Monday, July 6, 2009

Thus Spoke Ezrathustra

Says the Ezra Klein of today:
we need to distinguish between different types of public plan. There's the public plan which is actually a version of Medicare-for-All. Everyone can buy in, the plan can partner with Medicare to become the largest bargainer in the system, and the expectation is that it will eventually take over the insurance market. I could understand making that the definition of health-care reform, as it is a fundamental transformation of the health-care system. But if you don't think we can pass Medicare-for-All, there's not much reason to think we can pass that.
Sure, I can see how the insurance interests will hate all over the robust public plan which we could call Medicare-for-everyone-who-wants, knowing that it's a one-way trip to Medicare-for-all. And that's going to be a big obstacle.

But if Ezra has taught me anything, it's that we don't want to change everybody's health care all at once through legislation. Here's what he wrote in January 2008, and I doubt I'm the only person who took it to heart:
The line the Clinton campaign did use, "health security that can never be taken away," foundered because, before the plan offered that security, the health security that Americans currently trusted would be taken away.

"They couldn't defend it in simple terms," says Hacker, "because it actually meant a complex set of changes for most Americans." There was no concrete reference point, because the legislation was building something that didn't yet exist. The administration's argument, in essence, was "trust us." But when it comes to health care, it's one thing to make the system better. It's a whole other to remake it entirely. You can ask Americans to walk forward, slowly, knowing they can scramble back to the ledge if need be. You cannot ask them to jump.

That's why all us lefty kids had been loving the John Edwards plan subsequently picked up by Hillary Clinton and Max Baucus. Even if the insurance companies fought us just as hard as they would if we were trying to replace all the private health care with the model of efficiency that is Medicare, we had a one-line knockdown answer to the baseless fears that national health care in America would look like some bureaucratic nightmare from Stalinist Canada: "If you like your current health insurance, you can keep it."

That was the plan -- offer Medicare-for-everyone-who-wants, watch everybody make the choice to switch on their own, and perhaps go the last mile to true Medicare-for-all once a supermajority of Americans had come under the program and you wouldn't be messing with so many people's stuff. It was a good plan, just because it's politically easier to pass a robust public option and use individual choices as the vehicle for change than to mess with everybody's insurance by running straight to Medicare-for-all.

Certainly, I appreciate Ezra's attempts to enlighten us about parts of health care reform that get less attention. And the things he talks about look really important! Maybe he's trying to lower the emphasis on the public plan relative to robust subsidies and Medicaid expansion and health insurance exchanges and other stuff. And that might be a good idea. But I find myself a lot more convinced by his positive arguments for the importance of other stuff than his newfound negative arguments against the importance of the public plan.
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