When Wyden's office told me they had a health care video, my heart sank. These always suck. But this one, shockingly, is very good. More to the point, it's brave. As an article in next month's American Prospect will argue, I think Wyden's plan -- also known as the Wyden-Bennett plan -- is a very smart proposal with real cost control possibilities. More to the point, it's got 14 Senators signed on, 7 Democrats, and seven Republicans. Not all of them are solid "yea" votes, but all are open to the process behind the plan. It's the closest thing any health reform bill has to a plausible legislative majority, or even a path towards a plausible legislative majority, which means we should take it very seriously. But the Wyden plan has vulnerabilities, too. In particular, it contradicts one of Ezra's Rules of Health Policy Reform: Don't Screw With What People Have (otherwise known as "it's the status quo bias, stupid."). Rather than encouraging employers to buy into a group market, as most other plans do, Wyden dissolves the employer role in health care almost entirely. He forces them to redirect all money they were spending on employee insurance into paychecks. At the same time, he creates “Health Help Agencies,” one in each state, which are regulated markets where various insurers compete for business. No cherrypicking, no high premiums or denials of coverage for preexisting conditions. Everyone pays the same price, but everyone has to buy insurance that’s at least as comprehensive as the current Blue Cross-Blue Shield Standard Plan. There are subsidies for those with low-incomes, and penalties for those who don’t buy in. Medicare still exists for the elderly. As a policy idea, it's pretty damn good. It's a radical integration of the system, a sort of single-payer that uses private insurers as regulated subcontractors, rather than a multipayer that keeps them as independent players (which Obama and Clinton both do). Moreover, getting rid of the employer link in health care would be a tremendous boon for workers. But employer health insurance is the most popular part of the current system. It's the thing people have, the thing they like, and the thing that they're worried about losing. Saying you'll change it puts you on unsteady ground. What Wyden's video does is take aim at the weaknesses of employer-based health care: You may have it now, but if you lose your job, you can't keep it. in other words, your boss owns your health care. Which means you may have to stay in a job you hate, sucking up to managers you loathe, doing work you despise, all because Jenny needs braces. Far better, says Wyden, to have a world in which you own your insurance, a world in which you can keep it no matter the professional path you choose, and a world in which a fool supervisor doesn't control your access to your medical care. That's a world where employees have a whole lot more bargaining power, and can focus their energies on bettering their job rather than keeping their insurance. But it's also a world that's different than this one, and that scares people. The fight Wyden's picking isn't an easy one, but it's very worthy. And the video, I have to say, is surprisingly funny.
