So, obviously the big issue of the day (month, year, etc.) is health care. I'll preface this post by stating that I have a few different views of how I see health care and the health care debate:
1. We can do a "realist" analysis where we limit our expectations on what can actually get done and judge health care based on that. Taking into account the kind of dollars that flow from Big Pharma and the insurance industry into the coffers of Congress (yes, Little Timmy, into the warchests of Democrats too) helps us stake out what we think might actually get accomplished. In the end, this is more or less where I'll fall in terms of whether I consider what ends up getting passed as a net gain or not.
2. That said, it still behooves us to seriously consider what it would
actually take to "fix" health care. I don't think of this as dreamy pie-in-the-sky nonsense but, instead, the kind of analysis we all need to be doing on this and any other number of issues. Then, we can analyze the "realist" alternatives and pick the one that at least
begins to get us traveling down the road to real solutions to the problem at hand.
3. In terms of opposition to Obama's plan, while I have a number of reservations about it and may ultimately not support it, let's call a spade a spade: most of the vocal opposition to the plan has been utterly nuts. This does terrible damage in a few ways: a) It makes opposition to health care reform look ridiculous
in general, b) it further marginalizes honest opposition and criticism of the Obama Health Plan (or its variants), c) in marginalizing those criticisms, it seriously cripples the chances of actual, constructive input being given to help make the health care reform bill better - or at least less bad. While it shouldn't be surprising to anyone who pays any attention at all to politics, the health care debate has obviously been dominated by a team-first oriented approach and, especially in the case of the opposition, tactics of pure obstructionism. It's not surprising in the least, but it's still disappointing and it's
hurting this country.
4. I have no interest in debating whether Obama is good or evil or thinks he's doing right or wrong. I supported him in his election bid and I believe he generally thinks he's pursuing policy that will help most Americans. To me, most of issues here are institutionally grounded and playing musical chairs with leadership wouldn't be too helpful anyways.
Okay, those bits are out of the way and point #3 was a bit longer since I don't plan on revisiting crazy claims about Death Panels and all that - mainstream Dems have to spend enough time countering that stuff so there's no point in rehashing the more insane criticisms here. Moving on.
Let's start by laying down some framework for what we're talking about. We can generally discuss health care reform by
reading about it, to there isn't really any reason not have a basic grasp of what's being proposed.
So, in a nutshell, the plan is to tighten up some regulations on insurance providers making it harder for them to kick your coverage due to pre-existing conditions and to force some increases in who private insurers can cover. Fine, I guess. Unlike some of my fellows, I still think the plan outlines by Obama will make things a bit better than they are now, especially if some sort of "public option" is developed. However, even the sort of public option envisioned by Obama et al. is no great shakes - just something akin to an option of last resort. Ah well.
The biggest problem is that, despite how heated the debate on all this has been, there's a distinct whiff of "re-arranging the deck chairs on the titanic." If you look at the plan, not much is
actually changing. We're really just re-adjusting and making some new incentives and regulations. But nothing very major in
any way. Look, the way I see it is that health care reform can go down three different routes:
1. A shift towards Canadian or European-style government run health care.
2. The status quo with some minor shuffling of incentives and regulations.
3. A libertarian/anarchist approach that would eliminate state-privileged monopolies and regulatory systems, more on this in a moment.
It seems insane to me that anyone could
watch last night's speech by the President, read the basic analysis of the plan, and come away with any conclusion other than this is falling squarely in route #2. This should be one of those "no duh" kind of things. Even if the discussed "public option" makes it in, that's no real game changer in terms of the analysis. Now, the "realist" analysis in me says we really shouldn't expect options #1 or #3 happening anyways, so as far as "status quo" options go, Obama's plan is alright I suppose. But it kind of feels like I'm being forced to answer the eternal Mountain Dew or Crab Juice question here. There has to be a better way, right?
Well, yes, exactly right. Either options #1 or #3 would, to my mind, be a major improvement over what we have now. Minor tweaks here and there might help a few people out - and I certainly don't want to marginalize their experiences or be petty enough to suggest they don't matter - but in terms of a long term policy solution, the adhesive bandages just ain't gonna cut it. Now, the upshot of even this tepid reform plan is that it at least starts framing some of these issues in terms of a path that could lead route #1. Small comfort maybe, but hey, that's the upshot.
Maybe this makes me a bad libertarian lefty, but I can't help but look at countries like Canada and think: "that's still a hell of a lot better than what we have now." So, if this is the first baby step to that kind of system I'll be (sort of) happy. To my mind, the promise of expanding state power at least has the
possibility of enticing our lawmakers into going up against the insurance and pharmacutical companies. And, in this blogger's humble opinion, it's at least slightly better to have power amassed in the hand's of a state apparatus that purports to serve the will of the people than a handful of multi-national corporations that don't even pretend to serve anyone but their shareholders. Again, I guess I'll take the crab juice here.
