Selling Health Care

Matt and Kevin tee off my HSA post below with some thoughts on long-term political strategy. Their main point, which is probably correct, is that negotiating with ourselves doesn't make sense. As Matt says, the onus should really be for GM and Ford and the insurance industry to come to us and admit that health care is crumbling, and then we can all meet in the middle and figure something out. Kevin makes the point that, as a bargaining principle, you should always start hight (single-payer with all insurance industry execs thrown in jail) and then negotiate downwards as time goes on. Don't start down and hope to negotiate up.

All true on the political front. But I worry that Matt and Kevin are too sanguine about the death of private health care in this country. The move towards HSA's and consumer-shouldered risk, much like the migration towards PPO's, will begin to bring down costs for the country's major businesses. Indeed, the reason that GM and their friends are having such trouble is the high rate on unionization among their work force, which makes cutting health benefits much tougher. Others will simply shunt the costs onto their employees and call it a day. But it's not certain that businesses won't figure out a way to dodge costs and burden workers, thus guaranteeing their own survival if not a healthy society. Beyond that, the insurance industry will never come to the table and admit that health care is failing because every other option requires a radical and painful restructuring of their businesses, if they survive at all. So I wouldn't count on them as allies, well, ever (indeed, anything that they ever would ally with us on is probably a bad option anyway).