Monday, March 26, 2007

Toward a more thoughtful campaign discourse...and some thoughts on Health Care Reform

Campaign Candor - New York Times

Bob Herbert opines on the significance of the latest personal turn in the endless campaign:

It would be far more constructive and interesting if this heightened attention to Mr. Edwards’s campaign resulted in the media and the public taking a closer look at the issues he has been pushing, not just in the campaign but ever since his unsuccessful run for vice president in 2004.

If that were to happen it could be part of the silver lining that Elizabeth Edwards hopes will emerge from her family’s latest devastating crisis. ...

The war goes on, and fate has dealt the Edwards family another devastating blow. The rest of us can help invest the absurdity of their tragedy with meaning by paying closer attention to the issues that are important to them. Whether one ends up agreeing with them or not, it’s a way of opening the door to a more thoughtful, rational way of selecting our presidents.



Edwards has been talking about poverty in America, and has proposed a plan for health care reform. My own strong preference, in contrast with Edwards' variation of "play or pay", is for universal coverage under a single payer plan. I would be open to consideration of an (expensive, non-tax subsidized) opt-up for those willing to pay for faster access to non-emergent services and penthouse level amenities (a reluctant concession to the political realities of wealth and power in America). If the base plan is essentially Medicare (not Medicaid) for all, perhaps even strong egalitarians can come to tolerate the equivalent of Medicare-supplemental policies, and perhaps it might serve to buy-off some insurance company opposition (though I wouldn't hold my breath on that).

With more than nine months to go before the primaries, perhaps we can gestate and seriously debate some real ideas in this campaign. With health care as the leading domestic issue, and education and poverty (keys to meaningful opportunity in America) deserving a place not far behind, maybe Hillary, Barack and others can step up to the plate, and the media can devote the equivalent of their daily sports hole to serious consideration of the candidates' positions on issues that matter to the lives and life opportunities of all Americans. Who knows,maybe the public could even pay some attention to something beyond celebrity.

A place to begin: What can we learn from Hillary's catastrophically failed effort at health care reform in her husband's first term?

In the years since, most everything Harry and Louise warned of has come to pass: Health care has gotten much more expensive, waits have grown longer, and the conditions of service have become more bureaucratic. Someone other than the doctor at the bedside is making decisions on patient care (often on financial grounds, not medical considerations). Doctors are spending less time with their patients. Patients can't choose their own physicians: the docs quit and move their practices in response to intolerable bureaucratic constraints on their time and medical judgments, and employers switch plans to save a buck, leaving established doctor-patient relationships in the dust. (Who ever decided our employers should choose our doctors for us, and why?)

And access has gotten worse. More Americans are uninsured. People go to the ER for routine clinical services, waiting for untold hours and costing all of us a bundle. Drug prices are out of control. Administrative costs are insane.

Except it's the insurance companies and Big Pharma and the HMOs, not the government.

What can we learn from that?

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