Krugman on 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.
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.