Thursday, September 10, 2009


I think we have arrived, almost by chance, at a suitable means by which we can fashion a solution to the question of health care financing. I'm going to propose we tentatively adopt the concept of Individual Health Care Savings Accounts as our starting point. In future posts I'll refer to them as HCA's.

This is important, and reflects on the nature and purpose of our blog altogether.

As you know, health care reform is turning into something of a Mexican stand-off, both in Congress and the public. I won't ask you to agree with this Steve, but I like to think Republicans in Congress are cynically manipulating this issue as a matter of pure politics. They lost handily in the last election and have been looking for a way to redefine themselves as the party of fiscal responsibility and traditional values. Cynthia Tucker, who I never considered an intellectual heavyweight, this time nailed it:

"...Take those recent polls showing that the public has suddenly grown very concerned about ballooning deficits. Last month, Quinnipiac University released a poll in which respondents said — overwhelmingly — that they are more worried about the deficit than they are about fixing the health care system... Another factor is household debt, which, for many voters, can seem to mirror national debt woes. Americans understand their own personal circumstances, which often include high mortgage interest payments, staggering credit card debt and shrinking savings. Their personal budgets serve as a reminder of what can happen when an individual or a government takes on too much debt... " (my emphasis)

So, massive new government programs, like TARP, the Stimulus Plan and now Health Care Reform are being framed as wildly irresponsible, particularly during this time of recession and a shrinking economy - and this is a criticism which appears to be gaining traction. Whether you agree with this criticism or not (I suppose you do), its hard to argue that Republicans have any political motivation to negotiate in good faith. Tellingly, although Republicans mostly agree that reform is necessary, they haven't come up with any kind of detailed alternative whatsoever - other than the standard, vague platitudes.

Now I'm sure you have a higher opinion of Republicans than I do. But regardless, reform has become a political football, and both sides are now apparently calculating the effect of the issue on the next election - as opposed to whatever benefit or harm it will result in for the American public. Which brings us to you and me.

If we ever do arrive at a finished plan (I think we will), both of us are going to have to accept ideological compromises. I sincerely believe you are capable of that - and, despite my frequent ravings - I think you know I am too. That's the cool thing. And, HCA's are the perfect vehicle to begin sorting those compromises out. If properly constructed, they would have a mechanism which allows for consumer choice, which you favor, and universal access to a basic level of government sponsored health care, which I favor.

I think you already planted the seeds of compromise in your first post (7/28), where you said:

"A. The primary objective is to provide Health CARE (not “insurance”) to those who legitimately 'need' care, but are unable to pay for it for whatever reason.

B. Private (personally controlled) insurance programs must remain viable and available.

C. Any Government action must be designed to provide actual SERVICES, not simply payment or other types of funding transfers....

and then:

"I propose we start by expanding the existing VA program, which is absorbed into a new, comprehensive service-providing system."

I believe later on you asked why I hadn't responded to these basic ideas. Well, I thought they were excellent - but as usual, I am always getting caught up in all the crap flying around outside LRA&H and probably spent too much of our time blogging on that. Oh well. Give a Lib a break here, after all, we're the ones who turned tree hugging into an art form. This comment in your last post dovetails nicely into those earlier points:

"Likewise, we must directly and carefully address the SUPPLY side of the equation, not just the DEMAND side. "The demand for a free good or service is infinite." (That horse should be dead by now, but as long as it moves, I'll keep shooting at it.) If we don't address the staffing requirements for providing services, we will FAIL. Having the government HIRE and encourage the creation of *new* trained staff is critical. Simply working out an alternative payment plan is ineffective in the long run."

Next I'm going to start crunching some numbers. Be advised that I don't ever agree with everything you say. As a matter of fact, some of the things you accept as given actually horrify me. However I'm going to use as a starting point the bizarre idea that health care reform can be managed without one single cent of additional tax. Not only that, but it will also put a great deal of money currently spent in the private sector, back in our pockets. Imagine that!


P.S.: Sorry for the length of this post - since it really doesn't advance our agenda with any new stuff. But this is the first time we have agreed on a contentious issue and I don't feel creepy about it. Peace...

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