Wyden-Bennett (again)

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Erik Kain

Erik writes about video games at Forbes and politics at Mother Jones. He's the contributor of The League though he hasn't written much here lately. He can be found occasionally composing 140 character cultural analysis on Twitter.

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  1. Avatar Dan Miller
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    E.D.–I think you’re displaying an incredible amount of political naivete. Do you think that if HR 3200 goes down, then congressional Democrats and Republicans will get together and draft a better bill? Of course not. If this effort fails, we can’t just change the bill and try again, and we certainly won’t get any Republicans on board for the effort. This is a post that would have been helpful in 2007, but if you want to pass anything at all, it’s not helpful now. On the other hand, if you want to obstruct the one shot at reform that actually exists, it’s very helpful.

    I’m certainly not accusing you of bad faith; but I am trying to explain why this is so frustrating. Even if it’s not your intent, you’re hindering the efforts of any health care reform whatsoever, and helping those who support the current system.Report

    • Avatar E.D. Kain in reply to Dan Miller
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      Wyden-Bennett is sort of already drafted, actually.Report

      • Avatar Dan Miller in reply to E.D. Kain
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        says:

        Poorly worded on my part, perhaps, but the point stands: if this effort fails, we can’t just change the bill and try again. It will be taken as a political defeat for Obama, nervous Senators certainly won’t be willing to stick their necks out even more, and the whole effort will go down in flames. It’s simply misguided to think that Wyden-Bennett is still on the table. And it’s just as misguided to imagine that, if Republicans pick up seats or take over Congress, that they’ll come back and be willing to support something like Wyden-Bennett.Report

    • Avatar Mark Thompson in reply to Dan Miller
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      “but if you want to pass anything at all, it’s not helpful now. ”

      The problem with this is that it assumes that “anything at all” is worth doing. But HR3200, in the eyes of a lot of us, solves little while costing an unjustifiable fortune at a time when we’re running mind-boggling deficits to begin with. It’s not obstructionist to refuse to support legislation that you think does more harm than good.Report

      • Avatar E.D. Kain in reply to Mark Thompson
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        says:

        Exactly, Mark. I also don’t just see all Republican support walking away. If handled right, it could be just the sort of compromise needed to push health care reform.Report

        • Avatar Mark Thompson in reply to E.D. Kain
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          says:

          One thing that’s worth mentioning that I haven’t yet mentioned is that Wyden-Bennett is not exactly a new idea. It’s been around in more or less the same form (without the public option that has since been inserted, at least) for several years, and has had Republican support that whole time even though at the beginning, health care reform was not really on the national radar screen. Since health care was not really on the national radar screen at the time – indeed, the “public option” hadn’t even been introduced into the debate at all yet – there was no reason for Republicans to attach their name to it unless they were serious about it. In fact, more Republicans signed on to Wyden-Bennett in 2007-2008 than signed on to Coburn’s health care bill in that period (which is viewed as more or less the conservative ideal).

          Even the Heritage Foundation, while ultimately not supportive of it, voiced only muted criticism of the bill and praised the central features of the bill, focusing mostly on the increased regulation of the individual market. The political reality, of course, is that even if you think that increased regulation is a bad idea, that increased regulation is going to be a necessary political compromise if you are ever going to decouple employment and health insurance without creating a single-payer system. Heritage, I am quite certain, is aware of this.

          Given Heritage’s very muted criticism (which is combined with some pretty clear praise of the central element) of the bill in the past, I very much suspect that if it were truly on the table, they’d either be on board with it or at the very least take a more or less neutral stance on it.

          If that’s the position that Heritage would take, it’s very difficult to see the Republican leadership doing much to keep its membership in line with opposing the bill.

          Bottom line: I think the argument that the support of Republican co-sponsors of Wyden-Bennett is shallow and would evaporate if Wyden-Bennett were on the table is out of touch with what conservative-ish politicians would actually act.Report

          • Avatar Ryan in reply to Mark Thompson
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            I don’t know. I think you should repost this in the discussion about fantasy novels. If there’s one thing Republicans have not done, it’s show that they have any interest at all in compromising with Democrats for the purpose of good governance. You put this thing on the table for real and watch how fast the Heritage Foundation says, “We thought this was an okay bill, but can you believe they would actually give money to poor people? How are we going to buy our yaaaaaaaachts?!?!”Report

            • Avatar E.D. Kain in reply to Ryan
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              Your caricature of conservatives and conservative policy is as silly as the yapping talking-heads who dominate right-wing talk-radio. Vapid, verbose, and in the end, totally false.

