approach" "if" individuals and businesses "prefer" the public plan. And even that incredibly vague and qualified reference to single-payer health care will probably be further diluted or removed altogether if Edwards actually becomes the Democratic candidate (which itself seems increasingly unlikely).

Posted by Seamus | May 30, 2007 2:00 PM

"There's no such thing as a single-payer "option"

To be as charitable as possible, you obviously aren't quite up to speed on the whole healthcare topic, Seamus. You are incorrect here, and you've been incorrect multiple times upthread.

I'm certainly willing to chalk it up to insufficient research rather than limited intellectual capacity or mendacity.

Cheers.

Posted by Petey | May 30, 2007 2:08 PM

To be as polite as possible, Petey, you don't even understand the meaning of the word "option" let alone the meaning of "single payer." Either there's a single payer or there are multiple payers. There can't be both. That's called a contradiction. The Edwards plan clearly entails multiple payers--private employers, private individuals and the government. In fact, it doesn't even entail a single payer for the government's role in funding, but rather a continuation of the existing fragmented system of federal, state and local funding.

Posted by Seamus | May 30, 2007 2:15 PM

What drives me crazy about Matt's appeals to what's politically feasible is that he himself has argued against exactly those kind of arguments.

Brad DeLong passes on on an amusing remark from Robert Solow: "Well, if everything is politically impossible except what we have now, we could have saved a lot of time here."

So true. Meaningful political change is rarely "politically possible" in the sense that there is some obvious method through which the existing constellation of forces could easily bring it about. If it were, after all, it would have happened already. Which isn't to say it's a good idea to attempt the impossible -- if you do, you'll probably fail. But if nobody ever tried to do anything that was probably doomed to failure, then nothing would ever happen.

Well said, Matt. Everything is politically impossible until it stops being so. The idea that universal healthcare just isn't possible in American politics-- when it has been adopted in some form by every other Western country on earth-- is just more American exceptionalism.

Posted by Freddie | May 30, 2007 2:26 PM

Sorry about the italics, the second and third paragraphs are both Matt's.

Posted by Freddie | May 30, 2007 2:27 PM

"Everything is politically impossible until it stops being so. The idea that universal healthcare just isn't possible in American politics-- when it has been adopted in some form by every other Western country on earth-- is just more American exceptionalism."

If Matthew had made such an argument on the eve of the 2004 election, I would have agreed with him.

I don't think a left-leaning universal healthcare plan would have been enactable by the '05-'06 Congress if a Democratic President had been elected.

But if Matt doesn't understand that the current moment is different, he's just not paying attention to the current political climate.

Posted by Petey | May 30, 2007 2:48 PM

The idea that universal healthcare just isn't possible in American politics-- when it has been adopted in some form by every other Western country on earth-- is just more American exceptionalism.

Depends what you mean by "universal healthcare," exactly. We already have "universal healthcare" of a sort. And the sense in which the healthcare systems of other countries are "universal" also varies widely. It's a continuum of differences rather than an either/or. Large disparities in access to and quality of health care services exist even in countries with nominally "universal" systems. And of course, "universal" is not the same thing as "single payer." Single payer is the exception, not the norm. There's nothing exceptional about America having multiple sources of health care funding. I realize it's in the interests of those pushing for major reform to pretend that there are only two basic categories, America and everyone else, but the reality is much more complicated and nuanced.

Posted by Seamus | May 30, 2007 3:15 PM

"But if Matt doesn't understand that the current moment is different, he's just not paying attention to the current political climate."

Maybe...I hope so. However, it does not seem to me that the current Democratic resurgence has much to do with the American people decisively turning towards Democratic policies, but rather reflect the people getting really sick of Republican corruption/incompetence and the Iraq War.

So, I am unsure that the American people, generally speaking, are any more pro the Democratic domestic agenda than they were in 93 (polls always show Democratic advantages in healthcare).

It may be true, but I hardly see that it is obvious. I think the strongest indicator might be that corporations are getting sick of footing the bill for health insurance. Sticking a wedge between GM, GE, etc and the health insurance companies is essential.

