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Constipation, a major health-care problem

By Owen Paine on Friday March 10, 2006 04:01 PM

MJS passed along to me this TPMCafe contribution, by one Jonathan Cohn, a senior editor at the New Republic, to the donk wonk wrangle over the single payer universal health care solution.

What wrangle, you're thinking? Surely the solution is as obvious as the nose on an elephant's face. Well, not for Cohn: "it's so big... its a trunk... and that's different." He tells us that while others may "suggest that the debate within the Democratic Party is not over whether to insure everybody, but how.... I disagree."

Quite the bold fellow. Why does he disagree? Because "it's one thing to say it and another to commit the resources, political and financial, to do it." If he'd gone off stage right there to roll his pants and wade down to the water line this post would never have happened. But alas, he's staying on the pot awhile, just to make us wait, while he reviews the weedy, wind-rolling fields of his mind and fidgets at maddening length before finally, proudly producing his little gift.

Of course in this throne-room one-man show, the senior editor at New Repulsive also must play Mommy too. He concedes the obvious -- pushing for the plunge is "our" present task. Push, little America! Push!

But then... on the other hand: "First, there's a transition issue." Yup, we got millions doing next to nothing necessary -- shuffling IOU's and such inside lots of office buildings because of the Byzantine partitioning the present system engenders, enhances, and ultimately worships. Single payer would... well, to paraphrase: I can hear the deafening deadly job-killing silence as 3 million superfluous keyboards stop clicking. A magisterial note is struck: "All things being equal, disruption is bad."

So... can we slow-mo here? Can we "naturally evolve into a single-payer system?"

Citizen Paine's stentorian answer: Yup. In fact, bring it on. We can solve this one with uncle's credit line. Run in the red for a stretch. Deputize 'em all and do a slow winnow.

But our guy' wondrous idiocy peaks here. Listen:

"As a wise, widely respected health care scholar recently reminded me, it would have been one thing to set up a single-payer system back in the 1930s ....."

But now...? Ah, fans, you just can't make this stuff up.

He moves on -- sort of. "...Most single-payer systems .. sacrifice some level of choice," but but but "I think choice is frequently overrated in health care," but but but again "there is a philosohpical appeal to letting people choose what level of coverage they want and how much they want to pay for it." Ahthe endless joys of dither do -- always teetering on the brink, never quite there -- Tantric wonkery. Finally -- surprise, surprise -- it comes down to his own case. Do I want a one size fits all, gubmint-issue plan, when "I'm willing to spend a larger chunk of my paycheck on it in order to have easier access to more doctors." But but but then there's the preferences "of somebody else who might want ...."

Talk about scared of your own shadow -- this is a non-issue. Choice can build on top of basics. Easy. Next victim!

Now we get a lyrical little "small is beautiful" intermezzo: recall the wonders of... Group Health of Puget Sound, "true to the original idealistic spirit of managed care." Wouldn't an Uncle Sam unitary timber giant crush out this type of "ideaistic" littlehood?

Well, let's fucking hope so, for the sake of all humanity outside the local hand-thrown clay pot shop.

Moving along -- is single payer really "the easiest to explain?" Sure sounds easy -- just say "Medicare for all."

But but but but! "There's another way to look at it." What if they think that -- you know -- they get fearful -- they get spun -- after all, some sort of profit boys stand to lose here, and their long and lingering howls could scare folks. "Maybe we need to tell them... you get to keep the insurance you have."

But but but! That's not single payer anymore, is it? Self-checkmated again. What to do, what to do. "Incremental solutions have so many more problems," but but but! "single-payer has its inadequacies too, and they're worth thinking through."

No one, I'm sure, will be surprised to hear that this geep is "now at work on a book about the U.S. health care system."

He gets one point right, though, about single payer: "I think a substantial number of elected Democrats aren't there..." But but but! "Maybe deep, deep within the recesses of their hearts they are, in any event, I'm not sure it really matters if they can't admit it."

Comments (2)

If interested in the issue of a single payer health insurance system, there's a very good article on the subject in this month's edition of The New York Review of Books. I did not agree with all of their conclusions, but it certainly provides excellent food for thought. A copy of the article is available online through a link from my site at http://sparklightblog.blogspot.com.


read the krug piece
and agree with its outline
in particular the go for the brass ring in one shot strategy

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