Sam Uretsky

Dems Good on Health

The Democrats have the luxury of several good presidential candidates for the coming election — so good, in fact, that there’s no shame involved in having them admit that they can learn from the others. Doris Kearns Goodwin, in Team of Rivals [Simon & Schuster, 2005], described how Abraham Lincoln filled his cabinet with men who each thought they would be a better president than Lincoln. The result of these appointments may explain Why Lincoln Matters by Mario Cuomo [Harcourt and Co.. 2004].

Another way of phrasing it is to quote Sir Isaac Newton’s most famous quote, other than the Laws of Motion: “If I have seen farther than others it is by standing on the shoulders of Giants.” So, it’s a shame to see Sen. Barack Obama arguing with former Sen. John Edwards about their respective proposals for healthcare coverage. The two senators, along with Sen. Hillary Clinton, have proposed methods for assuring near-universal health insurance. None of these plans are perfect — they all kow-tow to political realities, which is a euphemism for the insurance company-sponsored Harry and Louise ad campaigns that deep-sixed the 1993 Clinton health-care reforms — but they’re all better than what we have now. The Edwards and Clinton proposals are very similar, but Edwards got there first, and has explained more of the details. Rep. Dennis Kucinich has proposed a universal single-payer plan to be phased in over 10 years, and former Sen. Mike Gravel has proposed a system of health-care vouchers. The other three candidates, Sens. Joe Biden and Chris Dodd and Gov. Bill Richardson, have their own proposals, each of which would be better than what we have now — although that’s not saying a lot.

The Edwards plan calls for mandatory purchase of health-care coverage. Purists will insist that we shouldn’t be buying insurance, we should have a National Health Service paid for out of general tax revenues, with everybody automatically covered, something similar to the Kucinich proposal. Purists are right. Based on experience all over the world, a universal, single-payer system offers the best care for the lowest price, but the insurance companies aren’t going to be pushed off the catbird seat. The Edwards and Clinton plans aren’t perfect, but they resolve the problem of the uninsured. That’s something.

Obama’s proposal calls for mandatory coverage for children, and optional coverage for adults. Since the proposal says that no one will be turned away because of illness or pre-existing condition, it means that someone can delay paying into the plan until they’re signing the consent form for open-heart surgery. That’s not how insurance works. The whole idea of insurance is that people pay for coverage when they don’t need it (or don’t think they need it) and that covers the costs for when, in the fullness of time, reality catches up with them. It’s the grasshopper and the ant. Since Obama’s proposal already makes provision for income related subsidies for people who don’t qualify for Medicaid or SCHIP, it shouldn’t be difficult to expand this into a mandatory system — and according to a report in the Boston Globe, one of Obama’s talking point is that after his initial proposal is enacted, it could be converted into universal coverage. While that’s technically true, the Edwards plan would be more efficient, more cost-effective, and would only have to be argued once.

Obama is right in saying that most people who don’t have health coverage simply can’t afford it — and the first issue is affordability — but there will be some people who will want to game the system, just as there are a few people who drive faster than the posted speed limits or cook hamburgers to less than 160 degrees (in Massachusetts the law only requires 140 degrees while California’s Uniform Retail Food Facilities Law of 1997 requires only 155 degrees, which shows that in politics, compromise may be necessary even in the most basic things.)

The Democrats have the luxury of several strong candidates and general agreement on most issues. In many cases, the differences are matters of style rather than substance. They’re so good, in fact, that it would be wonderful if they could get together and pick and choose the best ideas from each campaign. They can each learn something from each other and, if you go back to 1861, they can even learn from a Republican.

Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.

From The Progressive Populist, January 1-15, 2008

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