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Is Half a Loaf Better Than None?

That is essentially the question Josh Marshall asks about health care reform. And the answer is, when it comes to health care reform, half a loaf may well be worse than none:

In light of Max Baucus’ now circulating health care bill, Josh Marshall asks if he is “the only one who thinks that if the Dems pass a bill with mandates and subsidies for poor and moderate income people to purchase it but no public option or competition with the insurers, that it will be pretty much a catastrophe for the Democrats in political terms?”

As it so happens, he is not the only person who thinks this will be a catastrophe for the Democrats. As he notes, this kind of half-reform leaves Democrats in the worst possible position; it forces poor and moderate income people to purchase still-expensive insurance without providing adequate subsidies or substantively regulating the insurance market. A plan this timid would rightly be perceived by most Americans as burdensome and inefficient, and voters will respond accordingly in next year’s elections.

As I’ve said many – many – times, congressional Democrats need to realize that their electoral fortunes are tied directly to passing good legislation.  Not only will voters like and respect the party that passes effective health care reform, but Republicans will be completely discredited when health care reform passes and a year from now the United States hasn’t slipped into a commie/socialist/fascist totalitarian dictatorship. Rick Perlstein describes programs like Social Security and Medicare as efforts that created more Democrats, and if the party leadership really is interested in building a durable, long-term majority, it needs to remember that successful legislation leads to successful parties, and vice versa.

Ironically, the inability shown by the please-Republicans-at-all-costs faction in the White House to take this long-term view mirrors the seeming inability of many Republicans to see beyond the immediate costs of a robust public option:

The talking heads and the right wing still don’t admit that we all pay for lousy health care in the end. We pay hugely in lost wages, in lost lives, and in absurd last minute emergency care for trivial, manageable, chronic illnesses. We pay at the end, but as always we could save money and improve lives by agreeing to pay up front and at the start. It is essentially the same debate we have about Public Education vs Imprisonment. People who get a good public education and have good job prospects seldom end up in Prison. A year of Prison costs much more than a year at Harvard. And yet we can’t, as a society, bring ourselves to pay the money up front to improve lives–that would be socialism, or charity, or something. We are only willing, and that grudingly, to pay to punish people. The fact that the money is fungible and all comes from the same source, the taxpayer’s pocket, seems lost on our public discourse.

TMV’s very own, very valued commenter, Ron Beasley, thinks we are better off with no bill than with a bad bill:

The health care crisis in this country is going to have to get even worse and it will before legislators are forced to reform it.  [Matt] Taibbi concludes that it will take a revolution and we are to blame for it not occurring this time around.

Then again, some of the blame has to go to all of us. It’s more than a little conspicuous that the same electorate that poured its heart out last year for the Hallmark-card story line of the Obama campaign has not been seen much in this health care debate. The handful of legislators — the Weiners, Kuciniches, Wydens and Sanderses — who are fighting for something real should be doing so with armies at their back. Instead, all the noise is being made on the other side. Not so stupid after all — they, at least, understand that politics is a fight that does not end with the wearing of a T-shirt in November.

So we would be better off with no health care bill at all now.  The train wreck will only get worse and at some point the legislators will be forced to act.

  • Leonidas
    If you don't want your 1/2 Can I haz it?
  • vey9
    So what we end up is Corporations: 10 & Citizens: 0.
  • JeffersonDavis
    A few things need to be implemented in any possible health care proposal:
    1. Put in place a "wellness" plan that emphasizes and rewards good lifestyle choices (through lower premiums).
    2. Requres doctors to at least TRY to cure their patients, instead of immediately "treating" the symptoms.
    3. Eliminate frivolous lawsuits for doctors that act in good faith.
    4. Regulate the insurance industry with massive sweeping reform.
    5. Regulate the pharmaceutical industry with price caps on prescription drugs, and allow doctors to choose homeopathic remedies if available.

