[Below an Op-ed that I wrote for the Washington Post’s “Outlook” section. It appeared yesterday Sunday, November 15, 2009. Many readers have commented on the Washington Post website, but I’d also be interested in hearing from HealthBeat readers here.]
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If you're a progressive like me, and you're upset by the Stupak amendment, which bars federally subsidized insurance from covering abortions, consider this: What if we had a single-payer health-care system and someone like Jeb Bush were running the country?
Many liberals remain angry and disappointed that single-payer legislation never stood a chance in Washington. From the beginning the Obama administration made it clear: we cannot wipe the slate clean and start over from scratch; we must build on what we have. Yet, to single-payer advocates, a government-run health-care system seemed such an obvious way to put patients ahead of profits. I understand their frustration.
But a single-payer system would have put us at the mercy of whomever happened to take control of Washington. I'm very happy to have a public plan as an option. But since I don't know who will be in the White House in the years to come, I'm glad that government-run health care won't be the only game in town. If you're not happy about the Stupak amendment, imagine what other limits a conservative government could impose on our health care.
Parts of the country remain more conservative on issues of life and death than many progressives remember. When single-payer advocates imagine single-payer health care, they often look to Canada as an example of how it would work. But America isn't Canada; many of our fellow citizens are more conservative than the average Canadian. Moreover, in the United States we have let the dividing line between church and state blur. Christian conservatives are a political force in their own right, and the U.S. Conference of Catholic Bishops has felt free to weigh in on health-care reform. Under a conservative president, such beliefs might be reflected in single-payer health policies.
With such an administration in power, social conservatives might move to exert pressure on health-care decisions beyond abortion. For example, could women be told that their government insurance won't cover birth control? In 2001, President George W. Bush proposed eliminating the requirement that all Federal Employees Health Benefits plans include coverage for contraception. At the time, Susan Orr, who would later become Bush's deputy assistant secretary of health and human services for population affairs, applauded the president's suggestion, saying: "We're quite pleased because fertility is not a disease. It's not a medical necessity that you have [contraception.]"
In fact, the private insurers who cover federal employees were not required to reimburse for birth-control pills until 1998. Congress didn't like the idea of making “the Pill”part of the package. Until then, 10 percent of federal health plans offered no contraceptive coverage, and 81 percent of plans did not cover the full range of prescription contraceptives.
Or take end-of-life counseling, and hospice and palliative care. Do you remember how Jeb Bush, then governor of Florida, responded when Terri Schiavo's husband fought for her right to die? It's quite possible that under a single-payer system, conservatives would push to overturn laws that allow physicians to withhold food and water if this is what a dying patient has requested. Recently, Rep. Charles Boustany Jr. (R-La.) raised this issue, objecting to the fact that the House's health-care reform legislation does not prohibit the use of federal funds to pay for end-of-life care that involves denying nutrition and hydration. Boustany, a surgeon, doesn't want patients to have that choice. So much for death with dignity.
And what about fertility treatments? This month, the Conference of Catholic Bishops plans to vote on a document reaffirming the Catholic Church's opposition to in vitro fertilization, or IVF. No one elected the bishops to Congress, but the conference has already made its influence felt in the debate over the Stupak amendment. Under a single-payer plan, would the bishops persuade Congress that IVF should be prohibited?
Today, a dozen states mandate that carriers that offer group insurance reimburse for IVF. This may sound costly, but there is a clear health benefit. Because IVF is so expensive, couples who must scrape together their own money for the procedure are often tempted to implant as many embryos as possible in the hopes of not having to undergo the procedure a second time. In countries where the procedure is covered, however, women are far more likely to have just one embryo implanted at a time, rather than risking a multiple birth. This is safer for both mothers and children and is ultimately much less expensive.
Finally, if fiscal conservatives were in charge of a government-run system, they might decide that we all need to take more financial responsibility for our health-care decisions — in the form of, say, $75 co-pays to visit a doctor. Never mind research suggesting that when we shift the financial burden to patients, they aren't likely to forgo just unnecessary treatments — they are also likely to defer necessary preventive care.
