ALL OR NOTHING? As follow-up to my post elsewhere, I want to play around with the idea that the medical industrial-complex will attack any serious health reform with total ferocity, and so would-be reformers should simply try and legislate them out of existence, knowing that that's the path of maximal efficiency. Look at the Clinton push, these folks say. They tried to compromise and were torn apart for it. Single-payer style solutions, by contrast, are simpler, and will be easier to sell. It doesn't necessarily follow that since liberals have lost when they've sought compromise, they'll win with the opposite stance. It could be that a proposal closer to single-payer would've been even more disastrous. Indeed, what always strikes me about this argument is that the attitudes of the American people towards massive government regulation are largely ignored. Single-payer isn't simply blocked by industry despite overwhelming public support. It doesn't garner much support. As Chris reminds us in comments:
On the idea that single-payer will sell because it's simple to explain, Oregon had a single-payer health care bill, Measure 23, on the public ballot in 2002. It failed by 21.5% to 78.5%. California had a single-payer bill, Proposition 186, on the public ballot in 1994. It failed by 27% to 73%. If this is such a great idea that everyone supports and is so easy to sell, how come it's failed among the public by 50 points in two Blue states?
And here's a November 2006 poll on the question:
"Which of the following approaches for providing health care in the United States would you prefer: replacing the current health care system with a new government run health care system, or maintaining the current system based mostly on private health insurance?" Options rotated. N=478, MoE � 5 (Form B).Replace Maintain Unsure 11/9-12/06 39 51 10 11/7-10/05 41 49 10 11/7-10/04 32 63 5 11/3-5/03 38 57 5 11/8-11/01 33 61 6
Those aren't slam dunk numbers. Quite the opposite, in fact. In every poll, a plurality favors the retention of the private system. In four of the five, majorities do. And think back to the Clinton battles. A common element in the case against The New Republic is Betsy McCaughey's No Exit, a massively influential article published during Andrew Sullivan's watch that charged -- inaccurately -- that the Clinton plan would bar individuals from seeking private insurance if they were unhappy with the government's coverage. There would, in other words, be "no exit" from the system. This was roundly denounced as a smear job. "Roundly," because it was a hugely influential and effective attack, and so it enraged lots of people. The idea that Americans would be trapped in an untested, possibly awful government system was a powerful argument against the reforms. "Smear job" because it was untrue -- the legislation would have done no such thing. But if liberals are going to sign the insurance industry out of existence, it will be true. It won't be a smear. And while we think the end of insurers will be a good thing, history suggests that Americans may disagree, at least initially, at least while our option is unproven (and any new program -- even if it's an expansion of an old program -- covering a previously uncovered demographic is unproven). Our anger at Betsy McCaughey's article, and at The New Republic for publishing it, suggests that we, on some level, know that. Now, many will argue that it's a framing argument, that we need to call Government Care Medicare and Americans will sign up in droves. Maybe so. But even given the familiarity of Medicare, will expanding the program be more popular if we tie it to the end of all current insurance options, opening ourselves to the argument that, if this goes bad, Americans will have no recourse? Again, I'm open to evidence in the affirmative. But demanding the end of private health insurance and believing it will be not only popular, but more popular than alternative proposals, strikes me as something we should be examining, not assuming. I see little evidence for it in the history of health reform, or current polling. But I would, of course, like to be proven wrong. --Ezra Klein