              Or maybe the rich, special-interest infested Democratic leadership is somehow absolved of these things. Since they believe tax-based-redistribution is more effective than a strong economy and the redistribution of wealth through productive labor.Report

              • Avatar Ryan in reply to E.D. Kain
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                Those yapping talking-heads who dominate talk radio are the guys who actually set the policy goals and talking points for the Republican Party and conservatism generally. Just because you are one of the 3 or 4 conservatives in the country who isn’t completely insane, disingenuous, and utterly depraved doesn’t mean it isn’t a fair criticism of the movement itself.

                I have not absolved the Democratic leadership of anything. But after the last eight years, I find it laughable that anyone would assume the Republican Party is either competent to govern or interested in doing so. Again, I ask for evidence. Where is there the slightest bit of evidence that any number of elected Republicans give a damn about anything?Report

              • Avatar E.D. Kain in reply to Ryan
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                Congressman Jeff Flake representing my own State (though not my district) of Arizona, for instance. He’s someone I’d like to see represent the party in the future.Report

              • Avatar Ryan in reply to E.D. Kain
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                That’s fine. Until then, you get Jeff Sessions, Jim DeMint, Mitch McConnell, John Boehner, and Mike Pence – whose philosophical support consists almost entirely of people like Rush Limbaugh, Glenn Beck, Bill Kristol, and Charles Krauthammer. Whatever you might think about Harry Reid or Nancy Pelosi, I would take 400 of them over a single one of those Republican luminaries.Report

          • Avatar Dan Miller in reply to Mark Thompson
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            says:

            “Since health care was not really on the national radar screen at the time – indeed, the “public option” hadn’t even been introduced into the debate at all yet – there was no reason for Republicans to attach their name to it unless they were serious about it.”

            On the contrary. In fact, that way they get all the credit of looking like they support a serious solution on health care, but there’s no danger of it actually becoming law.Report

            • Avatar Mark Thompson in reply to Dan Miller
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              But there’s no benefit to looking like you “support a serious solution on health care” if health care isn’t even an issue in your campaigns. This is doubly true when you consider that people like Trent Lott and Mike Crapo supported it even though Lott was about to retire and Crapo holds probably the safest Republican seat in the Senate. Meanwhile, Lamar Alexander won last fall with 67 percent of the vote – again, no need to co-sponsor that legislation if you’re already in a safe seat with a conservative voter base.

              Also, see my latest post.Report

          • Avatar Michael Drew in reply to Mark Thompson
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            If that’s the position that Heritage would take, it’s very difficult to see the Republican leadership doing much to keep its membership in line with opposing the bill.

            Bottom line: I think the argument that the support of Republican co-sponsors of Wyden-Bennett is shallow and would evaporate if Wyden-Bennett were on the table is out of touch with what conservative-ish politicians would actually act.

            To the first, who’s to say the Heritage line doesn’t change when the bill is about to pass under a Democratic Congress and a Democratic president.

            To the second, you can say that they wouldn’t jump ship, and it’s nicely consistent with mainting this as a viable option that Dems are bullheadedly leaving off the table, but it doesn’t make it true. It’s just a supposition, and one that few share with you. To most, you just sound like you’re looking at Congressional politics through the rosiest of rose-colored glasses. Another consideration is that, even if most Republicans were to stay with the bill, they may be more than offset by Democrats that it would lose (though that’s just a guess).

            But as this Yglesias post (http://yglesias.thinkprogress.org/archives/2009/08/the-wyden-bennett-mirage.php) makes clear, you are standing on very shaky ground vouching for the earnestness of all Republican sponsors, given that they oppose key provisions of the bill.Report

            • Avatar Mark Thompson in reply to Michael Drew
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              Yglesias is making the same mistake as Klein, assuming that opposition to the regulatory aspects of the bill means that they wouldn’t vote for the bill if it actually came to such a vote. I realize that those aspects are pretty central to the bill from the perspective of liberals, but that does not mean that they are central to the bill from the perspective of conservatives/libertarians. What’s most important to the bill from the conservative/libertarian perspective is that it cuts the tie between employers and health care; the regulatory costs, while certainly problematic from a conservative viewpoint, are hardly so large as to warrant opposing the bill as a whole.

