Health Care Revisited

So President Obama has held the beginnings of a Great Plenary Council on health care reform, and inevitably, people are comparing it with the Clinton efforts in the early ‘90s. Which I was watching pretty closely at the time. So far as I could see, the administration made two major blunders. First, they started bargaining on their own bottom line. Last I heard, Yale Law School did have courses in negotiation strategy, like any good law school. Presumably one or both of the Clintons took such a course, so there is no excuse for the fact that they didn’t build any wiggle room into their first and final offer. Especially since there was, and is, an obvious bargaining position to set out with—single payer. It is what a large proportion of the American people wanted then and probably still want now, it is the cheapest way to go, and it has a proven track record of success in other countries. But the vogue then, in business and political negotiating, was the one-time-only take-it-or-leave-it offer. That’s what the administration offered, and the American people left it.

The second blunder was that the administration’s one-time-only-etc. offer built in large goodies for the private insurance companies. This had two major drawbacks: first, all the features of the Clinton plan that the American people liked least were built in to sweeten the deal for the insurance companies. And second, the insurance companies couldn’t be trusted to stay bought. Instead, they came back with the Harry and Louise campaign.

So here we are again. This time, the administration isn’t starting out on its own bottom line, but inviting all the players to contribute to a solution, which is an encouraging start. But the insurance companies are already griping about the administration’s advocacy of a government plan for people who can’t find a private plan they like (or can afford.) “Unfair competition,” they moan. Once again, the government’s relations with business are being attacked from both sides. Government operations shouldn’t make a profit, because that’s unfair competition with the private sector. And they shouldn’t lose money, because that’s a waste of the taxpayer’s dollar. Any government operation that doesn’t exactly break even is vulnerable to these arguments.

And the insurance companies and large corporations are also demanding that employer-funded health care be kept in place, which bewilders me. Health care costs, for employees and retirees, are one of the main reasons for the decline and probable fall of the Big Three auto companies. And, presumably, for similar problems among other private corporations. Health care is why American corporations have such a hard time competing with European, Japanese, and Canadian companies. Indeed, a few years ago, the US government was complaining that government-subsidized health care in Canada constituted an unfair trade practice. And now they want to keep it in place? Or are they just waiting for a better offer before allowing themselves to be lured into the briar patch?

Well, I have no better solutions for this mess than anybody else, but I do have a couple of suggestions. One: the administration should not trust the private insurance industry as far as a paper airplane will travel. If they do not get what they perceive to be the best deal possible, they are perfectly capable of pulling another Harry and Louise and scuttling the whole system.

And two: if the private insurance industry is to be allowed to have any part in the new improved system, the money to pay them should come out of funds clearly labeled “entitlements” or better still, “welfare.” Because they cannot make a single positive contribution to a solution. Single-handedly the private insurance industry has added more waste, fraud, and abuse to the health care system than any government agency over the last fifty years. If we can persuade them to get rid of most of it, that is the best we can expect. And the money one pays an otherwise useless entity to survive without excess harm to its neighbors is normally considered “welfare.” Yes, there are lots of otherwise decent people who support themselves and their families working for the insurance industry. Without that industry, they might have to look for useful work at a time when there isn’t very much of it available. So fine, let’s view it as a WPA or a CCC. Let’s leave it in place until the economy has revived enough to provide other kinds of more socially useful work. And not a minute longer.


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