Now for the promised "more". Matt replied to Jon Cohn, saying much of what I said below (single payer not going to happen all at once, do it sneakily, etc). But he also made a point that bears some examination:
I agree with various folks around here and around the web who don'tthink arguing about the details of a reform plan is the most productivething in the world. The class of things that count as "better than whatwe've got" is very big, and everyone in the history of American healthcare who's ever rejected an improvement on the theory that somethingeven better is right around the corner has been proving wrong. I'lltake what I can get, and I hope everyone who's thinking seriously aboutthis issue feels the same way. My main concern is that people notreject single-payer in favor of a "more feasible" compromise plan in advance.
Now this is, on one level, very true. The problem is, on another level, it's not very true at all. Matt and others have eloquently argued for the need to convince the public of our health plan's merits long before it ever comes up in a legislative context. Much like the GOP held hearings on the IRS years before they attacked it and much like they nicked government regulation with a thousand razors before Gingrich began a frontal assault, we have to be laying the groundwork for an opportunity that may not emerge for another decade or two. But to do that, we need to know what we're laying the groundwork for.
One thing we can sometimes forget is that it's not just the left batting around a thousand health care plans. The right's got their own idea infrastructure, and it's fairly humming with ways to shunt costs back onto the consumer and end progressive forms of risk pooling. If we just wait for business to falter and for the insurance companies to demand something new, we're as likely to get the right's dystopic vision as our Frenchified fantasy. For that reason, we really do need to have these intraleft policy disagreements and try and hammer something out.
On the other hand, Matt's right that this can't be as far as we go. Policy, for the left, is too often an intellectual exercise, a way of doing something constructive while achieving nothing at all. So once we settle on some sort of policy -- be it progressive HSA's, Medicare for All, single-payer, CAP-style FEHBP expansion,, or whatever -- we need to take a page out of CATO's book and figure out our own lenninist strategy for health care reform, and then set about building the consensus. That's what we don't do enough of -- hold hearings on private corruption in the health care industry, publicize sob stories of insurers who terminate health coverage when children get sick, etc, etc. There needs to be a forward-looking strategy in service of an understood, or at least generally understood, goal. With Medicare and Medicaid, we happily have our foot in the door. But from here, we need to decide exactly what we're going to look like when the public actually opens up, and then go about making enough noise that they actually come downstairs.
