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Hullabaloo


Saturday, January 16, 2016

 
Let 'em fight

by digby



















This argument between Sanders and Clinton over health care strikes me as a good thing. There is far too much complacency over the ACA among average Democratic voters and a spirited discussion in the campaign over how to improve the system is necessary and healthy.

Health policy expert Harold Pollack has written a useful overview of the issues on this as well as a realistic examination of the politics and structural impediments to various plans. This is the conclusion:
Some progressives hope that single-payer could provide an attractive replacement for the grubby, path-dependent logrolling that now dominate our $3 trillion health care political economy. No viable single-payer program will replace these grubby politics. That’s logically impossible, because such a program must be produced through that very same process. Barring a historically comprehensive defeat of Republicans at every level of American government, advocates for expanded health coverage will face this discomfiting reality.

Passing a single-payer plan requires precisely the same interest-group bargaining and logrolling required to pass the ACA. The resulting policies will thus replicate some of the very same scars, defects, and kludge that bedevil the ACA.

Progressives should still push for basic reforms that improve our current system. I supported the public option in 2009. I still do. I hope it resurfaces in some form, particularly for older participants in the state marketplaces . It may open a pathway to a true single-payer. If it doesn’t—which I suspect it will not—it might still provide a valuable alternative and source of pricing discipline within our pathological health care market.

Whatever policy one supports, we must actually consider how this imperfect and messy process will actually play out. There’s no immaculate conception in American politics.

He's right. I'm for single payer too. But it's very hard to see a pathway to getting it in one fell swoop. Most of our big social welfare programs have been implemented incrementally, even Social Security, and I cannot see how this would be any different under the current circumstances. And I expect that both Sanders and Clinton know that even better than the rest of us.

There are many ways to get to universal health care which is the underlying value in all this. Regardless of the method of delivering it, nobody should ever die or go broke for lack of access to health care especially in a modern, developed nation. But as other countries have shown you can successfully offer that in a number of ways. Some are single payer some are mixed (as ours is with employer mandates, Medicare, Medicaid, VA and Obamacare.) Most work a lot better than ours does although it has certainly improved with the advent of the ACA.

I don't think there's any doubt that we could do better than than what we have. The inability to mandate cost controls and our deluded fetish that competition and choice are all that's ever necessary to create low cost and high efficiency make our system ridiculously complicated for no good reason. But that's all a result of the political world in which we live and it's important to try to devise ways to outsmart the various impediments to getting where we want to go. It's time for Democrats to take on the task of creating a strategy and devising tactics to get that done and fighting over that in a presidential campaign is good place to start.


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