Posted by Patrick | May 30, 2007 3:27 PM

Frickin' Wal-Mart has lined up with unions to ask for universal health care. There isn't going to be a better political moment than 2009, should a Democrat win the Presidency. Democrats will likely retain the House and Senate and will have an interest in delivering wins for their party even if they disagree on some elements substantively.

People forget that Clinton's biggest mistake was not in trying to pass health care reform, but in freezing out the petty, privilege-mad establishment Democrats in Congress as he wrote the package. If a Democratic president-elect can learn that lesson, he/she can pass something big in his/her first year.

I am unsure that the American people, generally speaking, are any more pro the Democratic domestic agenda than they were in 93

The American people are not strong on policy specifics. They want problems fixed, and yes, they want this problem fixed more urgently than they did fourteen years ago. That's all that really matters.

Posted by Antid Oto | May 30, 2007 3:37 PM

I realize it's in the interests of those pushing for major reform to pretend that there are only two basic categories, America and everyone else, but the reality is much more complicated and nuanced.

Sure. I'm sorry if I suggested otherwise. But the fact of the matter is, in the industrialized world, there are incredibly few countries where people simply have no insurance at all. Of course there's variations in degree of coverage and quality and access. But what is indisputable is that no other Western country has a similar lack of basic coverage of any kind for such an enormous number of people. The fact that it happens to the country with the most powerful economy in the history of the world makes it even more inexplicable.

Posted by Freddie | May 30, 2007 3:38 PM

"However, it does not seem to me that the current Democratic resurgence has much to do with the American people decisively turning towards Democratic policies, but rather reflect the people getting really sick of Republican corruption/incompetence and the Iraq War."

Two points:

- You take your opportunities when they come. The Iraq fiasco has created an opening for Democratic ideas that we can use or let slip by. As a commenter noted above, the biggest Democratic initiatives passed in the last 60 years came as a result of the JFK assassination.

- There really has been a gradual shift in public opinion toward lefty economic ideas over the past 15 years.

Given the public mood, and given the favorable Senate matchups coming in '08, it's a good time to make law.

Posted by Petey | May 30, 2007 3:43 PM

And even aside from the current political moment-- the American people overwhelmingly support universal health care. Overwhelmingly. In poll after poll. The poll numbers here are a little old, and yes, it's Mother Jones. But it seems likely that support has grown since 2003, and the polling was done by independent parties.

Posted by Freddie | May 30, 2007 3:47 PM

"Given the public mood, and given the favorable Senate matchups coming in '08, it's a good time to make law."

Imagine a January '09 where Edwards wins the general election with 52% of the vote, carrying (conservatively) 3 more Dem Senators with him, getting us to 54.

He's run on his plan, been attacked on its details, refuted the attacks, and been validated by the electorate. The plan is moderate and reasonable.

In the political climate of January '09 that I'm describing, Edwards will hold the entire D Senate caucus for the plan. That's 54. A few R Senators from blue and purple states that Edwards won come along immediately. That's 57.

Suddenly, you can see cloture.

I don't care if we got there because of Iraq or because of New Orleans or because Americans suddenly want to be French. It's just a good time to make law.

Posted by Petey | May 30, 2007 3:50 PM

"And even aside from the current political moment-- the American people overwhelmingly support universal health care. Overwhelmingly. In poll after poll."

That's been true for a really long time.

Posted by Petey | May 30, 2007 4:01 PM

Sure. I'm sorry if I suggested otherwise. But the fact of the matter is, in the industrialized world, there are incredibly few countries where people simply have no insurance at all.

Yes, but "health insurance" is not the same thing as "health care," and the fixation on "insurance" or "coverage" rather than the actual ability to obtain health care services is something of a distraction. This isn't to say there isn't a relationship at all, just that the issue is complicated. Uninsured Americans can receive free or heavily subsidized health care through a large network of public and private agencies and programs, while "insured" Canadians and Britons are often denied, or must endure onerous waits for, health care services that their socioeconomic counterparts in the U.S. would receive promptly. As the Supreme Court of Canada said in its landmark Chaoulli decision, access to a waiting list is not access to health care.