I strongly support increasing our government's involvement in the health-care system by including a public option in the reform package. I believe that if Congress passes legislation that includes a public option, that option will be stronger than many pundits suggest. As I have argued on HealthBeat, ( here and here )such a plan could help lower costs while lifting the quality of care, and would provide serious competition to private insurers.
But I'm also wary that in four or eight years, someone else — someone less sympathetic to my views — may be in the White House. And conservatives could once again control Congress. So I am relieved that we don't seem to be headed toward a single-payer system. We simply cannot count on "good government" overseeing our health care.
One never knows who the American people will choose to elect. As a progressive, I have been stunned by the people's pick more than once in the past 30 years. Democracy offers choices but makes no promises.
So I want to hedge my bets. I want alternative insurance options, especially from nonprofits such as Kaiser Permanente. And I don't want to find myself locked into an insurance plan run by conservatives — or Democrats — who feel they have a right to impose their religious beliefs on my access to care.
I’m sorry Maggie but you lost me in the first paragraph. Why do the most prominent reformers in the US insist upon painting the issue as a choice between the dysfunctional model we have now and single-payer?
Why can’t we have full and open discussion about the other universal models that are delivering high-quality care, with more choice than we have in this country today?
Athena–
You need to read the whole post.
I am not saying it is a choice between single-payer and the status quo.
I am saying that I like what we are doing– offering a public option alongside private sector insurance.
The post is addressed to liberals who are still very disappointed that Congress didn’t embrace single-payer.
I’m suggesting that, if you think about it, single-payer could have turned out to be a very bad deal for liberals–if social conservatives took control of the White House.
It’s better if we all have options.
WOW! Maggie. That is certainly scary to think of. After the last eight years, this thought would be devastating!
Thanks for sharing this.
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You have made this point before and it changed my mind. We need to preserve and protect the notion of private insurance to hedge against potential abuses by whatever central authority happens to be in power.
My reaction to the coathanger amendment was at first that it must be removed, but I changed my mind about that as well. Future discussions regarding abortion will arise when the Freedom of Choice Act hits the floor. Extreme positions will at that time have to find common ground, which will likely be restrictions after “viability” or during the third trimester. (At the moment, there is no common ground. One side argues for no restrictions short of homicide and the other argues no abortions after conception. Some restrictions, some time, are inevitable.)
Legislating permission for incest and rape actually recognizes abortion as a procedure paid for with federal funds. I don’t know if the language of these two words is spelled out, but a clear legal definition for each is in order. Technically, incest might be between first cousins… or second cousins. And what if adopted siblings inadvertently marry and get pregnant? Moreover, “rape” might mean the result of a pregnancy involving a legally married couple, a man and a woman, as defined in the Defense of Marriate Act.
Maggie,
You are certainly correct that a single payer system would be under attack by any conservative government that gained power. But established social insurance programs are very resilient to attacks from the right.
Probably the best example in the United States is the failure of the conservatives in their efforts to convert Social Security from a defined benefit to a defined contribution program. That third rail may not have destroyed them, but it sure zapped them.
Another example is the effort to privatize Medicare through MMA. The traditional Medicare program has survived intact, and some of the negative provisions are being reversed. In a sense, their efforts backfired since we now have a Medicare prescription benefit, even if it does need several revisions.
In Canada, even conservative Prime Minister Stephen Harper has been relatively silent recently on his views in favor of privatization of their medicare program. Although their libertarian think tanks are noisy, they have not been able to impact policy.
My father (a Fabian socialist) taught me that a privilege once granted becomes an irrevocable right. Yes, once we have a universal social insurance program for health care, we will always have to fight to protect it. But we will be on the side of the people – a sure winner every time.
Don
Maggie, you will recall wanting to quell my pro-single payer comments, but this is very relevant:
All free market democracies with single payer systems have lower abortion rates than the US.
And if a conservative politician tries to meddle with Canada’s Medicare, they vote them out of office–just what needs to be done witn Stupak, Pitts et al.
