By now, the refrain against public healthcare in the United States is numbingly familiar. A government-funded insurance counterpart to the private system is a "slippery slope" that will take us "down the path to socialism" and undo "all the good" in our current system. But just for once, let's toss the first two parts of that rote sing-song of the lobbyists and right wing, and focus on that last bit. Ask yourself this: do you know anyone - any single American citizen - who is entirely satisfied with her access to healthcare?
OK, if you know someone with eight figures in the bank, then sure; they can pay for the best of the best and jet anywhere to get it. But anyone else?
I don't. Literally nobody. Everyone I know is either under-insured, fearful of losing their insurance, crushed under the weight of costs, frustrated with complexity - or all of the above. And almost everyone I know favors public healthcare insurance of some kind. Indeed, so do most people. This week, a CBS News/New York Times poll found that a clear majority of Americans - 72 percent - support a government-sponsored health care plan to compete with private insurers.
Yet what isn't blocked by the ideology of the right, seems to run into the swamp of disinformation - namely, that we have a decent system that works well and if a bunch of bureaucrats tinker with it, we're liable to lose it.
The week after President Obama's inauguration, the New Yorker writer Atul Gawande set the stage for the coming healthcare battle with a piece that recalled the founding of national healthcare systems in England and France, and called for a realistic reformation of the broken American system:
[snip]
This is the trouble with the lure of the ideal. Over and over in the health-reform debate, one hears serious policy analysts say that the only genuine solution is to replace our health-care system (with a single-payer system, a free-market system, or whatever); anything else is a missed opportunity. But this is a siren song.
Yes, American health care is an appallingly patched-together ship, with rotting timbers, water leaking in, mercenaries on board, and fifteen per cent of the passengers thrown over the rails just to keep it afloat. But hundreds of millions of people depend on it. The system provides more than thirty-five million hospital stays a year, sixty-four million surgical procedures, nine hundred million office visits, three and a half billion prescriptions. It represents a sixth of our economy. There is no dry-docking health care for a few months, or even for an afternoon, while we rebuild it. Grand plans admit no possibility of mistakes or failures, or the chance to learn from them. If we get things wrong, people will die. This doesn’t mean that ambitious reform is beyond us. But we have to start with what we have.
Dr. Gawande went on to argue (and remember, the Inauguration "change" glow was turned up to eleven) for a sort of "lifeboat" to help get that broken, patchwork system to an eventual public program that mandates (and pays for) coverage for everyone. The cancer specialist followed up with a fantastically incisive story four months later, looking at healthcare costs in McAllen, Texas - the highest in the country - and how an entrepreneurial business-oriented system has incented institutions and doctors to run up massive costs that do not improve either individual outcomes or community health.
The case is pretty clear, and as Dr. Gwande's reporting (and experience) illustrates, there is a path to massive reform and away from market-dominated healthcare - which, by the way, will relieve American companies of a burden that holds down both hiring and innovation during a killer recession. Yet we're starting summer in full staff mode: the Senate has entirely rejected any public options. The House says a public option is a prerequisite to any action. And the Obama Administration still seems to be listening and reflexively yearning for compromise, despite an incredibly rare political opportunity. Amazingly, the Administration may fail in its central healthcare promise - even without going to the mat.
I think that Digby, who has been doing important work in blogging this issue and taking on the reluctant and rudderless Democratic Party, has it entirely right:
It's not only necessary for the health of the economy to make some big systemic changes --- it's a political opportunity to challenge this free market, CEO worshipping fundamentalism as well. It doesn't appear that the Democratic party is interested in doing that, at least not yet, since they are as wedded to the system as the rest of the ruling elite. But it's an opportunity for someone.
Recommended reading:
Matt Yglesias: Public Opinion Strongly Favors Public Plan
Glenn Smith: Slavery and the Health Care Crisis
from Amazon.