But what is indisputable is that no other Western country has a similar lack of basic coverage of any kind for such an enormous number of people.

Everyone in the U.S., even illegal immigrants, has the legal right to emergency medical care. Everyone has the right to free or heavily subsidized primary health care services through the federal government's Bureau of Primary Health Care. There are many federal, state and local programs and clinics that provide health care services to indigent and uninsured Americans, not only basic and primary care, but advanced care like cancer treatment. There is a large network of free clinics operated by for-profit private hospitals that provide health care services to the poor and uninsured. I'm not saying no one falls through the cracks. I'm not saying no one is ever denied needed health care for lack of money. But the magnitude of the problem is greatly exaggerated by many critics of the current system. To the extent that Americans forgo needed health care, it is as much a problem of them failing to take advantage of the services that are available to them as it is the services not being available. A large percentage of those eligible for Medicaid never enroll.

Posted by Seamus | May 30, 2007 4:09 PM

And even aside from the current political moment-- the American people overwhelmingly support universal health care. Overwhelmingly. In poll after poll.

Yes, they want it in the abstract. It's easy to say yes to a poll question that contains no discussion of the pros and cons of the issue. But when people are presented with actual, real-world proposals for universal health care, they reject them overwhelming. Voters in California and Oregon, two of the bluest states in the country, overwhelmingly rejected ballot measures that would have provided universal health care. HillaryCare crashed and burned, despite Democratic control of the White House and congress, despite the fact that Clinton made health care reform a centerpiece of his election campaign. The true test is how people vote, and how they behave when they are presented with real, concrete proposals, not what they say to a pollster.

Posted by Seamus | May 30, 2007 4:18 PM

There is a large network of free clinics operated by for-profit private hospitals that provide health care services to the poor and uninsured. I'm not saying no one falls through the cracks. I'm not saying no one is ever denied needed health care for lack of money. But the magnitude of the problem is greatly exaggerated by many critics of the current system.

I'm sorry, but I just think that this is incredibly myopic. It's very, very easy for someone to say that it's not that difficult to obtain health coverage in the United States, or that getting free health care at an emergency room or clinic is comparable to having a real doctor with real coverage. The vast preponderance of statistical and anecdotal evidence disagrees with you.

Posted by Freddie | May 30, 2007 4:35 PM

The vast preponderance of statistical and anecdotal evidence disagrees with you.

No it doesn't. I'm not saying there's no difference, merely that the difference is grossly exaggerated by many critics of the U.S. system. A RAND study found that, on average, uninsured Americans receive about half the health care services received by insured Americans. That's not ideal, but it's not a catastrophe, either. And uninsured Americans would receive even more if they made better use of the services that are available to them. The federal government's Bureau of Primary Health Care operates a network of hundreds of health centers that provide free primary care to uninsured Americans. The facts simply don't support your pessimistic assessment.

Posted by Seamus | May 30, 2007 5:35 PM

Re: Uninsured Americans can receive free or heavily subsidized health care through a large network of public and private agencies and programs

The above needs at least one more word to make it true: Insert "maybe" or "sometimes" after "can" and it's true. Otherwise it's bullshit. And even when these agencies exist, getting help through them involves jumping through an intricate set of bureaucratic hoops, and long, long delays.

Re: While "insured" Canadians and Britons are often denied, or must endure onerous waits for, health care services

Here we go again with this stale old chesnut. Canadians and Britons are never denied urgently needed services. If you come down with, say, appendicitis in Canada, or fracture your leg in Britain you are NOT put on a waiting list, you are attended to promptly, and at little or no cost to yourself. Now, if you want something unnecessary but strictly elective, say a boob job or liposuction, then you may have a bit of a wait. Big deal.

Re: HillaryCare crashed and burned, despite Democratic control of the White House and congress

Due to the strange ineptness of the Clintons themselves on the issue at the time. They out their proposal out there then let it drop like a lead ballooon. The country wanted it. The Dems were ready to fight for it. Bob Dole and the (reasonable) Republicans were ready to cut deals. The Clintons though just ignored their reform and let it die. Had they fought for it with the same bare-knuckled tenacity that Bill Clinton went for deficit reduction and NAFTA something based on it would have passed handily.

