Tuesday, February 26, 2008

Is Nader Right?

First, let me say to my vast readership: I apologize to both of you for not writing for the past few weeks. I've been having some personal difficulties, and seem to have lost my muse. But I'll give it a try without the muse and see what happens.

I was listening to Ralph Nader talk about why he’s running again for president. And after I restrained myself from kicking the s#$% out of my radio for bringing me such insane news when there is so much at stake in this election, I had to admit something: he’s right.

Then later I watched the debate and heard Obama and Clinton argue about a tiny point of difference in their respective health care plans. What a waste of time. The fact is that both candidates would, as president, sign either plan if it passed congress. And they both should have said that.

But back to why they are wrong and Nader is right (and Clinton is closer to being right on this than Obama is). We need universal health care to be universal. If it’s not, then you don’t get the savings from covering everyone. Furthermore, if an individual can lose their coverage, for ANY reason, then none (except the very rich) can sleep easy knowing that they are, and forever will be, covered.

The simple (and possibly expensive, but I doubt it) expedient is to expand Medicare to cover everyone. Anyone could opt out by proving that they have other coverage, in which case their outside coverage premium would be subsidized by Medicare. Rich folk could opt out by self insuring (and keeping huge assets in their Health Care Reimbursement Accounts). Lots of folk would buy supplemental coverage to pay for additional stuff that isn’t covered under the basic plan. But everyone would be covered. This would provide all of the advantages of single payer (including all of the administrative cost savings) AND the advantages of private delivery (e.g. doctors would not be the employees of the government).

Obama’s point that people will buy health care if they can afford it is flat wrong. Some people will buy it. Others won’t. Some will think that they have, but will miss an important piece of mail, or forget to pay a bill, or get fired, or, or, or. Or worse yet, their life will fall apart due to an illness, and then they’ll make some paperwork mistake that causes loss of coverage. The point is that every crack in universal coverage is expensive in dollars and piece of mind. It is actually less expensive to cover everyone then not to.

But the absolute biggest reason to cover everyone under the same plan is to force the issue of what is covered into the public sphere. As a country, we currently ration health care by who can afford it, and by who is lucky to accurately predict exactly which illness they will be afflicted with when they pick their insurance. That’s insane. What needs to happen is that we decide what the basic level of health care that everyone gets by dint of being a citizen (or legal resident). That allows us to decide, as a society, that we will pay for aggressive pre-natal care, but will not pay for organ transplants for 90 year olds. If 90 year old want organ transplants, they can spend their grandchildrens' inheritance and pay for it themselves (that’s just a for instance).

There are lots more reasons to have single payer. Obama could bring it home if he chose to get us motivated to make it happen. I wish I knew why he didn’t push for it.

If you have contrary thoughts on this, please leave a comment. I will try to reply or incorporate your thoughts into later posts.

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