Monday, July 25, 2005

Making Health Care Happen

The marvellous Matthew Holt, proprietor of The Health Care Blog on Why Hillarycare failed. He explicitly rejects Clinton's own self-assessment (as reported in the New York Times) that she failed, because she rejected incrementalism and tried to do too much too fast. Matthew's basic thesis is just the opposite. Hillary didn't move fast enough.

Matthew says that Hillary dawdled by spending 6 months on a fact-finding journey with Ira Magaziner when there was 10-15 years of good research outlining what the problems were. What Hillary failed to grasp was that she had a very narrow window in which to act. Coming off of the recession there was a lot of insecurity about not having healthcare, and there was a sizable chunk of people who felt that the system needed to be completely revamped. So, it seems to me that we need to be ready to move when the next opportunity presents itself to move for universal coverage which is why I'm puzzled by the conclusion to Matthew's piece:

"Once we get it done, then we have a while to worry about sorting out the system to the purists' satisfaction later. So will you all still please stop arguing about what it should look like!"

I take his point that we'll have to work the kinks out over time, but I still think that we ought to have a few options on the shelf ready to go. We should have a basic single payer option, some sort of managed competition plan etc. and we should think about which current stakeholders would benefit from the different types. No insurance company--other than the Blues who might still play a role processing claims--would line up behind single payer, but the doctors might prefer it. So we need to figure out who our natural allies for each proposal are, and when the country's mood is right and the allies are mad enough, we need to strike. In the meantime we need the Democratic party to adopt a few of those plans and to have the borad outlines of a best and second-best option. We can't have every presidential candidate tackling it from scratch.


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