Gerry Canavan

the smartest kid on earth

More on Health Care and the Political Spectrum

with 2 comments

Starting off, I thought this insightful post from Matt Yglesias puts the central paradox in centrist/incrementalist approaches to health care reform very well:

The reason is that the way insurance companies make money is to segment the population based on risk. And the way centrist, moderate, or otherwise incrementalist approaches to reforming U.S. health care work is they attempt to regulate away insurance companies’ ability to do risk-segmentation effectively. But once you accept the premise that you don’t want insurance companies doing all this risk analysis, there’s basically nothing else for them to do. That’s just what an insurance company is.

Naturally I use that term “centrist” here quite advisedly, taking Shankar D’s point from the comments that it can sometimes obscure more than it reveals. But here again I think the term is meaningful and useful: “centrism” designates an approach to health care reform that leaves the current dominant coverage mechanism (for-profit insurance companies) basically intact and unchanged, in contrast to liberal or progressive approaches like (in order of radicality) co-operatives, public options, and single-payer, which are transformative in nature.

Ezra Klein takes up a more Shankarian style of analysis when he writes of the progressive blogosophere inappropriately making a fetish of the public option:

It might have been a necessary thing from an activism point of view, but convincing liberals that this bill was worthless in the absence of the public option was a terrible decision, wrong on the merits and unfair to the base. The achievement of this bill is $900 billion to help people purchase health-care coverage, a new market that begins to equalize the conditions of the unemployed and the employed, and a regulatory structure in which this country can build, for the first time, a universal health-care system. Thousands and thousands of lives will be saved by this bill. Bankruptcies will be averted. Rescission letters won’t be sent. Parents won’t have to fret because they can’t take their child, or themselves, to the emergency room. This bill will, without doubt, do more good than any single piece of legislation passed during my (admittedly brief) lifetime. If it passes, the party that fought for it for decades deserves to feel a sense of accomplishment.

Fair enough.

But this is also the same Ezra Klein who wrote, only a few days ago, that “This bill, when it’s finished, is not going to be very good. But it’s going to be a lot better than what we have, and almost more importantly, a lot easier to improve in the future.” And it is this argument—the expansionist argument—that I think remains the clearest justification for full-throated progressive support of this significantly imperfect bill. Obamacare is a base hit, not a home run. Recognizing it as such isn’t, and shouldn’t be confused with, rejecting it altogether.

2 Responses

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  1. It does seem like we are having a semantic dispute. I don’t think there’s any meaningful way to define a policy as “centrist.” I suppose you could ask whether it captures the support of the political center, but then, the public option would in some sense be a “centrist” solution.

    Incremental is fine to to the extent that it connotes something about the qualitative nature of reform (i.e., not transformative of the structural elements of an industry, etc). But ultimately, I don’t think much of this matters.

    The key point, from my perspective, is that a health care bill similar to the one the Senate is considering, even if stripped entirely of the public option, is a really big deal and a really good thing. It is, historically speaking, a progressive milestone. I’m not sure either you or traxus disagrees with that, but I do see a fair bit of comment from the left that it would literally be worse than nothing. I have a very hard time understanding how someone who is basically sympathetic to the need for people to have access to medical care could think that.

    Also, one more point – Yglesias’ use of the phrase “centrist/incremental” seems keyed to the insurance market reforms. But that’s not all that’s going on here. The key is the Medicaid expansion cum affordability credits that will allow millions more people to gain access to health insurance.

    Shankar D

    December 6, 2009 at 5:00 pm

  2. One other thing – I think that part of being a liberal/progressive/whatever is believing that ultimately, everything is a base hit.

    The arc of the moral universe is much, much longer than our lives.

    Shankar D

    December 6, 2009 at 8:14 pm


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