The Cure for American Health Care by Kuttner

[Guest guest]

The Cure That Dares Not Speak Its Name by Kuttner

Co-Founder and Co-Editor of The American Prospect

Posted: February 28, 2010 10:21 PM

In all of the debates about health care reform, one of the stubborn realities is

that neither the Obama plan, nor any of the Republican alternatives, will

seriously alter the trajectory of relentless cost-escalation in health care. If

you look at the Administration's own projections of federal deficits in the next

decade and after 2020, virtually all of the alarming growth in deficit spending

is Medicare and Medicaid.

And that's only the public part of the health care bill. In 2009, total health

care costs increased to 17.3 percent of GDP, with escalating premiums eating

into both corporate profits and worker take home pay. The consensus among the

usual policy experts is that there is no good solution. The march of technology

and demography will just continue to raise health costs.

But you can reach that conclusion only by ignoring how the rest of the club of

affluent countries manages to insure everyone for 9 or 10 percent of GDP, and

have a healthier and longer-lived population, to boot. They do it, of course,

through universal, socialized insurance.

There is no single formula. The Canadians do it with a single payer system for

the insurance part, but physicians are private. The Brits have an integrated

National Health Service. The Germans achieve near-universal coverage through a

system of nonprofit health insurance plans.

What every other nation has in common is that they have taken the commercialism

out of their health systems. As a consequence, they can direct health spending

to areas of medical need rather than letting the market direct health dollars to

areas of greatest profit. And with everyone covered, they can use highly

cost-effective strategies for prevention, wellness, and public health. That's

how you cover everyone for ten percent of GDP.

Our one island of single-payer medicine, Medicare, is phenomenally popular -- so

popular that the Republicans' most effective attack on the Obama plan is that it

would divert some money from Medicare. The Republicans, on the one hand,

fiercely attack " government-run health insurance, " while on the other they

defend Medicare (which they would just as soon privatize).

But most Democratic politicians and policy wonks behave as if the option of a

national health plan simply did not exist. These blinders are the result of the

immense power of the medical-pharmaceutical-insurance complex combined with a

failure of political leadership. Sooner or later, mainstream politicians will

stumble their way to some form of single payer because there are no good

alternatives unless we want to spend half of our GDP on health care.

In that regard, the best things about the still inconclusive end-game of Obama's

efforts to enact his plan are that (1) the administration finally broke with the

insurance industry, and (2) Obama is starting to get over the delusion of

bipartisanship. So if we don't need either Harry and Louise, or Boehner and

Mitch McConnell, as part of the health-reform coalition, we might as well do it

right.

With Obama's health summit behind us, there will now be a mad scramble for

Democratic votes in the House and Senate to pursue the strategy that Obama

should have used all along -- a Democrats-only bill relying on 51 votes in the

Senate via the reconciliation procedure.

The problem is that Obama may have missed the moment. The prolonged, enervating

battle for health reform, using a badly flawed bill, has scared off both

conservative and liberal Democrats in both houses. The bill is politically toxic

to legislators facing re-election, for good reason. The original formula,

designed to enlist insurance industry allies, required a mandate to purchase

insurance, diversion of Medicare funds, and unpopular taxes. Now that Obama has

broken with the industry, an entirely different formula should be possible.

Alas, we are too far down the present road to advance single-payer in this

legislative session. The president has done nothing to move public opinion in

that direction, and has backed away even from the truncated version of it, the

so-called public option.

I would put the odds at about one in three of Obama succeeding. Several

Democrats who voted for the House-passed bill in November by the narrow margin

of 220-215 have now defected, and several more are increasingly gun-shy. I don't

much like this bill, but I still hope it passes so that the Republicans don't

get rewarded for their relentless obstructionism.

Win or lose, the next great push should be for single-payer, assuming Democrats

have a working majority again in foreseeable future. Given the collateral damage

of Obama's strategy, that could be a long time coming.

http://www.huffingtonpost.com/robert-kuttner/the-cure-that-dares-not-s_b_480130.\

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