Healthcare reform: subterfuge, and the triumph of hope over experience

The House narrowly passes a healthcare reform bill.  Next stop the Senate.
But .....
First, from this NY Times piece that reports on Maine's healthcacre efforts:

Maine is the Charlie Brown of health care. The state’s legislators have tried for decades to fix its system, but their efforts have always fallen short: health insurance premiums are still among the least affordable in the nation, health care spending per person is among the highest and hospital emergency rooms are among the most crowded. Indeed, many overhauls to the system have done little more than squeeze a balloon — solving one problem while worsening another.

But like the Peanuts character, the state keeps trying. Indeed, Senator Olympia J. Snowe, Maine’s senior United States senator and so far one of only two Republicans in Congress to vote for an overhaul, spent two years in the late 1970s as chairwoman of the State Legislature’s joint Health and Human Services Committee pushing small reform efforts. “That’s where I garnered an enormous deference to the issue of health care and its complexities,” Ms. Snowe said in an interview.

Maine’s history is a cautionary tale for national health reform. The state could never figure out how to slow the spiraling increase in medical costs, hobbling its efforts to offer more people insurance coverage.

 And, then from John Cassidy's essay in the New Yorker:

So what does it all add up to? The U.S. government is making a costly and open-ended commitment to help provide health coverage for the vast majority of its citizens. I support this commitment, and I think the federal government’s spending priorities should be altered to make it happen. But let’s not pretend that it isn’t a big deal, or that it will be self-financing, or that it will work out exactly as planned. It won’t.

Many Democratic insiders know all this, or most of it. What is really unfolding, I suspect, is the scenario that many conservatives feared. The Obama Administration, like the Bush Administration before it (and many other Administrations before that) is creating a new entitlement program, which, once established, will be virtually impossible to rescind. At some point in the future, the fiscal consequences of the reform will have to be dealt with in a more meaningful way, but by then the principle of (near) universal coverage will be well established. Even a twenty-first-century Ronald Reagan will have great difficult overturning it.

That takes me back to where I began. Both in terms of the political calculus of the Democratic Party, and in terms of making the United States a more equitable society, expanding health-care coverage now and worrying later about its long-term consequences is an eminently defensible strategy. Putting on my amateur historian’s cap, I might even claim that some subterfuge is historically necessary to get great reforms enacted. But as an economics reporter and commentator, I feel obliged to put on my green eyeshade and count the dollars.

Ahem!

The public option swow(e) job

Here is Robert Reich:

So will Snowe play ball? It depends. Her idea (evidently encouraged by Rahm Emanuel, the President's chief of staff) is to hold off on any public option. Give the private insurance companies a period of time -- say, five years -- within which to make changes that extend coverage to more people and also drive down long-term costs. If those goals for coverage and cost aren't met by end of the five-year grace period, kaboom: the public option is triggered -- which will force such changes on the insurance companies.

The beauty of Snowe's proposal is that it seems to offer Blue Dogs a way out and liberal Democrats a way in. Nobody has to vote for or against a public option. The public option just happens automatically if its purposes -- wider coverage and lower costs -- aren't achieved. And the trigger idea seems so, well, centrist.

The problem is twofold. First, it's impossible to design airtight goals for coverage and cost reductions that won't be picked over by five thousand lobbyists and as many lawyers and litigators even if, at the end of the grace period, it's apparent to everyone else that the goals aren't met. Washington is a vast cesspool of well-paid specialists who know how to stop anything resembling a "trigger." Believe me, they will.

Second, any controversial proposal with some powerful support behind it that gets delayed -- for five years or three years or whenever -- is politically dead. Supporters lose interest. Public attention wanders. The media are on to other issues. Right now the public option is very much alive because so many Democrats care deeply about it, with good reason. But put it off for years, and assign it to the lawyers and lobbyists I just mentioned, and you can kiss it goodbye for ever.

If the idea is to have a public option waiting in the wings in case private insurers blow it, why wait for it at all? If it gets lower costs and wider coverage, it should be included right from the start.

What worries me isn't just that the mainstream media are calling Snowe's trigger "centrist," but that the White House might see it as an easy out. "I continue to believe that a public option within that basket of insurance choices would help improve quality and bring down costs," the President said Monday. Fine. But he hasn't yet said the public option is essential. He hasn't threatened to veto a bill lacking it.

If you are late to the party, and are wondering what "public option" means, no problems. Click here for details.