Posted by Jonf | May 30, 2007 10:22 PM

The above needs at least one more word to make it true: Insert "maybe" or "sometimes" after "can" and it's true. Otherwise it's bullshit. And even when these agencies exist, getting help through them involves jumping through an intricate set of bureaucratic hoops, and long, long delays.

You don't know what you're talking about. There are hundreds of federally-funded free clinics alone, in addition to all the state and local services and free clinics operated by private hospitals. And the "bureaucratic hoops" you refer to consists of calling the clinic on the phone and making an appointment to see a doctor. The Bureau of Primary Health Care even provides a web site tool to look up your nearest free clinic based on your ZIP code. Oh, what an awful, burdensome process!

Canadians and Britons are never denied urgently needed services.

Of course they are. Health care services are strictly rationed in both countries. If you need heart surgery or cancer treatment or some other urgent service but you don't satisfy the cost-benefit standards laid down by government healthcare bureaucrats, you won't get the service. An elderly patient who would receive life-saving heart surgery in the U.S. might well be denied it in Britain or Canada because his expected remaining lifespan or health status is deemed inadequate to justify the cost. That's the reality of socialized medicine.

Due to the strange ineptness of the Clintons themselves on the issue at the time.

Yeah, that must be it. The most politically skilled president in decades was incapable of selling a plan the people desperately wanted. Keep telling yourself that and ignore all evidence to the contrary.

Posted by Seamus | May 30, 2007 11:07 PM

Re: You don't know what you're talking about. There are hundreds of federally-funded free clinics alone, in addition to all the state and local services and free clinics operated by private hospitals. And the "bureaucratic hoops" you refer to consists of calling the clinic on the phone and making an appointment to see a doctor. The Bureau of Primary Health Care even provides a web site tool to look up your nearest free clinic based on your ZIP code. Oh, what an awful, burdensome process!

No, you don't know what you are talking about. The above is more full of bullshit than any barnyard I've seen. Perhaps you want to comfort a guilty conscience with these illusions but they aren't true. If free healthcare is so readily available than please explain the appalling number of medical bankruptcies.

Re: Health care services are strictly rationed in both countries.

Also in the United States. You just can't admit to reality.

Re: If you need heart surgery or cancer treatment or some other urgent service but you don't satisfy the cost-benefit standards laid down by government healthcare bureaucrats, you won't get the service.

Ditto for the US, except it's insurance industry bureaucrats not governmment bureaucrats who do the rationing. Ever hear of a "precert"? An "authorization"? "Care Management"? American euphemisms for rationing and the means by which it is done.

Re: The most politically skilled president in decades was incapable of selling a plan the people desperately wanted.

The public was hugely supportive of health care reform all through 1993. But the Clintons failed to keep the pot boiling and allowed rightwing demagogues and insurance industry scare-mongers to inflict a death of 100 cuts on the cause. I was alive and an adult at the time. I do remember what happened. Now please go back to the rightwing fever swamps where delusions like these are welcome and celebrated. Matt really needs to put his "Realiy based community" banner back on his website.

Posted by Jonf | May 31, 2007 7:53 AM

A RAND study found that, on average, uninsured Americans receive about half the health care services received by insured Americans. That's not ideal, but it's not a catastrophe, either

It's not a catastrophe? That millions upon millions of Americans receive half of what they're supposed to? Tell you what-- spend a year getting half of the medical care you are supposed to, and get back to me on that.

