TW:
The Politics:
1) The Republicans clearly perceive opposition to almost any Obama led health care reform as an electoral winner. We have posted on this previously. To a certain extent from a purely Machiavellian view it is logical. Cutting Obama off at his knees versus helping him attain a huge legislative goal is not a difficult choice. So far the strategy has worked, Obama's poll numbers are down from high levels. What is the end game though?
We now have the RNC chair, Mr. Mike "Buffoon" Steele issuing senior bill of rights which would enshrine Medicare cost growth at extraordinary rates into perpetuity. Expanding the wedge between those over 65 and those under. As an aside I actually think at this point Steele's buffoonery is very intentional and quite effective. He can be the carrier for whatever pandering the Republicans need presently. In a couple of years he can be tossed aside never to be heard from again.
Should the Republicans re-gain electoral strength then what? The Dems would cry uncle and say lets toss out all of their own views on universal care etc? The Republicans have done a fine job of irresponsibly opposing whilst providing nearly no viable alternatives to a growing problem that will not go away.
2) Universal care and cost containment have become nearly hopelessly conflated. The two are very different concepts. Most Americans I believe sympathize with the need for universal care, they may be unclear on how to pay for it, but they empathize with the need for it. They understand or at least sense many of the inequities in our system. However, the Republicans have done two things well. Accuse the Dems of expanding government recklessly and accuse the Dems of trying to pay for universal care on the backs of Medicare reductions for seniors.
3) Seniors have the best health care deal in America. Their funding is open-ended and with minimal shared costs, no issues with pre-existing conditions, insurance rescissions etc. They sense not irrationally that there is only one way for their care to go in a new system -down- either through increased cost sharing or new limitations.
4) Those under 65 sense they are bearing increased risks and facing escalating cost sharing but a bird in hand still beats one in the bush. This cost escalation is relentless but still generally an ever growing drip, drip rather than a cold slap in the face sufficient to motivate comfort with a new system.
5) Many folks have discomfort with "bigger government". Some have a visceral discomfort, others a more subtle discomfort. Few though can articulate how to "reform" health care without "bigger government", but again the bird in hand.
6) Overlaying all of this are the entrenched interests of health care providers, insurers, unions, suppliers, state and local governments, you name it, they have skin in the game.
The solutions post tomorrow...
2 comments:
One thing I would add to point #2 is that many Americans who see the "need" for universal coverage, do not see how it follows that government should have a hand in providing it.
And any solution you propose (I'm looking forward to this!) should either a) be one that doesn't require the government to fund universal coverage or b) if government is to fund the coverage, then you should argue for WHY it should, given that there's nothing in the constitution that suggests this would be the job of the government.
Maybe your solution would reflect the passion of so many individuals who "sense the inequities" and would therefore be willing to pony up their own money, start a non-profit organization, and insure the uninsured on their own dime. I would contribute to that foundation.
ummm...fish ain't bitin'
using strict construction arguments (I dont think strict construction is even the right word, your approach would require the founders to have figured out all hypotheticals 200+ years ago or at least would leave us enacting constitutional amendments once a week) we would have to repeal probably 90% of the legislation enacted since about 1789 or so.
We are not advocating the creation of an explicit right per se, we proposing a legislative solution to a perceived need. One route would be an amendment creating the right but it is not necessary. The constitution permits Congress and the Executive to enact legislation like universal care.
Either the government funds universal care or there is no universal care it is not complicated. If one gets hung up on that concept then they will just have to oppose universal care of course they would need to repeal Medicare amongst other things probably.
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