Maggie, I did read the entire post. Interesting spin on the risk of single payer for liberals. Of course, the fear of moderates, like myself, is that the public option is a prelude to single payer by suffocating the private payers over time. There are going to be tough choices to make. We cannot provide every conceivable medical benefit for every citizen or legal resident. We don’t have enough money. This is unlikely to change as the current health plans on both sides of the aisle do not control medical costs. In addition, not all medical benefits are created equal. Is IVF, which you define as a health benefit, equal to chemotherapy for breast cancer? If funds are limited, will society agree to fund IVF at the expense of other health benefits? We can’t have it all. Personally, I don’t place IVF on the same tier as other medical treatments. For example, if I desired IVF but needed care for diabetes, and I had to choose between them, it would be an easy choice. Finally, I take issue with your objection to patients paying more of their own dollars for health care. While I understand your point, giving patients some ‘skin in the game’ would serve as a brake on runaway medical testing. http://www.MDWhistleblower.blogspot.com
Maggie – I’m surprised that, given the well-documented track record of private healthcare, and healthcare insurance, you think it would be better to still have them as a significant part of healthcare. Are you thinking of them as some sort of fallback should the Repubs. come to power? I would expect the Repubs to try to cut or reduce any kind of healthcare system that departed from being low-tax and market-driven. And wouldn’t a single payer system in place be a more convincing sell to the Åmerican people than one not in place? Just as social security and Medicare have been?
I agree Micheal we can’t pay for everything. It can’t be all things to all people. With IVF, what if one treatment doesn’t work? Do you pay for two, three, ten? Do you put an age limit on it? Will you pay for Octomom’s IVF if she wants it? All things to all people that’s why we are in our current situation.
Harriette, Tom, Don, Hootsbuddy, Michael
Harriette–
In the past, when the post wasn’t about single-payer, I admit I have objected when single-payer advocates came in and took over the thread.
Especially because we had all said what we had to say about single-payer on earlier threads on HealthBeat, and so we seemed to just be spinning our wheels.
But this post Is about single-payer, so you are quite right to comment, making an argument for single-payer.
Here is my response: the U.S. isn’t Canada.
Many people in this country are far, far more conservative than any large group that you find in Canada.
Let me put it this way: my daughter went to college at McGill in Montreal. She had been there about a week when she called me to say “Mom, you know if you lived up here, you wouldn’t even be considered that far left!”
In New York City we lived on the upper-west-side, which is generally considered a bastion of liberalism. But among the Upper-west-side Moms, I was considered pretty left. (Largely because I gave my children quite a bit of freedom. They never abused it. My theory is that children are like students: they tend to live up to your expectations. And I trusted them.)
Anyway, back to the topic at hand:Tthe U.S., unlike other progressive countries has decided to blur the separation of church and state.
No other country has done this.
On abortion in other countires. First, as you know, no country in Western Europe is single-payer. They all have some sort of hybrid public and private system, with private insurers tightly regulated.
Only the UK and Canada have single-payer–Just wante dto clear that up.).
I imagine you’re right that all of these countires (Europe, Canada and UK) have lower abortion rates. This is because birth control is much more available to young people. Parents are much more likely to give brith control to their kids,.
We have a Puritan tradition that makes many Americans very reluctant to give teenagers birth control –and many are opposed to sex education in school.
So, we wind up with more unwanted pregnancies.
Tom– First, some non-profit private sector insurance is excellent (Kaiser Permanente, Geisinger, Community Cooperative in the State of Washington . . )
If I had Geisinger, I don’t think I would want to switch to a single-payer plan.
And it’s not “should the Republicans come to power” it’s “when the conservatives come to power again.”
Whatever happens to the Republican party, there will be a conservative party. This country is sufficiently divided –with enough conservatibes having enough power and money, that one can be fairly certain that at some point in the next 10 or 15 years, they’ll be in power again.
If there is a backlash against liberals (always a real possibiity, especially in a bad economy) they could be back in power in 3 or 7 years.
