We've Got The Facts and What Good Will It Do Us?

Ezra Klein describes "the central reality of health care politics," namely "most Americans are basically happy with what they have, but worried about keeping it. Policies that guarantee their futures are quite popular. Policies that radically change their presents are not."

Few if any journalists are any better plugged in to Democratic conventional wisdom about the politics and policy of health care than Ezra is, so this nicely encapsulates my mystification about what, exactly, it is everyone's doing. The underlying presumption here seems to be that if you devise a policy that does not, in fact, change anyone's current insurance then you'll be in good job. But if there's a policy that health insurance companies and others think it's worth spending a lot of money to defeat, they'll just say it will change your insurance for the worse and the fact that it's not true isn't going to be especially helpful in beating that argument back. Meanwhile, it puts the Democrats in the slightly bizarre situation of simultaneously arguing that we urgently need to pass a fundamental overhaul of the health care system, but don't worry, the changes won't affect insurance for the vast majority of you.

It seems to me that if it's really true that most people are happy with their health insurance and don't want to see the boat rocked (and since even liberals seem to concede that this is the case) that the prospects for fundamental health care reform are just very very bad and it would be better to settle for a more modest health care agenda and spend political capital on other things. After all, it's not as if the task at hand on the climate change front is so trivial and easy that there's nothing else to do but pass a health care reform that the public isn't demanding.

Alternatively, maybe the plan is to take the already somewhat odd mandate schemes that are currently on the table, then take out their best provisions — the public private competition, the stiff community rating rules, etc. — and wind up with what amounts to a package of subsidies to health insurance companies. Then you defuse interest-group opposition, making public opinion largely irrelevant, and giving your campaign contributors their money's worth.

Comments

It's also possible that Democrats want to shakedown the insurance industry for campaign donations. Blackmail is only convincing if the target thinks there's a chance of some bill contrary to their interests might pass.

Posted by stm177 | October 31, 2007 9:07 AM

Welcome to Lake Wobegon -- there may be problems in America, but Americans, by and large, are satified with their little corner of it. Or, maybe, they don't want to rock the boat because they think that no matter how bad it is today, it might get worse.

Posted by freelunch | October 31, 2007 9:11 AM

I am both somewhat happy with my current self-paid health insurance program, as long as nothing huge and expensive happens which would utterly bankrupt me, and I also would welcome some reform which placed me and my neighbors on firmer ground.

Posted by El Cid | October 31, 2007 9:12 AM

You can call it whatever kind of initiative you want. But if it doesn't confront the fundamental moral issue of 47 million people without coverage of any kind, then I don't particularly care what political capital it costs. So look-- under your modest changes, can someone still be denied treatment by their insurance company for necessary procedures? Could someone still have no coverage and no way to pay for treatment on their own? Would millions of people still not take part in any preventative care whatsoever because of the expense? And would anyone not meet a certain minimum threshold of quality of medical care based solely on their economic status? If the answer to any of those question is yes, than fuck your compromise.

I find the attitude that says "This position is moral, but it's too hard of a fight-- let's not fight it" to be really, really despicable.

Posted by Freddie | October 31, 2007 9:21 AM

I have a pretty good, corporate provided health care policy through a major insurer. While mostly happy with it I think my contentment may be largely due to the fact I seldom have to use it for major problems. Otherwise it sucks. My teeth are forever needing something or other done and the dental portion caps out after about two fillings or a crown. The optical pays for roughly a 5th of the cost of a check-up and new lenses/frames. My prescriptions have co-pays and you need an MBA to understand the reasons some drugs are full reimbursement, some cost you a little, some cost you a lot and some require you hold up a bank before proceeding to the pharmacy. If you do have some sort of issue requiring tests, an overnight in the hospital or a tricky procedure you're forever getting letters from everyone but your dead mother-in-law wanting money because in essence "Hey, your insurance sucks, you just didn't know how bad until now, send us our goddamned money!" Everyone I know regardless of where they work or who their carrier is pretty much has the same experience. I think since most people aren't chronically ill or always having to go to the hospital they're happy with what they have and don't want it altered. It's not a satisfaction because of quality coverage, it's becuase they don't use it often enough to know how much it really sucks.

Posted by steve duncan | October 31, 2007 9:23 AM

It seems to me that if it's really true that most people are happy with their health insurance and don't want to see the boat rocked (and since even liberals seem to concede that this is the case) that the prospects for fundamental health care reform are just very very bad and it would be better to settle for a more modest health care agenda and spend political capital on other things.

Tomorrow and tomorrow and tomorrow creeps in this petty pace from day to day.

Posted by Duncan Kinder | October 31, 2007 9:29 AM

I was in Europe (Germany) at the time that the currency shift to the Euro happened. By which I mean the superficial shift of the physical money - the banks has shifted earlier. What was interesting about the process was the nearly universal opposition to it. Nearly every country involved would have rejected the Euro if it were put to a popular vote. But the central forces that be decided this was going to happen - it wasn't an issue for public debate. Living in Germany more recently, I found scant if any lingering fondness for the old D-Mark.

One can quibble about whether the central forces were correct that this was a good move for Europe, which is not analogous to American health care (it's hard to argue sanely that saving half the cost and keeping the quality of care is a bad thing). But what is analogous, I think, is the route to change. Change is going to happen here because of GM and the shift in corperate America's perception of health care, not because of popular approval.

Posted by Ben V-L | October 31, 2007 9:34 AM

Serious health reform will come when businesses get tired of paying for it, and that day is not far away. My guess is that if you offered General Motors and Walmart the option of paying a fixed payroll tax and let them get out of the insurance business, they would take that deal.

