Lefties are predictably up in arms about the multi-payer Swiss/German amalgam universal health care bill that has been passed in both houses of Congress (in slightly different forms that will have to go through reconciliation). "We need single-payer!", many cry. There's one problem with that: in all the polls, the Swiss/German style multi-payer system polls higher than single-payer does. As in, 75% approval rating vs. 55% approval rating. And the chances of Democrats getting the spine to choose the less popular option are almost nil, jellyfish have more spine than the Democratic Congress.
So it simply isn't going to happen unless the American people as a whole change their mind. The notion that health care should be a right rather than a privilege has overwhelming support from the American people -- as in, close to 80% support in the polls I looked at. So the Republicans are pushing against the tide in their continual whining that health care should be a privilege rather than a right, there *will* be health care reform that has some measure of guarantee of universal health care for all Americans. But unless more Americans support single-payer than support multi-payer -- and all the polls say this is not the case -- single-payer has as much chance of being passed as my cat has of solving quantum physics problems. It just ain't happen. So we have to look at the possible, rather than the perfect, and try to make it as good as possible rather than the ideal that we'd all like.
There's nothing *inherently* wrong with the basic health care financing architecture set up by the bill. It's not single-payer, but single-payer is not necessary in order to get the benefits we typically attribute to single-payer (reduction in paperwork and claims-processing expenses, reducing in overhead, etc.). Heavily regulating health insurers to limit their profits to a certain percentage, eliminating arbitrary denials of coverage and lifetime limits, preventing them from arbitrarily denying claims, and forcing them to use a common claims-processing center that enforces common claims codes and paperwork across all insurers can get most of those benefits without single-payer. Switzerland, the Netherlands, Germany, and Austria (amongst others) get universal health care this way, after all. The question is whether we're going to regulate the health insurers sufficiently and give sufficient subsidies to the working class and lower middle class to make this setup work. Right now I'm seeing no signs that this is going to happen. We'll have to see, I guess.
- Badtux the Practical Penguin