At that point, as you suggest they would turn the single-player plan into a for-profit market-driven plan. It would probably be tiered, once again rationing care by ability to pay. The goal would be to privatize single-payer.
Almost certainly, it would not cover abortion, and it might well impose other “moral majority” restrictions on coverage.
The problem is that there would be no alternative–just the single payer plan.
By contrast, the hybrid plan being proposed (public option plus private sector plans,) gives people choices and doesn’t lock us in with whoever happen to be running the government in 2020.
And, in order to compete with a public plan, private insurers will have to clean up their act.
They will be regulated–as they are in Europe. Probably tightly regulated.
Some insurers will decide to drop out. Other private sector insurers will adapt. I would guess that many of the non-profits will do very well. They have had a hard time competing with some of the for-profits who cherry-pick quite ruthlessly.
As for who will be running D.C. in 2020:
Sometimes American voters make good choices. Sometimes they make horrible choices.
Don–Welcome. Although we don’t agree on single-payer, I appreciate your intelligent comments.
At the end of your comment, you suggest that liberals will be able to protect single-payer because “we will be on the side of the people.”
Don, very often, in this country “the people” don’t win.
The people are now being sent to Iraq, and to Afghanistan where they are being slaughered–the minds and bodies of young people are being broken.
For 8 years we had a government that felt free to lie to “the people” about WMD and then take us into Iraq.
In a country with free speeech, a free media chose to toe the government party line and dissmeinate lies about WMD.
In this country, “the people” (the 80% of all Americans on the bottom 4 steps of a 5 steps income ladder) have seen virtually no growth in wages, adjusted for inflation, since 1972.
Meanwhile the wealthiest 1% have seen extraordinary gains.
“The people” will now pay for the banking bailout.
One reaon Medicare has become so expensive for the people is becaue the government decided to pay a 14% “tip” to for-profit insurers if they would take Medicare patients.
We got very, very lucky that Obama was elected. (If a conservative had won again, they would probably have succeeded in privatizing Medicare. They already had made real inroads.) As for Social Security, it barely escaped privatization. The Century Foundation (where I work) was heavily involved in that fight. It was close. One reason SS wasn’t privatized is that Robert Rubin, who was Secretary of the Treasury at the time was against investing SS money in the stock market. If Larry Sommers had been Secretary of the Treasury –or someone else–it could easily have gone the other way.
We got lucky– Obama won , because he is smart, incredibly articulate, and has extraordinary impulse control
Meanwhile, he was running against a very weak conservative candidate–someone that only older fairly conservative white men could identify with (and probably some older, fairly conservative white women.)
I don’t dislike McCain. I’m sure that in many ways he’s an honorable man. But I haven’t seen such a weak candiate in decades.
Even then, Obama took only 48% of the white vote.
Liberals are on thin ice.
If the conservatives had put up a stronger candidate, he would have lost.
So I have no faith that we will always have a good government that protects the public interst.
Our government has allowed Medicaid to become a very, very poor plan for the poor. Poor people in the U.S. die 6 years earlier than wealthy people–even if they have access to health care. This isn’t true in other developed countires.
And the people in Washington over the past 18 years have let Medicare co-pays and deductibles grow to a point that many seniors can’t afford to use it.
Hootsbuddy–
Thanks.
And I agree, we’ll have to address abortion rights separate.
I do think that the Obama administration will insist that health care reform cannot Increase restrictions on abortion.
Health care reform shouldn’t be trying to change abortion law.
Michael —
We spend an average of 50% more than other developed countires on health care–and in many ways, thye provide better care– better outcomes, higher patient satisfaction, fewer complicatoins following surgery, better outcomes for heart diseases, fewer hopsital errors.
Spending $2.6 trillion, we have plenty of money to cover all of the things other countries cover (which includes IVF).for everyone.
(By the way, research shows that IVF costs a national insurance system very little– and may even save money. If insurance doesn’t cover it, many couples scrape together th e$10,000 to $12,000, But since they know they can’t afford to do it more than once, they have 8 embryos implanted. Too often, the woman becomes pregnant with quadruplets, sextuplets, etc.
