On One Hand

March 23, 2010

Healthcare Reform: Post-Mortem

Filed under: culture,elections,policy — ononehand @ 1:05 am
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Two comments; first: Yeah! We did it! Change!

And then: what the hell happened?

We had a popular new Democratic president with outstanding rhetorical skills, elected with the biggest percentage of voters in 20 years – largely on plans to reform healthcare – allied by the biggest Democratic majority in congress since 1976 – and in spite of that it took a year-long, caustic and fierce battle to the brink of political suicide to enact a bill that is so moderate and incremental that a liberal Republican could have thought of it. Indeed it has key elements John McCain supported in 2008 and looks somewhat like what Mitt Romney enacted in Massachusetts.

I’ll say it again: “Obamacare” is moderate and incremental. It doesn’t go as far to cover everyone as we will need to go in the future, and some will say it doesn’t even go far enough for now. Yet we’ve come out with a country more divided, with a more fearful status-quo, than we have seen since the Civil Rights era.

Lets create a scale of government involvement in a healthcare system for perspective. A totally government-run and non-optional healthcare system where all doctors and healthcare workers are government employees – say Cuba’s system – is ranked as 100 in government involvement. A totally unregulated “Ayn Rand’s Dream” free-market system where you only get what you can personally pay for even if you’re dying, and providers can set whatever price they want, will be a 0 in government involvement.

That would mean “Obamacare” moved us from about a 25 to a 35. Most of the developed world is between 50 and 90.

The National Health Service in the U.K., in which the government employs all doctors but a small minority of citizens still choose private plans and there are small fees for most services, would be a 95. Canada’s government-insured system where the government pays for care but you get it from private doctor’s offices and hospitals, would be about a 60 with some government and some market. A private insurance system that contains one “public option” letting people buy insurance from the government if they want – a true balance letting individuals opt for a government or private system – would be about a 45. Switzerland’s system with compulsory health insurance from nonprofit private companies (banned by law from earning a profit on their services) would be about a 40. America’s pre-2010 system, which guarantees care in worst-case scenarios where you are broke but dragged to the hospital bleeding, and provides mostly-free care to seniors, some poor people and veterans – but is mostly market-run and leaves many uninsured – would be about a 25. The new system, when fully initiated after 2014, will ensure that anyone can some level of routine care if they want it and enforces penalties to encourage everyone to do so, but from private companies that earn lots of profit for providing care. It’s a 35.

The changes will make a big difference for many uninsured and under-insured Americans, but the post-“Obamacare” American healthcare system is still one of the most right-leaning and market-oriented systems in the developed world. And the right-leaning half of the country is treating it like the plague.

So, what the hell happened!?

One word: politics. (more…)

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