              There is this implicit assumption that Republican politicians are so ideologically opposed to regulation that they will never vote for any kind of reform that contains regulation. But Republican politicians are no different from Dem politicians – outside of Ron Paul and a handful of others, they are willing to compromise smaller goals for larger goals, especially when those larger goals could be good for their personal electoral success. For the last however many years, I’ve heard liberals complain about Dems giving in on matters of principle because they wanted to be seen as supporting popular legislation; why does anyone think that Republicans are any different.

              Indeed, I would like to point out that last year the *&^%%& CPSIA passed with virtually unanimous Republican support even though it contained tremendous increases in government regulatory power and had exactly zero provisions that could be described as creating a freer market in other areas. In other words, the bill was all ideological downside, no ideological upside, yet Republicans jumped on board because they didn’t want to stand in the way of legislation that would be clearly popular (regardless of how terrible a piece of legislation it would turn out to be).Report

      • Avatar Michael Drew in reply to Mark Thompson
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        Listen, that’s the point. Yes, it’s unfortunate (perhaps) that Wyden-Bennett isn’t getting more attention. But the ship has massively sailed — it’s way too late to start pointing to alternatives now. That essentially is obstructionism — which, to be perfectly clear, is totally appropriate of you do in fact oppose the bill that’s being considered. But you (meaning everyone) now needs to come down on a side on that: do you want it to pass or do you want it to fail? That’s the question right now. And it’s entirely fair to want it to fail, and we should have that argument. But if you do, then you’re against health reform, at least for right now. Elections have consequences and all. If Wyden-Bennett comes up as a real possibility in the future, then that will be the question. But right now it’s basically a distraction and a dodge.

        See a new comment below for a link to Yglesias making the relevant points about Wyden-Bennett.Report

        • Avatar Mark Thompson in reply to Michael Drew
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          “Elections have consequences and all.”

          I’ve never liked this line of thinking, which seems to be shared by all sides of the political spectrum. It assumes too much. Specifically, it assumes that winning an election equates to popular support for every element of your preferred party’s platform, with as few changes as possible. In fact, even if it was just limited to assuming popular support for one aspect of a party’s platform, it would still be false unless you could say with a high degree of certainty that the election was a single-issue election.

          Bush made this mistake when he won in 2004, particularly in his push to change Social Security. I think the Dems are making the same mistake now by insisting that health care reform not only be done (for which there is more than enough popular support) but that it be done only with the approach that they want to take. They will be probably succeed in passing something nonetheless, since support for health care reform in general is far stronger than support for social security reform ever was, but what they pass is likely to be a complete mess because of all the watering down they have to do to preserve their general approach.Report

          • Avatar Michael Drew in reply to Mark Thompson
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            I don’t think it means an assumption that a supermajority is behind the policies the Congressional majority supports. I just think it means that this is a representative democracy not a direct democracy, and if a party wins on a platform to reform health care, they’re going to do it their way. There’s no way they can please everyone with an opinion on the issue. And failure to do anything will always look worse to them than passing even an extremely flawed bill. Those dynamics I think can be assumed.

            I should point out again that Republican misrepresentation of their position on Wyden-Bennett is not the only reason it hasn’t gone anywhere. It also guts a large part of the value union membership offers to workers, making it a non-starter for a lot of Democrats. Beyond that, it entails much more jarring change to those who currently have insurance than I think most of the country is receptive to right now, much as i wish it were otherwise. (A recent conversation with my mother and stepdad convinced me of this, when i saw the look on their faces when i brought up the notion of being taxed on the value of their benefits.) So it’s not just that some Republicans are doing a Lucy-and-Charlie routine on Wyden-Bennett, or that it’s reasonable for Democrats to fear that they are. It’s also that the political groundwork for that type of change (just as much as for single payer) has not been done.Report

  2. Avatar Dave Hunter
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    says:

    “Again, I’ve written a number of posts that present much more conservative proposals for health care reform”

    Really? The conservative approach here is a move towards some form of single-payer, which at this point is market-tested and safe. But instead you’re chastising your commenters for their “lack of imagination” and pushing for crazy utopian schemes. The proposals you favor are radical, not conservative.Report

    • Avatar E.D. Kain in reply to Dave Hunter
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      Yep, that’s me. Radical chastizing S.O.B.Report

      • Avatar Dave Hunter in reply to E.D. Kain
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        Yeah, whatever. The point I’m trying to make is that I always thought the word “conservative” was used to describe people who preferred safe and tested approaches to government, as opposed to crazy new schemes that more purely advance an ideology.