Posted by Freddie | May 31, 2007 8:24 AM

Since the issue of healthcare rationing has come up here I think we should confront it head on. The term "rationing" has a bad connotation and is used by the Right as a scare word, and yet the term "ration" has as its root the same word as "rational", with connections to "reason" and "reasonable". In and of itself "rationing" is not bad and in fact every finite good and service in existence is rationed in some fashion or other although we do not normally think of things that way.
Now with regard to foreign universal coverage systems, rationing is done by medical personal in the employ of the government (note: NOT by accountants, nor by "government bureaucrats"). They determine what (costly, difficult, and possibly risky) services will provide the best benefit overall. In the US we do this too: our health inusrance companies, HMOs and government programs also employ medical personnel (again, not medically ignorant accountants) to determine what treatments should be provided to which individuals. However the US system also rations services by two more completely illogical and random conditions: who has what health coverage or who has how much money. Not only is this a morally objectionable basis for rationing, it is also medically and economically absurd.
For examples of these two types of rationing in the US, consider the following from my own family:
Ten years ago my 82 year old aunt was diagnosed with multiple myeloma, a bone marrow cancer. The only cure is a bone marrow transplant, a very expensive, difficult and very risky procedure. As a rule, bone marrow transplants are not done for patients above a certain age: in effect, they are "rationed" for the young and middle aged and denied to the elderly. Which makes abundance sense when you consider that it's very unlikely an 82 year old would survive the procedure, something my aunt, a retired nurse, was well aware of. This is "good" rationing, the sort that is done in foreign healthcare systems and, yes, in the US, too, as my examples makes clear.
But also in the US: five years ago my step-sister was struck by a coworker's car in her parking lot at work. She needed knee surgery to correct an injury done her knee by this accident. Her HMO however classified this as a workplace accident, and refused to cover treatment beyond the initial exams. The driver's auto insurance also refused to cover the mishap since it occured at a workplace (and a court backed them up on this). The workers comp system however also also refused coverage by claiming (despite sworn testimony by my sister's doctor) that the knee injury was a pre-existing condition. Result: my sister could not get her surgery and walks with a limp to this day. This is, I hope everyone agrees, an absurd sort of rationing (a 35 year old woman denied a treatment for no better reason than conflicting insurance responsibilities and outright insurer dishonesty) and it would not happen under any universal care system.

Posted by JonF | May 31, 2007 12:43 PM

JonF,

No, you don't know what you are talking about.

No, you don't know what you're talking about. You keep making factual assertions and provide nothing to substantiate them. Which claims of mine, exactly, are you disputing? The existence of the Bureau of Primary Health Care? The existence of hundreds of free clinics providing health care services to uninsured or indigent Americans? Or what? Identify the precise statements of mine you're disputing, and back up your claims with evidence.

If free healthcare is so readily available than please explain the appalling number of medical bankruptcies.

Another total non-sequitur. Extensive health care services are available to poor and uninsured Americans through the programs and health centers I have described. That doesn't mean unlimited health care services are available for free. Ditto for health care services provided under an insurance plan. Bankruptcies due to unpaid medical bills happen to both the insured and uninsured. All insurance plans by necessity impose caps on expenditures and limits on covered treatments. Sometimes, people exceed these limits and go into debt to pay for their care. But more often, the primary cause of medically-related bankruptcy is not unpaid medical bills, but the loss of income that commonly accompanies an extended period of serious illness. When people can't work because they are too sick, they are likely to lose some or all of their income. When they lose income, they are often unable to cover ordinary living expenses--food, housing, transportation, credit cards, etc., etc. So they go into debt.

Ditto for the US, except it's insurance industry bureaucrats not governmment bureaucrats who do the rationing.

But the rationing is stricter when the care is funded by the government, which is why Britons and Canadians must endure long waits for consultations and treatments that Americans receive immediately, and why treatments that private insurers provide to Americans are denied to Britons and Canadians.

Posted by Seamus | May 31, 2007 2:08 PM

JonF,

Now with regard to foreign universal coverage systems, rationing is done by medical personal in the employ of the government (note: NOT by accountants, nor by "government bureaucrats"). They determine what (costly, difficult, and possibly risky) services will provide the best benefit overall.

No, the rationing is dictated by the size of the government health care budget and other political constraints, which are extremely unlikely to deliver "services that provide the best benefit overall." Single-payer health care systems are characterized by massive underfunding, leading to either strict rationing and long waiting lists for care (Britain, Canada), or chronic deficit spending (France). Governments are very, very bad at matching up the supply of goods and services with the demand for them, which is why we rely on markets for this purpose.

