Debating Healthcare

DEBATING HEALTHCARE….I was pretty taken aback last week by the white hot blasts of vitriol unleashed at Ezekiel Emanuel over his Universal Healthcare Voucher proposal. The reason I was taken aback is that universal healthcare is a fundamentally liberal idea, and the only real point of contention in the comment threads was over which kind of universal healthcare is better: a single-payer plan or a plan that incorporates competition via insurance companies? Why then was UHV treated as if it was an idea on loan from the Heritage Foundation?

I’m not sure, but since I never did a wrapup post on the subject I’m glad to see this from Jon Cohn over at TPMCafe:

This is a fine debate to be having within the liberal policy community right now; putting out new ideas is a great way to generate discussion and, ultimately, politically momentum. But I think it makes sense for everybody to keep an open mind on both the policy and political questions.

….Talking up this or that idea is one thing; trashing the others as hopeless is quite another. Fans of single-payer should not preemptively dismiss competition models simply because they involve the private insurance industry; competition advocates should not dismiss single-payer just because it seems to them a harder reach politically.

That’s spot on. The UHV proposal wasn’t an example of negotiating with ourselves, it was an example of a policy debate between liberals on a liberal website sponsored by a liberal magazine. Conservatives do this all the time ? despite frequent liberal fantasies about right wing monoculturalism ? and it makes them stronger. It makes us stronger too, but only if we refrain from ripping each other to shreds in the process.

And while we’re on the subject, a friend of mine sent me a link recently to an article that’s must reading for anyone interested in the healthcare debate. It’s called “Abandoned Surgery,” and it’s a 1995 piece by John Judis about how the business community at first supported Clinton’s healthcare plan but later turned against it, even though they largely agreed that it would benefit them.

It’s too long to excerpt, but it’s a timely piece to read since one of the memes floating around the debate right now is the idea that big corporations are getting sick and tired of hassling with healthcare and are therefore becoming more and more likely to support a universal healthcare plan that gets it off their backs. But guess what? It turns out that was true in 1994 too. There’s more to the story than just that, though, and if we’re going to argue about this stuff it’s best to truly understand the political and ideological forces working against us.

I will add one comment about Judis’s article, however, namely that it supports two diametrically opposed conclusions:

  1. Clinton tried hard to get the business community and the insurance industry to support his plan, but they turned on him anyway. If that’s the reality, we should just accept the fact that they’re going to be against us and not worry about trying to buy them off.

  2. The fact that big business and the insurance industry successfully scuttled Clinton’s plan shows how powerful they are. The reality is that this is what will happen every single time unless we figure out a way to get them on our side.

I don’t think it’s at all clear which lesson is the right one. But it’s a healthy debate to have.