The above point #3 - an anarchist/libertarian approach to health care - seems ultimately the most satisfactory to me. A good write up of it can be found
here. I think, if nothing else, this critique should serve as an excellent starting point in terms of what really needs to get done to fix health care. From the linked article:
- Stop offering protection to patents and copyrights.
- Eliminate hospital accrediting and professional licensing rules, leaving a variety of flexible, competing market-based certification systems to do the job.
- Limit malpractice awards to actual damages plus the costs of recovery (including reasonable legal fees).
- Repeal regulations that prevent the sale of insurance across state lines and the prevent the operation of what amount to insurance schemes by health professionals.
- Alter the tax code to de-link employment and insurance. (This change would have the potential to boost net taxes, of course, if it weren’t made in tandem with the tax cuts for which I’ve argued.)
- Replace the FDA approval process with alternative, voluntary private certification systems.
- Eliminate agricultural subsidies.
So, at best, Obama's plan is only addressing a sliver of the overall problem. While doing some tweaking on the insurance end of things may bring some welcome changes (hell, I trust an insurance agency to do right by me about as far as I can throw 'em), we're still firmly entrenched in "deck chair" mode until some of those points, ESPECIALLY points #1 and 2, are addressed.
Once you accept the bulk of those points as basic problems with health care here in the United States, the obvious solutions become ones of deregulation, but real deregulation. It's not enough to faux-deregulate and keep monopolistic powers entrenched. The whole point is to open up the arena of health insurance to allow lots of people to offer it, provide cheap medicines and medical services, and give real, sustained access and choice to people.
So, here's where the judgment call comes in. If the libertarian/anarchist model is the preferred choice out of the three presented, does it make sense to set a path towards socialized medicine first? In other words, does pursuing #1 as a short-to-medium term goal derail efforts towards the long-term goal of #3? In my judgment, the two need not be mutually exclusive efforts. While we have to be wary about the growth of state power, I still see the growth of state power at the expense of the insurance and pharmaceutical industries as something that's easier to manage and fight in the long term.
In terms of reform, I foresee (rose colored glasses on here) a gradual process that simultaneously develops a Canadian/European style socialized health care system while at the same time loosening the stranglehold on copyright and patent protections. I think that given some of the unique tendencies in American society and politics, the government won't ever eliminate - or hobble as critically - the private insurance industry as we see in other countries. I hope that as plans to develop state run health care progress, the counter-balance will be increasing deregulation of private alternatives to placate citizens concerned with the amassing of state power. This has the benefit of accomplishing some of the goals set forth in an anarchist health care plan while framing it in terms of what we may realistically expect policy-wise.
At some point, of course, the state as an entity needs to be dealt with, but hopefully by that point we'll have seen enough deregulation and opening in the private market that most folks will come to see the state option as superfluous. That's the hope anyways.
How do we accomplish this? Obviously, this is a long term plan and whatever happens with Obama's health care bill (personally, I think a bill
will be passed) the long term goals and considerations can't be forgotten or overlooked. Unlike some of my voluntaryist friends, I still see value in working within institutions. Indeed, I think there would be a real public current in favor of my loose program of the simultaneous development of a state option coupled with deregulation in the private sector. Since health care is regulated and controlled to the hilt right now, people looking for alternative solutions need one of two things to happen: 1) the collapse of the state or 2) deregulation from the state. While I see the first option as possible goal in the long term, in the short and medium term I think deregulation is a possible and, dare I say
realistic goal. While the nature of the state is always towards increased power and control, careful vigilance can stem some of this and, in some areas, even roll back this control. I think a careful program of working both within the system and without it may yield some success.
In any case, I think we've all gotten to the point where we realize
something needs to be done - because plans to simply perpetuate the status quo will lead to ever increasing misery. Let's hope we can see real positive change in our lifetimes.
Further reading:
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Health Care: An Anarchist Approach by Gary Chartier
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How Government Solved the Health Care Crisis: Medical Insurance That Worked - Until the Government "Fixed" It by Roderick T. Long
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Forcing Insurance Companies to Cover Preexisting Conditions is Immoral by Sheldon Richman*
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Obamacare: Status Quo on Steroids by Sheldon Richman**
*Addendum: In the comments section, Gene posted a link to the above linked article. I've included it since I think it's some excellent food for thought. I've given some cursory reactions in the comments section, but some of the issues discussed may be worthy of a dedicated post in the future.
**Addedum II: Gene has posted another excellent link in the comments section, added here. Another from Richman, this delves into some other important/interesting issues touched on in this post and worthy of further considertation.