James Hamilton, talking about Mitt Romney's attempts to restructure health care by ending free medical care in emergency rooms but subsidizing the needy, writes:
Even so, I count it as progress of sorts if we might in this fashion find ourselves at least able to agree on what we want to buy, leaving just the little matter of haggling over the price. A proposal like Romney's strikes me as a constructive way to frame a public discussion of exactly where America stands on who should pay the medical costs of the uninsured.
I don't know about that. Outside of the blogosphere, it's fairly impressive how much of the health care debate really is about haggling over prices. The constituency actively pushing single-payer in this country is quite small, in large part due to fears about its political viability. Moreover, support for health care entitlement programs like Medicare, Medicaid, CHIP, is widely bipartisan, almost sacrosanct. Even with a budget deficit spiraling rapidly out of control, the most radical Republican majority in memory couldn't force serious cuts in Medicaid. Back in the mid-90's, Newt's Revolution suffered a major public defeat when they tried to simply restrain the growth of Medicare. Bush just tacked a massive prescription drug enhancement onto the same program. Conservatives have no stomach for cutting health subsidization, and often find themselves expanding it.
So what we have in this country, to a large degree, is a health care consensus. Some degree of subsidization is necessary, particularly for the elderly, children, and the impoverished. That part's not a problem. What is a problem is that the status quo can only last so long, health care costs are moving too fast and our system is becoming too burdened for this consensus to hold. And that's when we'll really see folks have to pick sides. Not now, when it's safe to support what exists and prudent to oppose what doesn't, but when what exists becomes untenable and what comes next becomes pressing.