It's awfully early to be deciding on a presidential candidate; probably a half-dozen worthy contenders nobody is presently talking about will have made an appearance by the time of the primary race. But we have to do something to entertain ourselves. I haven't changed my mind about Howie; I'd love to see the doc run again. I think Kerry shouldn't run, partly because I think the last campaign showed how hard it would be for him to win, and partly because I think we'd like to keep him in the Senate (sure, in Massachusetts, if he didn't run for Senate a Democrat would almost certainly replace him, but he's been pretty good in the Senate, and seniority matters there). I think Hillary is a much better choice than seems to be generally believed.
However, I've been an on and off fan of Gore for a long time (I was hoping he'd be the presidential candidate for the Democrats in '88). Having now been informed by Ezra that Gore supports single-payer health care, I have to say he's looking a lot more appealing as a possibility. I think that's an excellent issue for Democrats to rally around. There is strong evidence that one of the main reasons our health care is so expensive is that vast sums of money are wasted by various parts of the system trying to make other parts of the system pay. The single-payer model would obviously eliminate all of that waste, so there's reason to think insuring all Americans could end up being cheaper than our present failure to insure tens of millions. Canada, among many other countries which succeed in covering everyone, spends less per capita on health care than we do.
Further, while the insurance companies could be expected to fight this tooth and nail, there's even cause to hope that other business sectors might support this measure; GM wants relief from the current system, and as I already indicated in an earlier post, Toyota also prefers to operate in an environment free of insurance company extortion. So this might not be as bad an issue for fundraising as at first appears.
As for those who encourage a more moderate approach, Kerry had the most sensible moderate approach I could possibly imagine. He proposed national catastropic health care insurance, to intervene and cover the extra costs if a particularly severe health problem ended up costing more than $50,000. This would, obviously, help greatly with one of the huge weaknesses of the current system; it would mean insurance companies would have less incentive to deny insurance to those at risk of catastrophic illness, because the costs to them would be constrained. But this eminently sensible, moderate plan got nowhere. I say it's time we give extremism a shot. Whether it's Gore or someone else, whoever runs for the Democrats next should advocate single-payer.
Several things need to happen for us to get universal health care. Big pharmaceutical companies have to diversify, such that they make more generics; this would enable them to make at least some money in a regulated formulary system. This is already happening, to some extent.
The myth, that a free market always finds the most efficient solution, must be dispelled. Also, the myth that our health care system is a free market needs to be dispelled. These things are not happening, despite an abundance of contrary evidence.
Big Medicine, as exemplified by the AMA, has to get completely fed up with insurance companies. This is starting to happen. I predict it will happen faster once the Medicare drug coverage plan goes into effect
Big industry, as you already pointed out, is getting on board.
Doctors trained in the 80's and 90's will have to replace those of greater vintage in positions of influence. This, obviously, is inevitable.
I actually think it is likely that we will see universal coverage in the next few decades.
Posted by: Joseph j7uy5 | July 31, 2005 at 10:46 PM