Posted by Robert Sullivan | October 31, 2007 9:36 AM

Yes, it's true that most people are happy with their present health insurance.

But most people are also afraid of the possibility of losing their present insurance, and wonder if they're one downsizing, or one expensive hospital stay, away from losing theirs.

Think that fear has no political potency? I bet it does.

They're also aware that a lot of people have no health insurance at all, and genuinely believe that everyone should be covered. That may not be as powerful as the fear angle by a good margin, but it's still nontrivial.

And in an era where people have heard all the lies from the corporate tools already, an outright lie from the insurance lobby ("they're going to mess with your insurance") is going to be a lot less potent than you'd expect when the pols stand up and say "no we're not - we're not doing anything to your current insurance, unless you decide to trade it in for the government-backed option."

In short, I think the environment for passing a Hillary- or Edwards-style universal health care proposal will be really quite good after the 2008 elections, when the Dems should have picked up at least a few more Senate seats.

Posted by low-tech cyclist | October 31, 2007 9:53 AM

Odd that you always seem to find evidence of your predrawn conclusion.

One of the key differences is that passing universal healthcare will actually earn political capital, just like Medicare or Social Security. While I agree Global Warming is a big crisis, the solutions (cap and trade or carbon tax) will cost political capital, even after they pass. In fact they seem likely to cost more afterward, at least in the short term, due to increased costs than they will in passing them.

That isn't to say we shouldn't pass carbon controls, but it would be better to go into the next election with a new positive services as well.

Posted by AJ | October 31, 2007 9:57 AM

Errr, or maybe people aren't all about them? I'm a relatively young, healthy person, so I'm ok with my insurance. My grandmother, on the other side, has a crappy, crappy deal.

I would like to see her deal get better, and am willing to see a change in my system because I love my grandmother, and because the way it is right now I'm afraid of where I will be in 20 years.

Posted by Dan | October 31, 2007 10:25 AM

The only people happy with their health insurance are totally healthy people who don't have medical problems. Everybody else would be quite happy to see major changes imposed on their insurance companies with their pre-existing conditions, pre-certifications, incomprehensible benefit packages, and arbitrary denials of claims.

Posted by Ron | October 31, 2007 10:53 AM

" ... most people are happy with their present health insurance ..."

Most people who work for corporate or government are, I'd say.

Separate out the audiences. Address small business owners (up to, say, a dozen employees, but including the self-employed). Non-owner employees of those business.

This is a boatload of people. Collectively, they are not overwhelmingly in either camp. The percentage who are satisfied with their health insurance is surpassingly low, believe it.

Posted by drinkof | October 31, 2007 11:06 AM

So why not simply offer universal Medicare as an option at some break-even premium and let people switch to it if they so desire? Or stay where they are....

Posted by elle loco | October 31, 2007 11:13 AM

The last time there was an attempt to overhaul the health-insurance system, the Democrats could claim 259 Representatives and 56 Senators, not to mention the presidency--and still it failed. Methinks there's a lot of work to be done.

Posted by Henderstock | October 31, 2007 12:04 PM

10 years ago and 5 years ago I was quite happy with
my employer-subsidised health insurance: the
premiums were cheap, the copays were low, there
were no deductibles. But it's gone downhill
rapidly: now I don't have an HMO option, the
premiums and copays have gone up, the deductibles
are just terrible, and on top of all that they're
so slow in paying claims that it's impossible
to keep track of which claims have been denied and
which are just going through the system really
slowly.

To provide a specific example, one of my two-year-
old twin boys has asthma. When he first had an
asthma attack, we took him to the pediatrician,
she sent him on to the E.R., and he was admitted
for an overnight stay. That resulted in about
$2-3000 of bills, and cost us $600 out-of-pocket
for his individual annual deductible. I'm lucky
enough to be able to pay that and move on: but
a lot of people are going to have to think twice
about getting their kids the care they need even
if they're supposedly "insured".

And since I'm in a pretty mainstream corporation,
I'm fairly sure this is a widespread trend.
Employers used to be able to afford generous
healthcare plans; now they're squeezed between
rapidly-escalating premiums and stockmarket
pressure for profits, and the outcome is that
the employer-provided healthcare system is just
rotting away as they provide worse and worse
coverage for fewer and fewer employees.

I have a strong suspicion that individual
mandates like Romney's Massachusetts plan are
just going to accelerate this trend until
most so-called "insurance" policies become
cheap but almost worthless, leaving the sick
(and/or the relatives of the sick) with
thousands of dollars of unpredictable out-of-
pocket costs.

Bottom line: we need a single-payer system so
that the healthcare industry has an incentive
to provide health, not just to make profits.

Posted by Richard Cownie | October 31, 2007 1:13 PM

Being ok with your current plan doesn't mean you're happy with your health care situation. I'm happy with my plan, but scared to switch jobs on the chance I get either a not so good plan or, worse, get diagnosed with something terrible in the gap between my jobs. Cobra works sort of, but people aren't saying they're satisfied with Cobra.

Posted by crack | October 31, 2007 2:05 PM

How can you be happy with something that in a few years you won't be able to afford. What's the average insurance for a middle class family of 4? Somwthing around $1200/month if I rememeber correctly. And that goes up 8-12-15% a year. Even if your employer is paying a good chunk of it now, how can they continue to do so? My wife's employers have changed health insurance three time since she started working for them. Each time the deal gets worse. I think we pay about $400/month plus copays and deductables. So, for me, the main problem with our health care system is that it is unaffordable. That is what has to be fixed.

Posted by cw | October 31, 2007 3:29 PM