Price of Failure

Lots of people seem to think that if we don’t get all the way to single payer (or some other abstract, personal measure of “success” in health insurance reforms) that the reform is not worth doing. I think Ezra Klein destroys that meme rather completely while noting that failure doesn’t breed more expansive second-tries; instead, it only breeds more caution on the subsequent go-round:

Truman sought single payer. His failure led to Kennedy and Johnson, who confined their ambitions to poor families and the elderly. Then came Nixon, whose reform plan was entirely based around private insurers and government regulation. He was followed by Carter, who favored an incremental, and private, approach, and Clinton, who again sought to reform the system by putting private insurers into a market that would be structured and regulated by the government. His failure birthed Obama’s much less ambitious proposal, which attempts to reform not the health-care system, but the small group and nongroup portions of the health-care system by putting a small minority of private insurance plans into a market that’s structured and regulated by the government, and closed off to most Americans.

Never get tired of talking about Nixon re: healthcare reform. Anywho, Ezra goes on:

Medicare and Medicaid began as fairly limited programs. Medicaid was pretty much limited to extremely poor children and their caregivers. Medicare didn’t cover prescription drugs, or individuals with disabilities, or home health services.

But once the programs were passed into law, they were slowly and continually improved. They became more expansive, with Medicaid growing to cover not only poor families but also poor adults, and the federal government giving states the option, and matching dollars, to include more people under the program’s umbrella. Medicare was charged with covering people with long-term disabilities, and it was eventually strengthened with a drug benefit, more preventive coverage, the option of supplementary plans and much more.

Pass something. The worst version of the Baucus bill would indisputably improve the lot of millions, millions of Americans. The main thing to focus on is keeping the outcome one that quantifiably improves the experience for many, if not most, consumers. The voters out there can accept an imperfect solution, so long as they sense they are no longer being utterly screwed by their insurance company. This will (presumably) happen the first time they make a claim, or change jobs, or (hopefully) see their premiums drop and their pay rise accordingly post-reform.

Every vote over the minimum necessary to secure passage represents compromises that the Democrats as a group would prefer not to make. It’s not that Nancy Pelosi was lucky to pass the bill, it’s that the Democrats wrote the strongest bill they could that would get enough votes to pass. That’s good strategy.

Rafe Colburn, who I currently agree with 100%.