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Krugman on HR 676

a little night musing's picture
Submitted by a little night ... on Tue, 07/28/2009 - 1:27pm
Thread: 
In Sickness and In Health
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Paul Krugman
single payer
HR 676

Krugman has finally broken his silence on HR 676:

1. If I could start from scratch, I’d go for single-payer. Where introducing single-payer has proved politically possible, it’s been a smashing success.

2. However, there are other systems that also work well. The Netherlands, for example, relies largely on private insurers, although they’re tightly regulated and there are extensive cross-subsidies. And they have universal care at much lower expense than we do. So single-payer isn’t the unique ideal.

3. Politically, single payer is not going to happen any time soon. It’s not just the power of the insurance lobby: voters tend to fear the unknown, so that it’s much easier to pursue incremental reform than to make a giant leap into a completely different system. And incremental reform has a good — better than 50/50 — chance of happening this year.

So yes, I’d favor HR676 if I thought it could pass; but I’ll accept something else, even if it’s a bit of a Rube Goldberg device, to get the job done.

But a later blog post today* made me think, "Uh-oh."

*People in the know say not to worry too much about the awfulness of the Finance proposal; the important thing is getting it out of committee, so that it can be fixed in later negotiations. I hope they’re right.

[my emphasis]

I want something a little stronger than hope. Various people keep trying to assure us that shit can be turned into shinola later on: I would really appreciate some actual examples of that sort of thing ever happening in the past, before I start "hoping".

In an excellent op-ed, Krugman wrote:**

Reform, if it happens, will rest on four main pillars: regulation, mandates, subsidies and competition.

So Paul, if the legislation that emerges from the House or the Senate falls down on one or more of your four pillars, what then? At that point would you say that this will not "get it done"?

I'm receiving emails from SEIU asking me to push this (as yet not determined) health care reform package on the basis that "it will save you an average of $2,200 per year.' This number comes from a Commonwealth Fund report which looks at three versions of a public plan, and the $2,200 savings reported is what they say a household would save on average in the most aggressive of the plans, a public plan payer Medicare rates. How do we know that we will get this, or anything like this, in the final bill?

You know what, I really hate it when my union brothers ask me to sign a blank check.

------------------

* Which you really should read. It's quite funny, this footnote aside.

** And I am glad that Krugman, unlike Obama, thinks that competition in the form of a public option is an essential part that reform must contain. From the op-ed:

Finally, there would be a public option: a government-run insurance plan competing with private insurers, which would help hold down costs.

This is the only place in the op-ed that he writes about what would constitute "competition", one of his four pillars.

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DCblogger's picture
Submitted by DCblogger on

I wish people like Krugman would look at what has been proposed instead of academic comparisons of different systems. There is the House Bill which Ian Walsh demolished, and then there are other proposals that are even worse. The best proposal is the amendment that permits states to enact their own single payer system, that is the most pragmatic approach.

keep commenting online, keep writing letters to the editor, keep refusing to shut up, the wind is at our back.

a little night musing's picture
Submitted by a little night ... on

I wish people like Krugman would look at what has been proposed instead of academic comparisons of different systems

To be fair, though, in this op-ed he does seem to be discussing the content of the bills, although very vaguely. It's disappointing. That's why I ask if there would be any point at which he would say, "no, this bill is not sufficient to start the ball rolling, and I can't support it."

Perhaps we can leave comments on his blog asking him about the Kucinich amendment?

I also note that in his talk about regulation, he does not mention the form of game-playing which is the insurers not paying for covered treatments and making you jump through hoops in an appeals process to get them paid for. There are proposed regulations preventing recission and preventing excluding people for pre-existing conditions, but the insurers also have it in their power to just wear people (who are ill, needing treatment) out and make them want to move to a different insurer. Of course, if it's your employer-provided insurance in which this is happening, you couldn't switch anyway, unless you wanted to pay 100% of the premiums (and maybe not even then).

This kind of shit has happened to every single person I know who has had to use their insurance for something more complicated than just regular check-ups. That's a whole lot of different insurance companies.

lambert's picture
Submitted by lambert on

Good to know. Maybe if Krugman had tried to help make it politically possible when it made a difference, we'd all be better off. That's not knowable, of course.

* * *

My note to Krugman:

Professor Krugman:

1. Do you have any evidence that the "public option", as described by the Commonwealth fund, bears any resemblance to the "public option" on offer? Press Secretary Gibbs, for example, has said that Obama might view public option and co-ops as "equal." Do you agree?

2. Do you have any evidence that a system like the Netherlands, or anything like it, is contemplated here? Last I checked, the Netherlands system, unlike HR676, had no co-sponsors in the House.

3. Have you considered the possibility that if you'd weighed in at some point BEFORE the House leadership passed out a three-ring binder of HR3200 for discussion, HR676 might be more "politically possible" than it is today. Just saying.

See here for a useful review of public option as advocated by progressives:

http://www.pnhp.org/blog/2009/07/20/bait...“public-option”-was-sold/

Submitted by gob on

one Elwood Anderson says

As I recall there were a lot of people who supported Hillary because they thought Obama couldn’t get elected. They were wrong. Now there’s a lot of people that think single payer will never fly. They are wrong. It just takes the same effort that got Obama elected.