        The reason state-sponsored single-payer health care appeals to me is that versions of it seem to have had pretty decent and steady results in other countries. And it’s a lot cheaper then what we have going on in America. That’s about all I need to hear.

        I don’t particularly understand how you can have “principled objection” to a policy that basically works fine and still call yourself conservative. Aren’t you just an ideologue when you cross that line?Report

        • Avatar E.D. Kain in reply to Dave Hunter
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          How do you know it “works fine”? Because it works, to some degree, elsewhere? Aren’t there many, many systems that “work fine” in other countries? What is “conservative” about saying this hodge-podge of policy ideas will “work fine” as opposed to any of these others? What is tried and true about this system in America where we have neither tried it or proven it to be true?Report

          • Avatar Ryan in reply to E.D. Kain
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            That’s a very strange way to think about the scientific method. However imperfect it may be to assume that what works elsewhere would work here, it remains the case that people who share much of our cultural heritage and most of our assumptions about what is good, etc., have these systems and get better results than we get with ours.

            What’s really kind of odd – and maybe it’s not “conservative” or maybe it is (who cares?) – is this idea that a set of ideas that work in Canada, Britain, France, Germany, the Netherlands, Sweden, Norway, Denmark, and so on would definitely not work here because we’re so incredibly different. That’s just preposterous.

            (Leaving aside the degree to which those places have different systems than we do, it remains the case that bills like HR 3200 would move us closer to the median European model than we are now. Which, I would argue, is basically the only relevant issue here.)Report

            • Avatar E.D. Kain in reply to Ryan
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              See, but that’s just a very nonsensical thing to say – I mean, which should we adopt? The Netherlands or the UK? Canada or Germany? Their systems are entirely different from one another. The Netherlands system is as different from the UK system as it is from the US system. You can’t just say that we should adopt some “median” system because that’s simply not possible, or practical.

              Now – the only thing I think you can adopt is the attitude or the position that there should be, somehow, universal health insurance. That’s one agreed-upon starting point that most Western European nations share. Beyond that, though, the implementation and success varies widely. In fact, I’ve argued for a system much more like that of the Netherlands. Why is that radical whereas arguing for something more akin to the UK or Canadian systems (not that HR3200 is either of those) sane or rational or what-have-you?

              Implementation is everything. If we implement health care reform poorly it could become very expensive with very poor results. That’s what I’m worried about. I’m also pro-reform as I see the current system as wholly unsustainable.Report

              • Avatar Ryan in reply to E.D. Kain
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                I think the basic point is *it doesn’t matter*. Pick one out of a hat, if you like. They’re *all* better than ours! We have, among the major Western democracies we’re talking about, the worst, cruelest, most ineffective, most inhumane, most immoral system already. The beauty of deciding whether to support something like HR 3200 (let alone single-payer or a Netherlands system or what-have-you) is that anything would be an improvement.Report

              • Avatar E.D. Kain in reply to Ryan
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                Well I can’t argue there – to some degree.Report

              • Avatar Mark Thompson in reply to Ryan
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                But I would argue HR3200 doesn’t even move us in the direction of any of those other countries. Yes, it may or may not include a mandate, and yes it will move in the general direction of universal coverage, but it also reinforces the single aspect of our existing system that most differentiates us from all other Western democracies (the employer-based nature of our system). It is not far-fetched at all to believe that HR3200 will just worsen a lot of the worst elements of our system.Report

              • Avatar Ryan in reply to Mark Thompson
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                The Netherlands and Germany both have large roles for employers in the health insurance market. I will agree that it’s not quite the same as our system, but an employer-based system is not unheard of.

                We do agree that removing the employer from the equation has a lot going for it, though.Report

          • Avatar Ryan in reply to E.D. Kain
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            Erm… I mean, “Leaving aside the degree to which those places have systems differing from one another…”Report

  3. Avatar mike farmer
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    E.D., are you carrying a swastika?Report

  4. Avatar North
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    I’d prefer Wyden-Bennett myself, but honestly I can’t blame the Democrats from refusing to be suckered into it. It seems relatively rudimentary politics to me that the only reason Wyden-Bennett commands Republican support is that it has a snowballs chance in hell of actually passing. If there were any indication that Democrats were actually going to let their own bill die and take up Wyden-Bennett the republican backers would vanish like dew in the dawn and throw their support behind a new competing bill even further to the right.Report

