Monday, August 17, 2009

Health Insurance Reform

The lefty blogo-sphere is inflamed... that the White House is indicating that it isn't wedded to a "public option", and my fellow liberal bloggers are pressing progressives in the House to vote against any bill that doesn't have it. If you don't have progresssives on board then you don't have a bill. Thus the question is whether it's better to get nothing if reform doesn't include a public option. The answer here is unquestionably no... as Paul Krugman pointed out yesterday, universal coverage without a public option looks like what the Swiss do:
Switzerland offers the clearest example: everyone is required to buy insurance, insurers can’t discriminate based on medical history or pre-existing conditions, and lower-income citizens get government help in paying for their policies.

In this country, the Massachusetts health reform more or less follows the Swiss model; costs are running higher than expected, but the reform has greatly reduced the number of uninsured. And the most common form of health insurance in America, employment-based coverage, actually has some “Swiss” aspects: to avoid making benefits taxable, employers have to follow rules that effectively rule out discrimination based on medical history and subsidize care for lower-wage workers.

So where does Obamacare fit into all this? Basically, it’s a plan to Swissify America, using regulation and subsidies to ensure universal coverage.

If we were starting from scratch we probably wouldn’t have chosen this route. True “socialized medicine” would undoubtedly cost less, and a straightforward extension of Medicare-type coverage to all Americans would probably be cheaper than a Swiss-style system. That’s why I and others believe that a true public option competing with private insurers is extremely important: otherwise, rising costs could all too easily undermine the whole effort.

But a Swiss-style system of universal coverage would be a vast improvement on what we have now. And we already know that such systems work.

That's not particularly awesome... and I'd rather Medicare for everybody too, but I don't know where you find the votes for it. There are very good reasons for the inclusion of a public option... essentially, we'll need "bigger government" to effectively regulate the private insurance market... but it's not more important than reforming insurance itself. I'd rather see a more forceful effort being made to convince Blue Dogs (and Americans in general) why the public option is a really good idea, but if "socialism" is such a dirty word that you can't make people see sense about it, then I'd say you drop it and come back for it later. Of course, I don't mean to suggest that progressives should stop raising a ruckus about any plans to kill a public option... I just don't think it should be our Alamo. Getting Swiss style health insurance would be worlds better than what we currently have, even if sub-optimal.

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