The two health care camps

by Jay McDonough

Amidst all the news about the White House circling wagons and developing a new strategy for health care reform, Ezra Klein reports
there's a pretty significant debate going on in the Administration over
the new position.  Klein notes that two camps have formed:

The
first camp could be called "universal-lite." They're focused on
preserving the basic shape of the bill. They think a universal plan is
necessary for a number of reasons: For one thing, the insurance market
regulations don't work without universality, as you can't really ask
insurers to offer standard prices if the healthy and the young don't
have to enter the system. For another, it will be easier to change
subsidies or improve the benefit package down the road if the initial
offerings prove inadequate. New numbers are easier than new features.
Creating a robust structure is the most important thing. This camp
seems to be largely headed by the policy people.

The
second camp is not universal at all. This camp believes the bill needs
to be scaled back sharply in order to ensure passage. Covering 20
million people isn't as good as covering 40 million people, but it's a
whole lot better than letting the bill fall apart and covering no one
at all. It's also a success of some sort, and it gives you something to
build on. What that sacrifices in terms of structure it gains in terms
of political appeal. This camp is largely headed by members of the
political team.

Both
camps accept that the administration's proposal will be less generous
than what has emerged from either the HELP or House Committees. The
question, it seems, is how much less generous.

This
may be hindsight, but I think the Obama team made three significant
mistakes in how they approached their health care objectives.

1. They failed to make their objectives clear, no doubt hoping to
   avoid the "Hillarycare" fate, and allowed Congress to draft the health
   care reform bills.  Having an entity that's radically polarized and
   almost universally distrusted draft your administrations signature
   legislation is a recipe for disaster.


2. The Administration should have framed the debate in easily
   understood concepts.  How many folks do you think can explain the term
   "single payer"?  And how many hear "public option" and think the term
   refers to unisex restrooms?  The whole debate should have started and
   been framed as...


3. "Medicare for All." It should have been the going in position for
   three reasons; it would have sent Republicans into cardiac arrest
   (imagine them criticizing the notion of offering everyone a program
   they claim to love) and it would have allowed compromise down to the
   public option position (ask for the sun, settle for the moon).  The
   third reason?  If one is really serious about lowering costs and can
   avoid getting caught up in esoteric ideological arguments, it's the
   logical way to accomplish it. 

It's water under the bridge now.  But the objectives for health care
reform today are the same as they were going in; expand coverage and
lower cost.  And the two objectives are interlinked.  Providing
coverage to everyone provides economies of scale that will result in
lower costs and lower costs provide the opportunity to insure more.

I understand the political camps argument that something is better than nothing.  But I would argue that something is worse
than nothing if that something fails to deliver on either of the two
objectives of the reform and just perpetuates a system that, in fact,
ends up costing more and insuring even fewer.