Krugman on Healthcare: Aim for Mediocrity
Paul Krugman’s Times column today is disappointing on a number of fronts. He counsels the Democrats to go for the usual mixed bag of government guidelines cobbled together with private insurers on the grounds that
“it’s better to have an imperfect health care plan than none at all.”
But Krugman has to know that the opposition to health care reform will be just as strong against an incremental approach like the one he advocates as it will be against a medicare-for-everyone comprehensive overhaul. The real risk is that a new Democratic administration will go for a watered-down program and will still lose. Sound familiar? See the Clinton folks c. 1993.
Most disappointing, however, is Krugman’s selection of the Massachusetts healthcare reform law as his shining example of how change can happen. He admits that the law “has come in for a lot of criticism,” citing its individual mandates. But he doesn’t mention two of the criticisms that he himself has focused on time again: the weak effort to control costs and the unattractive products-with high premiums and high deductibles- that private insurers have thus far offered.
The low point is the following sentence:
“And its costs are running higher than expected, mainly because it turns out that there were more people without insurance than anyone realized.”
This is downright deceitful. Krugman cannot be ignorant of the criticisms leveled in 2006 of the estimates of the numbers of uninsured people in Massachusetts. The figure of 500,00 was obtained through a telephone survey conducted only in English and Spanish and only of people with landline phones. As a number of critics pointed out at the time, this substantially underestimated those who were uninsured. (The U.S. Census, for example, estimated 748,000.) National survey data available at the time showed that over 48% of uninsured people did not have a landline-type phone.
The costs for the new health law were based on the lower figures, which, of course, underestimated these costs. This helped it pass. Now more people have signed up because there always were more people who needed subsidized insurance. And the law does far too little to control costs, adding to the overall expense. It’s not, as Krugman writes, that no one realized that there were so many un-insured. It’s precisely that proponent of the law wanted to undercount the actual number of uninsured to make their budget projections work.
Now this deception is being touted as “success.” In today’s Globe Scott Allen (Leaders nip, tuck, healthcare policy, August 11) repeats a dubious contention as fact. He writes that
the [healthcare reform] law has been so successful-prompting an estimated 345,000 people statewide to obtain insurance-that it has been far more expensive than expected….
This, I point out, was printed as a straight news story, not an opinion column. The local and national media have been sold-and have bought-the story that “Gosh-more people want to buy in to our nifty new healthcare program, isn’t this just wonderful?” It’s a classic case of bait-and-switch. And this is model for national emulation?
Paul Krugman wants a health reform program that deliberately aims for mediocrity-knowing all the time that we’ll fall short of that mark.
By my reading of the column, Massachusetts was the opposite of a shining example. He was arguing that, once in place, universal health care coverage would become popular. He indicates that the Massachusetts system despite lots of problems is pretty popular. The flawed nature of the Massachusetts system is central to his argument.
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p>His assessment of the politics of this thing is quite right. Republicans, almost every single one of them, are united in ideological opposition to single payer. Libertarians certainly don’t like it. Paleo-conservatives don’t like it: they’ve been paleo-ing against social security these many years. Religious conservatives will bridle at paying indirectly for sexual health. Corporate conservatives will be split but the insurance industry certainly won’t be.
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p>Winning single payer requires a huge ideological victory, by which I mean, it requires trouncing conservatism so thoroughly that Republicans try to hide from that label as much as Democrats tried to hide from the liberal label after Reagan. A progressive victory on that scale, with an inspiring but centrist Presidential nominee and Blue Dogs swelling the ranks of the Democratic caucus, isn’t in the cards for 2008.
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p>So Krugman may be right: the choice is between nothing and mediocre. And yes, even getting to mediocre requires making a lot of noise for single payer.
The State government can’t build a bridge overpass without going 300% over budget so did anyone really believe their cost estimates?
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p>In May, in a statement to bond rating agencies, the Governor has estimated that the fiscal year 2008-2009 costs will be more like $1.1 billion–a 50% increase over the original estimate from less than two years ago! The original estimate was $472, then $650M, then $725M, then it moved to $869M, then $969M and now $1.1B. Sounds like the Big Dig all over again.
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p>And we have quite a few more people to enroll in the system who will be paying on the “low” end of the contribution model. More red ink will flow.
These aren’t just state government estimates. The private sector has a big hand in them.
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p>It would seem to me that Big Dig under-estimates are precisely what you’d expect when government deals with outside contractors. After one wades through unrealistic bids, insufficient oversight, conflicts of interest, multiple layers trying to defer bad news, and the natural tendency of engineering projects to be underestimated, this seems unsurprising — though unfortunate.
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p>At least with stuff like single payer health care, other countries have a track record that could make estimation more realistic. These “yikes! no socialism!” approaches, as SmallTownGuy will probably argue more persuasively than I, are probably impossible to estimate accurately.
Healthcare-NOW!, formed about 4 years ago: http://www.healthhare-now.org
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p>Health Care For America Now!, formed about 4 weeks ago (after 3 years of groundwork being laid):
http://healthcareforamericanow…
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p>Physicians for a National Health Program, formed about 15 years ago: http://www.pnhp.org
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p>MassCare, statewide group that formed about 14 years ago:
http://www.masscare.org
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p>All these groups are composed of smart passionate people who are committed to the value of health care justice and the the public policy vehicles of responsive accountable government and effective public programs. Now’s the time to pick a group, learn about the issues and the proposed solutions (a way to delve deeper into the topic of this post), and to get involved.
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p>We can be sure that, as always, healthcare reform that aims for real reform and not just tinkering is going to be a surefire David vs. Goliath battle. Which side are you on?
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p>Please consider signing on to one or more of the above groups and know that any effort you make, of money, time, etc, will indeed make a positive difference.