Monday, August 31, 2009

Why we will never have universal health care, Part One

Updated A week and a-half ago, Tgirsch at LeanLeft set out out to, as he (I assume teasingly) put it, "intentionally antagonize" me by linking to a column by one John Avalon at The Daily Beast which argued that those pushing for a public option in any health care reform bill are engaging in "all or nothing" thinking. That, Avalon insisted, is "self-defeating stupidity" and insisting on a public option is the behavior of "extremists" that will not only kill any possible reform bill but will thus damage the entire liberal-reformist prospect.

And ya know what? he says with his eyes lighting up like a five-year old about to reveal some secret. You know all you have to do to make the flowers bloom and save Tinkerbell? Jettison the public option in favor of some mythical perfect vision of co-ops anf guess what? "The reasonable edge of the opposition evaporates."

Now, the fact is, this bilge does not deserve serious response for a couple of reasons, one of which is that he is the former chief speechwriter for Rudy Giuliani and a former associate editor for the New York Sun and why liberals, progressives, and other assorted lefties are supposed to take advice from a jerk like that escapes me.

A second is that it spews the bullcrap that there is a "reasonable" opposition to serious health care reform - and does it even though he himself says "the RNC is already at work trying to paint even the co-op as government-run health care," trying to undercut his own preferred, his own save-the-day, option even before it's been formally proposed.

And a third is that it's the same old, same old: The left had better not insist on something, they better not say "this far and no farther," 'cause if they do, they will DIE!! In the eyes of Avalon and the rest of his buffoonish ilk, the left is not allowed, is never allowed, to say "this just isn't good enough." While the right (and I include the Blue Dogs in that category on this) must be appeased at all costs, the left must be scolded and slammed for daring to show a spine.

Still, it does deserve note for its perfect distillation of what passes for strategic thinking on the part of the "reasonable" Democrats - you know, the ones who aren't self-defeating extremists. And distillation is a particularly apt word because I swear he must have been drunk to come up with this crap.

Insisting on a strong public option is "all or nothing" and we should "compromise?" Hogwash! What everyone seems to forget is that the "public option" was the compromise! Single-payer has traditionally drawn public support in polls over the years, but its advocates - which included, at one time, Barack Obama - were to accept that that was "off the table" at least for now, but that in its place there would be a program that at minimum was intended to provide universal access.

And now we're supposed to compromise on the compromise and go to co-ops? Unbelievable. (Well, no, not unbelievable; all too believable. But it should be unbelievable.) The blunt fact is that while co-ops are fine on their own merits, in dealing with the issues at hand they are unquestionably utter failures: They do not offer lower costs overall and they will not significantly reduce the number of uninsured. Anything that fails at both of those - lowering costs and reducing the uninsured - and especially which fails at the latter cannot be considered reform in any meaningful sense of the word. And I really do not care what "I'll take the nail out of the stick I'm hitting you with" improvements are left over. No significant reduction in the number of uninsured - in fact, let me change that to a more general and more meaningful form, no significant expansion in access to care - equals no reform.

In a response to my comment on his "intentionally antagonizing" post, Tgirsch said:
From where I sit, and end to rescission, the preexisting condition nonsense, gender-based rate disparities, and rate hikes because you got sick, while far from being the comprehensive reform we really need, would all be worth having.
To which I replied:
Of course they would. And if those kinds of changes had been the goal from the beginning, I’d say well done. But they weren’t, and you have to do the whole equation, not just half. What do you lose in the course of getting those? What is the price? If the price is politicos and corporations being able to say “okay, we’ve done health care reform,” which means facing another generation of rising costs, rising premiums and rising deductibles, rising bankruptcies, rising numbers without coverage or access, another generation of living in a nation ranked, what was it because I’ve no time to look it up now, 30-something in health care - I say the price is too high.
The point here is that negotiations are supposed to involve give and take, give-to-get: "I'll drop this if you'll include that." But so far, it's all been about what we'll give and nothing about what we'll get in return. And that's been as true for the supposed "pragmatists" as it has been for the "extremists." It's about time we realized that every time we, meaning everyone on our whole side of the debate, offer some compromise, the response we get is "that's great, now what else will you give up?"

Out of curiosity, maybe there is something but I don't know of it so someone tell me, can anyone name anything which in the course of all these "negotiations" has been added to these bills that makes them stronger than they were when they were first introduced? I don't even mean made the whole bill necessarily stronger, but a provision that makes some aspect of the bill, I dunno, price controls or access or something, better than the original version, even at the cost of weakening some other equally-important provision. (No examples that involve giving up a diamond here to get a rhinestone there.) Anyone? With "Gang of Six" GOPper Senator Mike Enzi openly declaring "It's not where I get them to compromise, it's what I get them to leave out," let's just say I do not expect a lot of responses.

Yes, yes, I know all about sausage-making, probably more than a lot of folks reading this, having been involved in it myself. I know you never get everything you want. That's why you should never start out proposing what you will settle for or what you think will pass. You shoot for the max and then, if necessary, negotiate back to what you'll settle for.

But at some point there has to be that minimum which you will settle for. There has to be a point where you say "this far and no farther." And for me, a bill that does not have a strong public option - which is the only thing actually on the table that has the potential to get some coverage to a big hunk of the uninsured, that is, to widely expand access - crosses that line. Crosses into "too far."

So I will reverse the argument of Avalon and his fellow travelers from "if they don't pass something, anything, that can be made palatable to the naysayers, it'll be political suicide" to "if under these conditions, with big majorities, majority public support, control of the bully pulpit, and the vast power of the White House to bring pressure on recalcitrant party members, if under these conditions they can't pass something actually worth passing, they don't deserve political life."

Updated to include the reference to the RNC attacking co-ops and the link to the US ranking in health care.

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