However the US system also rations services by two more completely illogical and random conditions: who has what health coverage or who has how much money. Not only is this a morally objectionable basis for rationing, it is also medically and economically absurd.

More utter nonsense. Do you also consider it "morally objectionable" and "economically absurd" that people have the freedom to buy better food, better housing, better education, better cars, or better varieties of every other kind of goods and services if they can afford it? If not, why is this freedom "morally objectionable" and "economically absurd" with respect to health care, and only health care, but not everything else? And if you truly believe that people should be denied the freedom to purchase better health care with their own money, do you propose to ban all private funding and provision of health care services? Do you propose to make it a crime for Americans who can afford it to travel to other countries for better health care?

Posted by Seamus | May 31, 2007 2:30 PM

Seamus,

your basic contention (if I read you correctly)is that the differences in health care provision among Western countries exist a long a kind of spectrum of (nuanced) variance RATHER than there being a fundamental gulf between the U.S. and the rest of the Western world when it comes to providing health-care. If you really think this, then I'm sorry, but you are simply out to lunch. The rest of the advanced Western countries provide quality health-care to all their citizens, and even for those non-citizens just living there. I'm sorry, but that's a basic empirical claim. And in the United States, millions of people have no health insurance, and every year, scads (I'd have to look up the number)die from curable conditions/problems that they just couldn't AFFORD to get treated. Your claims of free clinics, etc., as some kind of counter-weight to those who aren't covered is laughable. Typical neo-liberal apologetics. I would suggest you get out more often. Try living in Western Europe for a while or something. (Although I have to say that Southern Europe, Italy and Spain, do have some structural health-care issues and aren't perfect). The best universal care is found in France, the Benelux countries and Northern Europe (Germany and Scandinavia). The insular information/ideological bubble most Americans live under is really quite something.

Posted by Warren | May 31, 2007 3:49 PM

The rest of the advanced Western countries provide quality health-care to all their citizens, and even for those non-citizens just living there. I'm sorry, but that's a basic empirical claim.

Great. Then you should be able to substantiate it with basic empirical evidence. Please do so. If you can't, we need not take your assertion seriously.

Before you start, you'd better define the worthlessly-vague phrase "quality health care" in clear empirical terms, so it can be verified with actual evidence. Then you need to actually produce evidence showing that the health care provided by "the rest of the advanced Western countries" satisfies this definition, while the health care provided by the U.S. does not. By the way, are the long waiting periods for routine consultations and surgeries that are common in Canada and Britain a form of "quality health care?" The Supreme Court of Canada (for instance) doesn't seem to think so.

Good luck.

Posted by Seamus | May 31, 2007 5:27 PM

And in the United States, millions of people have no health insurance, and every year, scads (I'd have to look up the number)die from curable conditions/problems that they just couldn't AFFORD to get treated.

Yes, please do look up that number, and then post it here. With a clear citation to your source, of course. I'm looking forward to seeing your reference. You do have one, right?

Posted by Seamus | May 31, 2007 5:32 PM

Y'know, you repeatedly get your facts wrong, Seamus, on all different facets of the topic. And best I can tell, you seem to be a real scumbag as well.

Do you have an HSA business on the side by any chance?

The only folks I've seen who are this enthusiastic about pumping out misleading info on healthcare reform seem to have a financial incentive for retaining the current system.

Or are you just a rightwing scumbag on all topics?

Posted by Petey | May 31, 2007 5:42 PM

Re: No, the rationing is dictated by the size of the government health care budget and other political constraints,

Um, that's true of everything isn't it? Your own personal budget is determined (or should be) by the limits of your income or assets. Your own health plan also has its limits of what it can afford to pay, and therefore must limit its payouts (and believe me as I have worked in the industry, health plans are extraordinarily skilled at doing so!). Why are you objecting to something that is normal, universal in all areas of life, and often makes sense?

