Thoughts on Reforming the Provision of Healthcare in the United States: Introduction (Part 1 of 10)

Perhaps healthcare reform seems like an unusual choice of topic to restart (after a few months of silence) this blog on international relations. But political economy is Endgame of History’s secondary topic, and the debate over government involvement with healthcare is, in many ways, a debate on political economy.

An Itemized Critique

One of the many reasons I might have avoided this topic is its breadth. But a template for conveniently collating some of my thoughts on the current debate came in the form of a Wall Street Journal article last week, “New Rx for Health Plan: Split Bill.”

The point of interest to me is the table at the bottom, “Splitting the Bill,” which contains a simplified overview of the major Democratic proposals for healthcare reform (and their potential legislative future). In a conversation with a coworker, I discovered a convenient method of illustrating my perspective: simply arranging the eight proposals from my greatest agreement / least opposition to greatest opposition / least agreement. I didn’t have to come out completely in favor of, or completely opposed to, any specific idea; I merely indicated what bothered me less and what more.

Another advantage of itemizing elements of the proposal is that it increases the likelihood that any two people may find common ground in the debate, even while more clearly understanding where (and, perhaps, why) they disagree. Many pundits lean on itemized analyses, and I hope most congressmen do, but I’m not convinced that many of the most vocal citizens are analyzing healthcare reform piece by piece. (Or, rather, I’m convinced that many are not.)

Is the Opposition Reasonable?

Which leads me to the final reason I decided to blog on this topic. For better or worse (depending on your political perspective), the opponents of the current healthcare reform proposals who are receiving the most media attention are not legislators, professors, or thoughtful “ordinary” citizens. Rather, they are those who are (at least in media portrayals) radically and irrationally against any healthcare reform, allegedly spreading myths and falsely vilifying many current plans and ideas (even those of moderate Republicans) as “socializing” our healthcare system. And while I do think much of the media attention has focused on a minority of poorly behaved, poorly informed opponents (albeit the most vocal), my assumption is that these bona fide loudmouths are the only opponents most healthcare reform advocates are hearing.1

Thus, given the masking noise generated by the most radical healthcare opponents, advocates conclude there is, essentially, no reasonable opposition to—and thus no reasonable concern about—HR 3200 (warning: 1,017-page PDF) and its legislative kin.

The Plan

Returning to the itemized list of healthcare proposals: In the forthcoming series of entries, I will individually examine the eight proposal elements presented in the Journal article, using each as a springboard to discuss the relevant questions and my perspective on the “pros” and “cons” of each. I will examine the proposals in descending order of my personal support.

Also, note that, for mostly practical reasons, these entries will remain almost entirely on the theoretical level (preliminary to statistical analysis). I realize there is a host of studies and reports on healthcare specifics, e.g., the number of uninsured Latino children living in North Dakota, and the data should play an important role in the debate. But given my background and the limitations of time, I believe I am best suited to analyzing the fundamentals of political economy and allowing others to input solutions based on their personal values and the numerical details.

Return soon as I begin posting my examinations of the eight proposals:

1. Cap out-of-pocket expenses
2. Require most Americans to have health insurance or pay fine
3. Prohibit insurers from rejecting customers over pre-existing conditions
4. Set up “exchanges” where people can comparison-shop for insurance
5. Expansion of Medicaid
6. Federal subsidies to buy insurance
7. New taxes to pay for these items
8. Establish public health-insurance plan or nonprofit co-operatives to compete with private insurers

Note

1. I do think the media has misrepresented the opposition, even if only because the loudest individuals generally receive the most attention. If I went to a town hall meeting and said what I plan to say in the forthcoming blog entries, I probably would receive far less media attention than a gun-toting healthcare opponent holding a sign suggesting President Obama is a closet Nazi. However, I do think Democrats have overreacted to some of the “less refined” criticism. While Democrats today bemoan the swastikas brandished in opposition to healthcare reform, I remember no similar outcry at the parade of equally sophomoric Hitler-mustached Bush posters circa (primarily) 2002–2003. ^

[Via http://endgameofhistory.wordpress.com]