Sunday, March 28, 2010

Health Care Postscript

There's been some discussion on liberal blogs lately about the true meaning of the recent health care reform victory that has reflected some of my own thoughts. It is a great progressive acheivement, and yet the legislation itself is pointedly centrist, even Republican. This has struck me as quite a contradiction. But over at Jon Chait's blog, a commenter known as 'Virginia Centrist' has articulated an accurate dissection of this idea:
I think the answer here is that this isn't really an ideal moderate Republican plan. It's a plan that a few moderate Republicans have proposed before...but they only proposed it as an alternative to an incredibly liberal plan. Very few moderate Republicans have fought for a plan like this or even supported one. Their support was nominal.

The exception was Mitt Romney...but even he was working with a huge liberal Democratic majority (8-1 in one legislature).

In a vacuum, would any Republican actually seriously push for this plan or any other healthcare plan? No. They simply don't care about healthcare. It's not on their agenda. So it's hard to really ascribe the plan to any of them and be 100% accurate. It works as a political rhetoric, but it's a stretch in practice.

I think this is a progressive victory. We're providing public insurance (Medicaid) for [~15] millions, spending on public health clinics, giving subsidies to millions, and we're moving towards a system where private insurance companies are more like heavily regulated utilities. That's a system that can work, and has worked in other countries.

There are many ways to skin the healthcare cat. There are many different systems that can work. We're heading towards the heavily regulated private market approach. That's fine.

One note: if progressives continue to enjoy political success for the foreseeable future, it's likely that some kind of Medicare buy-in or public insurance option will be added to the reform structure. If this happens, I would argue that something like French system of insurance may evolve over the coming decades. All else being equal, we're looking at a Dutch or Swiss system as a worst case scenario. Both countries acknowledge health care as a right, legally and culturally. That's why the Affordable Care Act is an historic progressive achievement.