I totally agree, though maybe with from a slightly different angle. How about getting that advertising team that did such a bang-up job last year????

a little night musing's picture
Submitted by a little night ... on

In which I ask, in somewhat more detail, the question I asked in my comment above:

So, Prof. Krugman, what is your bottom line for something that will “get the job done”?

You’ve previously mentioned four pillars: “regulation, mandates, subsidies and competition.”

What if the regulation aspect is weakened? We already know that insurers sometimes refuse to pay for treatments, forcing ill people to jump through appeals hoops to get payments. The bills I have seen do not even address that. And insurance companies have shown in the past that they are quite willing to just ignore regulations until they are caught and fined.

The employer mandates I read seemed dangerously likely to promote further part-timing of full-time jobs.

What if the subsidies are not adequate? This seems a point on which the proposed bills could be especially politically vulnerable to fiscal conservatives and others who hate entitlements.

What if the bill we end up with does not contain a public option, or contains one that is so weak and so delayed and so small that it does not provide any real competition to the private insurers?

What I’m asking, is there any point at which a bill would be so watered down, so weakened, that you would say, “No, I cannot support this”? Or do you believe that we have to pass something, anything, now?

Submitted by gob on

really bugs me. If they want to be incremental, why don't they keep it simple and incrementally extend the age of Medicare eligibility downward over time?

Their idea of "incremental" smells excremental to me.

brucedixon's picture
Submitted by brucedixon on

that's the best answer to the incremental thing I have heard yet. i promise to use it in a piece i am writing for tomorrow.

mass's picture
Submitted by mass on

Yeah, our biggest Connector cheerleaders.

I'll just continue to toil away without "affordable" insurance, while Krugman celebrates getting the job done. It occurred to me last night how "everyone has the right to affordable insurance" is just a catch-phrase for pushing the health care crisis back onto the little guy. No one says "everyone has the right to affordable auto insurance". They say by law drivers who have the privilege of owning a car must insure it.

How depressing that he parrots Obama..."if we were starting from scratch". Come on. If we were starting from scratch we'd do something equitable, cheaper and better. But because we are starting from crisis, we won't? That's not logical. They could just scrap this and extend Medicare down to 55-65 years olds. That would be appreciable progress.

Submitted by jawbone on

Haven't heard much yet.

If everyone covered, everyone must make some kind of contribution.

Person on with Krugman, British accent, says that sounds problematic. Sees employer mandate as not really very good, as employer may just offer crap or there will be pressure on Congress to relieve burdens.

Mandate or tax? Employers will do the math. And those imposed benefits will come out of employees' take home income. Get away from employee based system.

Ah, the guest with British accent is from Heritage and against any health care plan.

Submitted by jawbone on

if Dems had gone with "Medicare for All," perhaps the Repubs' and right wingers' attacks on health care reform would not have worked as well.

Just a thought, Mr. President.

Would have helped if Obama had not tossed single payer and disses Canada's system. Medicare IS single payer; Canada's system is essentially Medicare on a universal care basis.

mass's picture
Submitted by mass on

This cartoon says it all:

http://www.salon.com/comics/tomo/2009/06...

Indeed, if they had promoted Medicare for All, I think the Repubs would argue for individual private mandates, and the Dem's would argue that puts an undue burden on the middle class to buy unaffordable private insurance. It would have been an entirely different debate.

tedraicer's picture
Submitted by tedraicer on

Krugman's position on this is untenable, and I regret it. It is clear that in this regard he is simply unwilling to say (or perhaps admit to himself) that Obamacare is a fraud. But he has done fine work for 10 years and in other areas continues to do so. No one is perfect.

a little night musing's picture
Submitted by a little night ... on

Why "untenable"? My disappointment is that he does not really seem to deal with the details of how hiw four pillars would be achieved (or not) in the bills we have seen.

I'm surprised he hasn't commented on Obama's backpedaling on the public option, as well. But Krugman's way has always been to give the benefit of the doubt as long as possible to politicians (and others) he thinks are acting in good faith for desirable goals, and apparently he thinks this about Obama. My own way is to keep pushing for the whole fracking loaf.

I'm not all that far away from his position - To answer the question Ian Welsh poses here, his "four pillars" are pretty much my bottom line, if by "competition" you read "strong public option." I would gladly support such a plan as a first step toward getting the for-profit insurers out of the basic health care market. But that's not the plan we've got, and I am alarmed that the weak-tea public options are getting even more weakened (or eliminated), and I am really doubtful that that aspect will improve in future negotiations.

I think PK is being diplomatic, as he often is when he thinks he can persuade that way, and (perhaps) allowing the fact that he believes Obama understands what the issues are to persuade him that we're going to get something that will work, along the lines he has laid out.

(Yes, the Shrill One is often diplomatic. That's why that name is so ironic.)

tedraicer's picture
Submitted by tedraicer on

>Why "untenable"?

I meant untenable in treating Obama as if he is acting in good faith, when all the evidence suggests otherwise.

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