Marcia Angell on Moyers made the case why it shouldn't pass. She thinks overall it's going to make things worse despite its positives. And if it's going to get worse, better it should do so without government-run healthcare to blame. Maybe she's right. I'd like to hear her in a debate with Ezra Klein. But if nothing else, her argument makes me feel a little better if this bill goes down. You should watch the whole interview, but this except is the heart of her point:
BILL MOYERS: But the President is pushing ahead; he wants Congress to act in the next month. What would you have us do?
MARCIA ANGELL: I think the problem is this, Bill. If this plan is passed, and I think there's real doubt as to whether it will be, and there's even more doubt as to whether it would ever be fully implemented, but let's say that it's passed. It will begin to unravel almost immediately. And then what will people do? Well, they'll say, "We tried health reform, and it didn't work. Better not try that anymore."
It'll be like what happened after the Clinton plan failed. There'll be another 16 years before anybody comes up with the courage to try that again. People say, "Too expensive. Just can't have universal care. Tried that, did that, didn't work, good-bye." Whereas if the bill dies now, people can say, "This bill died because it was a bad bill." And the problem is still on the front burner. And then one can hope that we get some version of Medicare for all. And that we don't have to wait 16 years.
BILL MOYERS: What makes you think it would come back in 16 years or more? What makes you think it will ever be back on the table?
MARCIA ANGELL: Oh, I think it has to be. I mean, I think that this system is unraveling so fast, doing nothing or doing the Obama plan, so fast, that something will have to be done. Unless we want to, you know, explicitly be a third world country. So I don't think it's going to wait. But if we pass this plan, it's going to delay.
She dismisses the political argument that Obama and the Dems need the win to stave off Republican takeover. And she may or may not be right about that. But it is galling to think of Jim DeMint's victory dance if this bill goes down. But ultimately Obama and the Dems brought this on themselves by cutting the deals they did. They gave the store away. Angel again:
What this bill does is not only permit the commercial insurance industry to remain in place, but it actually expands and cements their position as the lynchpin of health care reform. And these companies they profit by denying health care, not providing health care. And they will be able to charge whatever they like. So if they're regulated in some way and it cuts into their profits, all they have to do is just raise their premiums. And they'll do that.
Not only does it keep them in place, but it pours about 500 billion dollars of public money into these companies over 10 years. And it mandates that people buy these companies' products for whatever they charge. Now that's a recipe for the growth in health care costs, not only to continue, but to skyrocket, to grow even faster.
This should have been framed from the beginning as a Medicare buy-in for all.
UPDATE: Ezra Klein today:
But that private insurance will now be a very different beast: It will have to spend 85 percent or 80 percent (depending on the market) of every premium dollar on care. It won't be able to reject people for preexisting conditions. It will be in a regulated exchange where it has to justify premium increases and bad behavior or face exclusion. And those exchanges, regulations and subsidies will also create the core structure of a universal health-care system in this country, which should be comforting to progressives who look to the improvements in Social Security and Medicare and Medicaid and CHIP and the EITC and know that the history of American social policy is that, in general, we build on our imperfect foundations and make them stronger and fairer over time.
Marcia Angell would dispute most of these assertions, and I don't know if she's right or not. I think the one thing I don't understand very well is whether the
exchanges will have a significant effect in preventing capricious
premium increases. It's one thing in theory, but what will the real impact be of "exclusion" for bad behavior. Will exclusion in the exchanges matter? Will the people running the exchanges be tough enough to kick insurance companies out for bad behavior, or will they be creatures of the insurance industry, especially when Republicans are in office.
Here's Dennis Kucinich making the same points. I'm not a big Kucinich fan, but if his facts are correct, I can't begrudge him his refusal to vote for this bill:
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