27 March 2009

You want socialism? We'll give you socialism!

Socialist senator Bernie Sanders (yes, he really does call himself a socialist) has introduced a single-payer health reform bill in the US Senate.   Kossack DrSteveB discusses co-sponsors and cost containment within the plan.

On the merits: fair enough, I can concede that single-payer does have the best potential for real savings, efficiency, and slowing down the growth in health care costs.   The downside is the inevitable government abuse of its monopsony power and subsequent downward pressure on physician reimbursement.

On the politics:  I don't want to be dismissive, but this doesn't have a chance in hell of becoming law.   Even the moderate consensus-based compromise plan will be a herculean task.   But it does have its use -- a bit of pressure from the left to encourage Senate leaders to keep the public plan as a viable part of the final health reform package.  This is particulary nic in light of recent comments by Senator Baucus, as (sort of) reported by Time's Karen Tumulty:
The insurance companies hate [the public plan], saying it is would be unfair for them to be forced to compete with the government. Many health care experts, however, argue that this provision is crucial, as a means of holding down health care costs. [...] Conservatives oppose it as well, because they see it as a first step toward a Canadian-style single-payer system.

What Baucus had to say will not give much comfort to those who support the idea of a public plan as it is presently being proposed. He strongly suggested that its main value, at this point, is as a bargaining chip to get the health insurance companies to agree to other things that reformers want to see:

"Essentially, it's to keep it on the table to encourage the private health insurance industry to move in the direction it knows it should move toward—namely, health insurance reform, which means eliminating pre-existing conditions, guaranteed issue, modified community ratings.  It's all those actions that insurance companies must take in order to provide affordable coverage. And the public option helps encourage the private companies to move in that direction, because they're worried. We might have to modify the public option to get enough votes. I hear some concerns among Republicans about the public option. The main purpose is to keep the health insurance feet to the fire."

I think it is essential that there be a public plan to force the insurance companies to compete on cost, customer service, and efficiency.   And that there be private plans to force the public plan to compete on the provider side with fair payment rates.   Talk like this of the public plan option as a bargaining chip does cause me some concern.   So, while it may be politically DOA, it's not altogether a bad thing for a purely public plan (single payer) to be emerging on Baucus' left flank.  


  1. "So, while it may be politically DOA, it's not altogether a bad thing for a purely public plan (single payer) to be emerging on Baucus' left flank."

    I agree. I never listen to AirAmerica (no one does) and I only rarely watch Olberman or Maddow. Nonetheless, it is helpful to have them when folks try to say that the two schools of thought in media are Fox(right) and CNN(left). You can say, well, the anti-O'Reilly is Olberman not Wolf Blitzer.

    Likewise, I think it will be helpful to be able to say, "No, you're thinking of Sanders plan. Ours is the middle road bill."

  2. For the life of me, I can't understand why Americans are so afraid of a Canadian-styled health care system.

    Canadians have high quality medical care, never have to worry about "pre-existing conditions" & aren't in danger of losing their homes because of medical bills.

    Low income Canadians do not have to rely on expensive emergency rooms for their care, thus making more efficient use of primary care services.

    I would far rather pay more taxes than think that people who are struggling financially are not getting the medical care they require.

  3. You used the word monopsony. I'm impressed!


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