    As I've told my liberal brother, Father_Time, after he stated (correctly) that the healthcare system is set up to "rape the public for all you can get under the guise of free enterprise":

    we had the same situation with labor in the 1920's and 1930's (coal miners, steelworkers, sweatshops), where corporations raped the worker to maximize profits.

    We fixed that problem, not through nationalizing the industries and adopting socialism; but through legislation and oversight through a newly created Department of Labor. Capitalism is still alive and well in those industries.

    Similarly, socialism is not needed here. We could fix the problem through regulation and actually using the Department of Health and Human Resources for it's original purpose: overseeing and regulating the healthcare, health insurance, and pharmaceutical industries.
  • stephanie2009
    Changes which reinforce and further empower a broken status quo is not reform. And it is immoral to require citizens to further subsidize it. Period. We can make some changes in terms of regulation, but passing bad policy is bad policy, period. It does not help reform the system nor does it help the American people.

    I think a line should be drawn in the sand that enrollment mandates cannot be instituted if what is available is still based on a for-profit system.

    If people don't want the public option (which they do in the majority) or a single-payer insurance (which is the most efficient and would mean our reps are in the same system we are), then we should at least draw the line at for-profit insurance companies.

    Look at Minnesota. They ban for-profit insurance companies there, as does ALL of the industrialized world. As a result, their overhead is only 9 cents of every healthcare dollar - which is still nearly double Medicare's 5 cents and ten times of Canada's 1.5 but a huge improvement over the 20-30+ cents you see in other states using for-profit models.

    People cannot afford to buy into the system as it exists at this time. And, there is just not one good reason to create policy which mandates a broken, for-profit status quo.

    People talking about tort reform as healthcare reform are missing the lessons learned from it. Texas did it. Malpractice costs decreased a meager 1.5% (PA got something like 10.5% due to higher competition). There was no 'trickle down' to the patients. In fact, healthcare costs rose. Quality 'decreased precipitiously'.

    There are other, safer ways to go after the nebulous 'defensive medicine' claims. It should start with finding out definitively what if any role it is playing here, but a complete, accessible medical record, physician time to consult and collaborate with other medical providers and standards of care are far more effective and reasonable. In addition, the single most important factor in whether a patient sues in the face of medical errors is their relationship with their MD. If the MD takes time to get to know them and develop a positive relationship and apologizes when mistakes are made, malpractice drops preciptiously instead of quality of care.

    What is needed is change which creates a patient-centered system of care, not a corporate, shareholder, profit centered approach.

    And let's not forget the role of unions in fixing the problems with labor in the 20's and 30's - though your point, JeffersonDavis is noteworthy in that it indicates that government intervention is not a dive into some socialistic hell.

    Even today, healthcare costs are rising and insurance companies are defending their 'rescissions'. 12,600,000 people have been denied insurance due to pre-existing conditions. Others pay far more for policies. In the past 18 months alone, California's 5 largest insurers paid almost $19 million in fines for marooning policyholders who had fallen ill. That includes a $1 million fine against Health Net, which admitted offering bonuses to employees for finding reasons to cancel policies, according to company documents released in court. Insurance companies pay 1.2 million daily for lobbiests on Capital Hill. Their numbers are four times the number of our Congress. This money is apparently nothing to them compared to their profits.

    Bottom line? This system is not a little broken and in need of a little tweaking. The problems are deeply rooted - and deeply embedded into our country, apparently. It requires fundamental reform.

    If there is not the will for that in the US, that's a tragic thing for all of us. Good, responsible, hard-working people are in a world of hurt. All but the very rich are one lay-off or medical issue away from catastrophy. Others, like myself, sacrifise our health to preserve our healthcare while insurance companies profit. My career is my calling and yet...everything else in my life suffers because I have to keep my job to keep my insurance. Private practice is out of the question. So is relocation. So is taking a period off from employment to focus on long-neglected areas of my life. I can't imagine doing this for 20-30 more years. And I am one of the 'lucky' ones, so far...
  • DLS
    Poor extremists, not getting What We Want, NOW!

    Here's a better site for the extremist viewpoint.

    http://www.pnhp.org/
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