The complications– for the mother and for the preemies that may spend monhts in the hospital– are much more expensive. And the system pays for that.
In counries that cover IVF, some limit implantatoin to one embryo at a time. But couples can try it three times, or more.
Money saved, safer for mother and child.
Finally, for some women, not being able to have children leads to deep, chronic depression. They mourn for years. This can happen to men to, but more likely for women.
Chronic depression leads to other expensive problems- . .
AS to whether the insurance industry will survive when competing with the government, non-profits will do fine.
I think the economy going off a cliff had more to do Obama’s win rather than the strength of the Candidate. With Bush fatigue and crashing economy, the Republicans could have cloned Abraham Lincoln and Obama would have beat him. But in the same vein, what got him elected could be his undoing as well. I agree he is on thin ice, if unemployment is above 10, the Republicans could probably run Joe the Plumber and win.
“But a single-payer system would have put us at the mercy of whomever happened to take control of Washington.”
they haven’t dismantled medicare yet. that’s one of the reasons to expand medicare until it covers all the rest of us, it’s about as bulletproof a program as we’ve got.
I did read the whole post Maggie; as well as the comments here and elsewhere on the web. 95% of readers interpreted your piece as I did: a binary choice between single payer (look at how many references to Canada there are) vs what we have now only with an extra “public option”. The exchanges, with or without a public option, do not constitute reform; they are an extension of the dysfunctional model.
I haven’t seen any substantive discussion of any actual universal models — all-payer (e.g. France and Germany) or individual payer (Netherlands and Switzerland) — except the discredited single-payer one.
The fact that reformers in this country have adopted the equation of insurance with care is a big problem. “Universal” health care doesn’t mean that everyone has some kind of insurance (after all, even though 78% of bankrupts last year had insurance, 62% listed medical debt as a precipitating factor in their insolvency) ; it means that everyone has the same access to the same basic coverage provided within a framework that applies to everyone.
Ms. Mahar,
Great admiration for you but what possesses you to think a President can change a massive law willy-nilly?
Has Medicare or Social Security changed when the White House has changed parties? Those are your models and they are sound.
Changes have to go through exhaustive legislation as we are witnessing now.
Sorry, you lose points on this argument, big time.
As you stipulated but didn’t quite say at the beginning of this post, the real question is “What risk is Single Payer in the Wrong Hands?” (Ans: Too great to risk.)
But it ought to be much blunter. It should say “Why do conservatives hate Americans so much?” And, why are these Wrong Hands so successful in the Home of the Free?
Never fails to boggle my mind.
Noni
Billy, Athena, Hipparchia,
Thanks Billy.
I didn’t say a president would do this single-handedly.
With a conservative president comes a conservative Congress.
This is what I meant when I revferred to “whoever takes control of Washington.”‘ (For the sake of space, the Washington Post’s editors cut more explicit references to a conservative Congress, assuming that a “conservative government” meant executive and legislative. )
Together, a conservative gov’t can make major changes.
In recent years, we came periloudly close to privatizing Social Secruity–too close for my taste. ( don’t know how closely you followed what was happending with SS, but it was a very serious and scary battle. If the stock market crash had happened in 2003 instead of 2000, SS probably would have begun privatization.
Under the Bush administration, Congress and the White House went a long way toward privatizing Medicare with the Medicare Advantage program.
Moreover, by paying insurers 14% more than it would cost traditonal Medicare to cover those same seniors, we pushed Medicare that much closer to insolvency, and caused hikes in co-pays and deductibles that are now making Medicare too expensive for many seniors to use.
(IF you’re not over 65, you’re probably not aware how much Medicare has changed.)
If Obama had lost the election (and keep in mind he won only 48% of the white vote), it’s quite possible that 4 years from now Medicare would largely privatized. And the public portion (traditional Medicare) would be close to broke.
You might also think about what enormous changes Ronald Reagan and his followers made.