    • Avatar E.D. Kain in reply to North
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      I don’t know. Maybe I’m too optimistic or suffer from some other unnatural disorder, but I honestly think it would be a far better option for conservatives to embrace than our current system. And it was born with bipartisan support which certainly means something.Report

      • Avatar North in reply to E.D. Kain
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        Oh I understand E.D. but you’re thinking like a principled conservative. Democrats have no indication that the Republicans and the core of their party’s conservatives are acting in good faith and a lot of indications that they are not.
        I guess the nub of it is you’re talking principles but both of their sides are thinking politics. The Dems want a healthcare bill and they genuinely believe that Wyden-Bennett is only a stategic tool to prevent any healthcare bill from being passed. Surely you would agree that the Congressional and Senate Republicans haven’t exactly established a reputation for themselves as being good faith bargainers.Report

    • Avatar Ryan in reply to North
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      That’s correct. Even the Republican cosponsors of Wyden-Bennett don’t support it. Ezra wrote about this the other day. It looks bipartisan only because Republicans aren’t being asked to vote for it. If it came to the floor, that support would vanish in an instant.Report

      • Avatar E.D. Kain in reply to Ryan
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        By the way, where’s the link to the Klein piece you’re talking about Ryan?Report

          • Avatar Dan Miller in reply to Ryan
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            Klein actually addresses it again today, and I’d urge E.D. and Mark to take a look. http://voices.washingtonpost.com/ezra-klein/2009/08/can_there_be_a_good_compromise.htmlReport

            • Avatar Mark Thompson in reply to Dan Miller
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              Ok, so now he seems to be acknowledging that most of the Republican co-sponsors, including f’ing Mike Crapo, are serious about it since they signed their name to the op-ed, but he still claims that “most conservatives reject it” such that it’s not worth trying – and offers no evidence for this whatsoever beyond the blanket assertion, even though its most important feature is precisely the reform that conservatives have been pushing for. True, the GOP leadership could hardly be expected to push for it for political reasons, but that’s different from saying that a good chunk of the Republican rank-and-file wouldn’t vote for it if it came to that.

              He does hint at the real reason why Wyden-Bennett would have no chance, though: it’s absolutely toxic to labor unions since it would destroy their ability to include health benefits in collective bargaining agreements. Even if most Democrats would back Wyden-Bennett if it came to a vote, the Dem leadership is not about to enfuriate one of their most important constituencies by putting it to such a vote.Report

              • Avatar Michael Drew in reply to Mark Thompson
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                True, the GOP leadership could hardly be expected to push for it for political reasons

                What are those?

                the Dem leadership is not about to enfuriate one of their most important constituencies by putting it to such a vote.

                And nor should they when the groundwork for the change has not been done. Unions hate that legislation, that is true, but I don’t think the justification for the policy has been made understood by anything like a sufficient number of voting Americans to make that approach viable. Obama made the judgement that he had to sell health reform by saying if you like what you have, you can keep it. I don’t think that was a wrong judgement at this point politically. The job of explaining to people why they should tell their representative to vote for something that would blow up the insurance arrangement that they currently have and are more or less satisfied with is not one I would tell someone to take on unless they were fully committed to that particular reform at all costs. Obama has made clear at all points that he had very few hard and fast requirements for a bill beyond basic outlines. The Wyden-Bennett reform doesn’t have a sufficient constituency at this point to become law. It’s pretty much that simple.

                That leaves pretty much just the question of whether a person supports the reform that is possible now or not, of which either position is entirely legitimate.Report

  5. Avatar Ryan
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    “At some point conservatives are going to have to admit that there is simply no political will to attempt a purely market-based solution, and progressives are going to need to begin accepting the fact that competition can really create a better, more efficient, and more consumer-friendly system.”

    There are two problems with this:

    1. It’s a non sequitur. No health care bill in the Congress would do away with “the market”. Subsidies, exchanges, and even a public option are totally unrelated to socialism. In fact, exchanges and (arguably) the public option would make the system *more* competitive. If anyone to the right of Bernie Sanders were proposing single payer, this argument might be on point. But, as it is, you’re arguing with strawmen.