Re: No, the rationing is dictated by the size of the government health care budget and other political constraints,

OK, you are under the delusion that we are talking a single-payor haelthcare system, a la Canada (or maybe a single provider system like Britain's). Those are actually very uncommon in the world. And we are just talking about universal coverage here, not "Socialized medicine". And by the way, Medicare has these types of limits too. Ask any senior citizen if they feel they have been denied healthcare by Medicare absent a very good medical reason.

Re: ...chronic deficit spending...

Anyone who feigns a horror of deficit spending in the teeth of what George W Bush has done to this country has just committed the Absurdity of the Century.

Re: Do you also consider it "morally objectionable" and "economically absurd" that people have the freedom to buy better food, better housing, better education, better cars, or better varieties of every other kind of goods and services if they can afford it?

We are talking about something that is qualitatively different from the goods you cite, a social good that belongs rightly to all, not an individual good. Would you consider it just if the rich alone were defended by our army or alone had recourse to our courts? Same with healthcare. It belongs to everyone equally and should no more be left to the vagaries of the marketplace (where all the incentives work exactly backwards realtive to the goods you cite) than defense or justice should be. Good grief.

Re: And if you truly believe that people should be denied the freedom to purchase better health care with their own money

Don't put words in my mouth. I'm perfectly happy to see rich people buy all the face lifts and boob jobs and colonic irrigations and private duty nurses and fat farm trips they want. But necessary life saving treatments should and must be provided to all who qualify medically.

Re: Do you propose to make it a crime for Americans who can afford it to travel to other countries for better health care?

Hmm. A few days ago I told someone on these boards to put down their vodka bottle, but I think you need to pick one up and take a good, long swig. You are well into the realm of paranoia and hysteria now. I have never proposed any such nonsense, nor has anyone else, and as far as I know no country on Earth has any such law, with the possible exception of a handful of tyrannies whose purpose is to interdict travel by their citizens for any reason whatsoever. And yes, a couple countries with rigid abortion bans.

Posted by JonF | May 31, 2007 10:07 PM

JonF,

Um, that's true of everything isn't it?

No, of course not. If the government isn't paying for it (as is the case for most health care in the U.S.) then it's obviously not dictated by the size of the government budget. The amount of health care funded by private insurers in the U.S. is not limited to some maximum by government decree. It can grow arbitrarily large depending on the demand from consumers.

OK, you are under the delusion that we are talking a single-payor haelthcare system, a la Canada (or maybe a single provider system like Britain's).

No, I am under the assumption that you are talking about health care services administered by the government, because that's what you said ("rationing is done by medical personal in the employ of the government"). If that's not what you meant to say, then you need to say what you meant.

Anyone who feigns a horror of deficit spending in the teeth of what George W Bush has done to this country has just committed the Absurdity of the Century.

This statement is just a complete non-sequitur, an attempt to change the subject to avoid addressing the problem I described. The French public health insurance fund is chronically in the red. It is running massive, unsustainable deficits. That is what tends to happen under single-payer health care when there is little or no rationing of care, as in France. It is also what's happening in the U.S. under Medicare. Medicare is projected to become insolvent about a decade from now. It's a huge, looming fiscal catastrophe. The idea that we should expand the role of government in funding health care when the existing system is already headed for bankruptcy is foolish.

Posted by Seamus | May 31, 2007 10:31 PM

JonF,

We are talking about something that is qualitatively different from the goods you cite, a social good that belongs rightly to all, not an individual good.

If health care is a "social good that belongs rightly to all" rather than an "individual good," why aren't food, shelter, and clothing also "social goods?" Why isn't employment a social good? Why isn't a college education a social good? For that matter, why aren't other major types of insurance also "social goods?" In fact, what is your test for distinguishing "social goods" from "individual goods?" Do you also believe that it is "morally objectionable" and "economically absurd" to "ration" food, housing and clothing by "who has how much money?" If not, why is this "objectionable" and "absurd" with respect to health care? Why don't people have the right to buy more or better health care if they can afford it just as they have the right to buy more or better food, more or better housing, more or better clothes, more or better education, and so on?

Posted by Seamus | May 31, 2007 10:50 PM