Before 1980, the vast majority of private sector health insurers were non-proifts. Reagan removed the gov’t support for non-profit insuers, and by the end of the 1980s, for-profit insurers had taken over the industry.
Or, consider the war on poverty and programs for the poor. Reagan marked the beginning of the end.
Take a look at a chart of the percent of American children living below the poverty line from 1970 through today. With the Reagan adminisration, the share of kids trapped in poverty began to climb.
Finally, tax policy. Reagan began the redistribution of wealth upwad.
Athena–
How do you know how 95% of readers interpreted the column?
Also, if you read the legislation, you will find that it does offer everyone access to very comprehensive coverage.
The coverage that all insurers will have to offer is comparable to what affluent Americans have now–plus vision and dental for chldren.
Private insurers have to meet those standards for comprehensive coverage, and can’t turn anyone down–or charge them more because they are sick.
Many of those private insurers will be excellent non-profits (I think of Geisinger and Kiaiser).
And under this system, more non-profits are likely to spring up.
Our hybrid system would be much like Germany’s (where people have a choice between private sector and public sector insurance.
Over a period of years, all Americans will have access to the public option. (We don’t want everyone in the country changing their insurance in one or two years. No country that even approaches our size has tried that. See Atul Gawande’s excellent New Yorker article about how, in other countries, insurance reform evolved over time, building on what the systems they already had.
Hipparachia–
Medicare was greatly weakened under teh Bush adminsitration.
I’m guessing you’re under 65. (I am too, but I’m just old enough to know people on Medicare. Co-pays and deductibles have been rising to a point that more and more seniors have a hard time affording it–
At one time, health care under Medicare was virtually free. Today, many people are shocked when they turn 65 and find out how expensive it is–often more expensive than the very good employer-based insurance that they had before they retired.
This happened because conservatives wanted to privatize Medicare–the fact that traditonal Medicare was becoming expensive was all to the good. That meant that more people would move over the Medicare Advantage (Medicare through private insurers).
Jegna–
I agree that the terrible economy helped Obama win.
But if you look at who voted for Obama– many well-educated young people as well as Latinos and African Americans, their votes had less to do with pocket-book issues, more to do with the fact that they trusted him.
But I agree that the Obama administration is going to have to begin creating WPA -type jobs.
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Yesterday, at a local university, I was pleased to participate in a panel on health care “around the world.” I explained Canadian single payer; a native Brit outlined the UK system which ressembles our VA; a German professor explained her country’s “hybrid” system, emphasizing the fact that the insurers are highly regulated and NON-PROFIT. My understanding is that France also uses private non-profit insurers to supplement their government-financed plan.
Of course you know all this, Maggie–I add it only to clarify how dramatically different European plans are from the proposed public-private mix being discussed in the US Congress.
“Our hybrid system would be much like Germany’s (where people have a choice between private sector and public sector insurance.” – MM
I have read your book Maggie and I have a lot of respect for your research. To claim though, that the patchwork of financing plans that is continued by the current legislation would have any resemblance to the German model where everyone chooses his plan is misrepresentation.
Healthcare in Germany is much more privatized than the US today and a public option will make the US system even less so. “Public” in Germany doesn’t mean a government run company, it means that the private, non-profit plan is part of a coordinated universal health care program.
FWIW, I don’t think that insurance companies per se are the problem in this country. As someone who has had the opportunity to work in several other countries and experienced universal coverage first-hand, I’d say the problem here is that all the players — insurers, physicians, patients, pharmaceutical companies, etc. — are operating in a bad model. You can’t tweak that into a good one, you have to first decide what you want in terms of health policy then construct a path to get there. Without some sort of basic agreement about where you want to go, all you get are more convoluted and costly programs.
I have read Gwande article about “Getting there from Here”. The exchanges, with or without a public option, do not represent a path to actual universal care and anyone outside the US understands the concept; they are a detour.
I can’t help but feel that supporters who think that a public insurance plan constitutes a path to an actual policy are deluding themselves.