    2. It’s far from obvious that competition is a good or necessary thing. As Ezra has pointed out a few times, if you rank various health care systems that already exist in the US in order of quality, it goes something like VA, Medicare, private insurance. It is already the case that the least “competitive” options are superior to the “market”. That may change if everyone were in one of those systems, but I’d like to see some evidence for it. So far that evidence exists only in the rhetoric of conservatives.Report

    • Avatar E.D. Kain in reply to Ryan
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      I don’t see the strawman. In fact, I think I just pretty much said that no pure market system would work but that competition can still be an integral part of reform. Where is the strawman in that?

      Second, there is no competition in today’s system. That is simply false. We do not have a market-based health care system, we have one that is basically comprised of tightly regulated monopolies. A more competitive system would be a system like the Dutch or the Swiss have. And yes, even such a system with a public option alongside it would still probably be more of a competitive system than we have. The Dutch and Swiss market-based health care systems are consistently ranked at the top of European health care charts, by the way.

      The fact that you have to order it this way: VA, Medicare, private insurance – says a great deal about the state of affairs here. In a truly competitive system we would be able to break out the insurers that were really top notch from those that weren’t.Report

      • Avatar Ryan in reply to E.D. Kain
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        The strawman is the implication that progressives are opposed to competition. I think it’s a poor characterization of the progressive position, and it’s a VERY poor characterization of what’s actually going on in the Congress. Show me a “progressive [who doesn’t support] the fact that competition can really create a better, more efficient, and more consumer-friendly system” who is also serving in the United States Congress. Show me an important bill being considered that doesn’t try to include competition and market mechanisms.

        As for whether there is currently competition, this is a pretty standard libertarian fallback. Whenever we have a market that doesn’t work, it’s always because it’s not *really* a free market. Communist sympathizers used to play this game too, and it’s just as crazy now as it was then. The Dutch and the Swiss have truly competitive systems because they regulate the crap out of those systems. The Netherlands has mandatory insurance, government subsidies, and state-run long-term care. That’s a whole lot less “free” than our current system, and in fact looks a bit like what we could get out of Congress.

        I guess I’m basically just not sure what you think is *in* the bills Congress is considering. Max Baucus is not writing the “Freedom Sucks Bill of 2009” that would eliminate all private companies and force you to eat pancakes for dinner. What exactly do you think is happening here?Report

        • Avatar E.D. Kain in reply to Ryan
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          Okay, so you do realize that you say, on the one hand that progressives are not opposed to competition, and then on the other that competition isn’t all it’s cracked out to be, right?

          And no, this is not a “libertarian fallback.” This is pretty widely accepted in the health care debate – that our current system is not competitive, not really a market system at all. Explain to me how it is a market. The Netherlands does have mandatory insurance (and it is also mandatory to provide coverage) but you are required to buy it on the market (though yes, again, they subsidize those who can’t afford it, something I support). I am not aware of their state-run long-term care, could you provide a link? And no, it’s not less “free.” In our system there is no real competition because A) the market is so tightly regulated that in most communities only one provider exists and B) insurance is provided through an employer rather than purchased by a consumer. The Dutch model actually makes people buy their own insurance, thus spurring competition between private insurers. I think the re-insurance model, which helps over-burdened companies provide for their disproportionate share of sick people, is a far better system than one like ours which leads all to often to rescission, etc. etc.

          And…last but not least…what I think is happening here is that we’re going to see a bill that actually does very little. It does nothing to remove the subsidies to insurance companies in the form of huge tax breaks vis-a-vis employee-based insurance. It does nothing to increase portability of insurance, keeping most Americans chained to employer-based coverage. It does nothing to increase efficiency or competition (again, allowing monopolistic insurance companies to continue to do business as usual without fear of competition) and it doesn’t cover all Americans. Notice – I never once said “I fear government run health care.” What I fear is the collusion of government and industry to create anti-competitive, costly, and ultimately second-rate health care that leads us further and further down the spiral of debt and fiscal insolvency for very little result.Report

          • Avatar Ryan in reply to E.D. Kain
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            I’m not a progressive. Problem solved.

            More seriously, my claim is that progressives who are actually involved in the debate at the policy-making level are not interested in ending competition in any way. Nor am I, really. But I’m also saying that it wouldn’t make that much difference because there are far, far more important goals (like universal coverage) than just preserving something that I may or may not be ideologically predisposed to liking. There are plenty of uncompetitive health care systems in the world that do a way better job than ours. And there are competitive ones that work too. But there is basically no evidence at all that competition is actually that important to health care insurance provision. You simply like competition the way I like chocolate cake.

