My article on the "Elusive Politics of Health Reform" is up at The American Prospect, and though I'm going to excerpt some of the article here, I'm really doing it so I have enough text to set off the cool, illustrated graph the magazine got for the piece:If health insurance were cheap, we could all buy it. If universal health care could get 60 votes in the Senate, we'd all have it. But these two imperatives -- the need to control costs and the need to attract the 60 Senate votes required to overcome a filibuster -- point in opposite directions. This is the central paradox of health reform.The most intractable policy problem is not, fundamentally, the 47 million uninsured or the fact that insurers have a business model right out of Dickens. It's cost. In 2006, the average family policy cost $13,600. This is why one out of six Americans are uninsured; they can't afford the premiums. An October 2007 Kaiser Family Foundation poll found that more Americans were "very worried" about being priced out of their health insurance than feared losing their job, their house, or being in a terrorist attack. And with good reason: Premiums have gone up 98 percent since 2000. Wages have not.[...]The question, then, is how to limit heath-care costs while still surviving the legislative process. A single-payer system would increase efficiencies, but critics fear that it would control costs excessively, limiting care. Politically, single-payer would mean restructuring about 17 percent of our economy and eliminating multibillion-dollar industries that provide tens of thousands of jobs. It would have to be legislated over the fierce objections of the Republican Party and all conservative Democrats. Conversely, many Republicans, John McCain included, advocate a radical shift of costs onto individuals, controlling spending by pricing care out of reach for tens of millions. Few Democrats or moderate Republicans -- or voters -- favor this course.I go on to examine, in detail, the Hacker, Wyden, and presidential plans, assessing their political viability and their capacity to control costs. One of my major principles here is whether they effectively integrate the system, as I believe cost control is but a dream if you can't bring some order to the system itself. That's what the graph shows: In the current system, there's no order in the private market, In hacker's system, there's a large regulated group market that has to compete with the current, chaotic system. And in Wyden's plan, everything is brought into defined structures. Al of this, of course, is explained in the article.