My apologies, I think I accidentally posted my comment to the previous day’s blog. It really fits here, but I won’t repeat if it cannot be erased.
Athena, Harriette
Thanks for our comments.
Athena–Non-profit insurers are very powerful in many parts of the U.S.
If you live in much of the Northeast or Florida, you don’t see or feel their presence.
But if you live in the Northwest,
Upper Midwest, Nothern California, parts of the Southwest — non-profit insurers are strong and very important.
They are much like the non-profit insurers in countries like Germany.
If you study the economics of health care insurance in the U.S., you will see that for-profit insurers have a profit margin of only 3%.
Unless they make radical changes in their business model–proviidng much better, more efficent, patient-centered and affordable care– most won’t be able to survive while competing with the public option under the regulations included in the reform legislation.
Under the regulatons proposed in the Congressonal plans insurers will have to pay out 85% of revenues in reimbursements, they cannot turn customers down because of pre-existing conditions, or charge them more, they must offer the very comprehensive coverage that the public plan offers, copmly with regulation on raising premiums, can’t charge co-pays for primary care . . .etc. etc. etc.
Probably the vast majority of insurers who do survive will be non-profits. And many will thrive.
This is why many who understand how for-profit insurers make money now–and who have read the legislation– believe that it will lead a hybrid system much like Germany’s.
(I have close relatives who have been living in Germany for many years, so I am very familiar with that system.
Harriette–
Please see my response to
Athena. I think we’ll wind up with a hybrid system that is a combination of a government plan and non-profit insurers here.
In some parts of the country (paticularly teh Northeast, where I live) people just aren’t aware of how mnay Americans are covered by non-profit private insurance, and what a growing force is it.
See the excellent story in last Sunday’s NYT magazine Intermountain–like
yes, it’s true that the medicare modernization act was anything but that, and it’s further true that this particular congress is only feebly working on rolling back the worst of those changes.
the privatization of medicaid has proceeded to a much greater extent though, and i think it’s fair to attribute this to the fact that poor people have fewer resources to fight back against any abuses, nor does our society put much stock in protecting the poor.
seniors, however, are a vocal and relatively organized group, and despite the fact that aarp was instrumental in rallying them FOR the mma, instead of against it, you have to acknowledge that they’re a group that gets heard.
if all 300 million of us were in one single pool, instead of being separated into medicare and medicaid and public option and private insurance silos, we would have more influence when we need to be able to fight back against industry influence. that kind of solidarity is not foolproof of course, but it’s the best chance we have.
you are right, i’m not in medicare myself, but my dad the retired insurance industry executive and beneficiary of [traditional] medicare for many years now has taken great pains to educate his kids on the ins and outs of both systems.
hipparchia–
The good news is that the health reform legislation will cancel the premiums that we are now paying most Medicare advantage insurers.
There’s no threat of a government-monopoly, single-payer system happening in the short term – although that is the (unstated) long-term goal of the legislation. There is really no fear of “conservatives” in government executing a pro-life agenda after a government monopoly is imposed. The Canadian experience shows that the creation of a new, powerful class of government workers and the people’s fall into government dependency takes effect very rapidly, and cannot be overturned by a Conservative government. Demographics, not a passion for liberty, will end single-payer health care.
John–
We’re not Canada.
In Canada there is a very sharp separation of church and state.
That’s not true in the U.S.
The is why Congress didn’t require that federal gov’t employees health insurance cover contraception until 1998.
In the U.S., a conservative administration and Congress is likely to bring its moral and religious values to health care reform.
And, in the U.S. fiscal conservatives would argue that as a society, we have no responsiblity to provide high quality care for everyone.
Many conservatives feel that people shoudl take care of themelves. Health is a matter of personal responsbility.
They don’t believe that a civilized society has a repsonsiblity to make sure that everyone has access to care.
As Margaret Thatcher famously put it: “There is no such thing as society.
There are only individuals and their families.”
Thatcher was perfectly attuned to Reagan’s philosophy, a philosphy which set the template for
modern conservativsm int he U.S.