            On the Netherlands, everything I know I learned from Wikipedia: http://en.wikipedia.org/wiki/Health_care_in_the_Netherlands

            Note that health care in the Netherlands is 62% government-funded, 38% privately-funded. Note that 50% of the system is funded by payroll taxes paid by employers. This sounds an awful lot like the sort of thing Congress may actually give us. And I like it.Report

            • Avatar E.D. Kain in reply to Ryan
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              says:

              It’s not just about the spending, Ryan, it’s about how it’s spent. That is an important distinction. Is it spent to give unfair and expensive advantages to strong lobbying interests? Crony capitalism, in other words. Or is it spent on people who are then allowed to choose what works best for them, thus driving competition? Big difference, and wholly in implementation. The latter, I’d say, also controls rising costs far better than the former, because it puts the patient directly into the line of decision-making about their own health care – without the undeniable financial risk that our system entails.Report

  6. Avatar Ryan
    Ignored
    says:

    Did you see Pearlstein’s column today?

    http://www.washingtonpost.com/wp-dyn/content/article/2009/08/06/AR2009080603854.html?hpid=news-col-blog

    That’s basically how I feel. One side is presenting an approach that has its flaws and uncertainties, and the other side is openly lying and fear-mongering about those flaws and uncertainties. To turn around and announce a pox on both houses is a substantial missing-of-the-boat.Report

  7. Avatar Kathie Brown
    Ignored
    says:

    E.D., what is in the Wyden-Bennett bill to guarantee insurance eligibility for those with pre-existing or chronic conditions? I ask this because a conservative acquaintance was telling me yesterday about opting out of his teacher spouse’s employer plan and purchasing individual insurance for himself, prompted by coming premium increases. He found a plan with a $2000 deductible that had monthly premiums of $360/month. I asked him, considering the good price (sort of) and his ability to fork over $6000 a year (deductible plus premium), why the big companies couldn’t deliver prices like those for employer plans (my insurance costs the company over 2x that). I’m guessing that it’s because he had to apply to and be approved by the insurer; they could directly hedge for his risk potential. Employer group insurance does not have this risk control by individual enrollee. Those insurers can only raise rates after the first year’s loss experience, which they do (my insurance had to change in May due to a 30% rise in premiums).

    I would like to hear from an economist who specializes in this area about health care cost accounting. The problem for most individuals is that medical care costs (better, is billed at) so much. Higher deductibles, touted by many, can be spent quickly given one non-life-threatening event out of the ordinary. A broken leg or arm can do it (my femur is at $25,000 and counting). My sister had a small skin cancer (not basal cell) on her eyelid that required excision and plastic surgery. Fortunately for her, her employer had a modest deductible plan in place (she makes less that $22,ooo/year). Now her employer has switched the company to a $5,ooo deductible HSA plan with a $2,000 contribution by the company; if anything comparable to last year’s event happens, she’s in big trouble — not much fat in $22,000 and certainly not $3,000 of fat. And, now she’s acquired a pre-existing condition, cancer.

    The Wyden-Bennett approach has promise to increase coverage but how does it address the cost of health care? And, it will take a lot of regulation to keep the insurers honest so it may open up modest competition but for how long? I remember when HMOs were going to solve our problems; just add a few gatekeepers and over-utilization would vanish overnight. It didn’t but HMOs are fading to be replaced by HSAs. I think one consideration is that this may not be an area where risk — the crux of the insurance analogy — can be managed to accomplish our goals of affordability, near-universal coverage, and cost control (the latter not something that insurance is meant to do anyway). It’s not like betting on hurricanes and fires and automobile accidents.Report

  8. Avatar Michael Drew
    Ignored
    says:

    I saw this Yglesias post on Wyden-Bennett a couple days ago and wanted to come straight over here and link it, but there wasn’t an active, relevant thread in which to do it. Well, there is now!

    http://yglesias.thinkprogress.org/archives/2009/08/the-wyden-bennett-mirage.phpReport

  9. Avatar mike farmer
    Ignored
    says:

    If the Democrats get their way, and this reform turns out to be the first step toward single payer, I predict the Democrats will be ruined politically for a long time to come. I don’t see any way the government can effectively run such a program in a nation like the U.S. It looks like a big prize now for the liberals and the progressives, but it could be a fatal blow to Democrats if it turns out to be huge government fiasco which enrages the public. It will be seen as the Great European Experiment that obliterated the statists and turned Americans back toward limited government. If that’s the outcome, then I say let them devise what they want, and we’ll see what happens.Report

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