Health Insurance

Paul Krugman wrote a column that ran in the Times this morning that has created a bit of a firestorm. Krugman has been harping on Barack Obama's health care plan for some time, and now, just before Super Tuesday, he seems to have hit on some nerves.

I am almost always a big Krugman fan, though he does write with a fairly blunt instrument. If you care about the health insurance implications of this election, I highly recommend reading Krugman's column, and a couple responses:

Clinton, Obama, Insurance, by Paul Krugman

Krugman Wrong on Obama and Mandates, by Dean Baker

Dean Baker is Wrong, by Paul Krugman

An Open Letter to Paul Krugman, by Harold Pollack

I think, of these, Pollack makes the best point:

Let's suppose, for the sake of argument, that everything you say is right. President Obama gets himself elected. He successfully enacts health reform, but he leaves out an individual mandate. Indeed, let's suppose that we later discover that too many people fail to buy insurance coverage or try to free-ride. We would have to address these problems.

In the meanwhile, all we will have accomplished would be:

1. to bar insurers from denying coverage based on preexisting conditions;
2. to provide significant financial subsidies to millions of low-income people to help them buy coverage;
3. to prevent people from losing their homes because they are diagnosed with cancer;
4. to cover all children;
5. to make safety-net providers (and the local governments that run them) more financially secure because they no longer bear the burden of treating 47 million uninsured people.

I'd be pretty darned happy with this outcome--although I (like you) would ultimately prefer "Medicare for All" or some other version of a single-payer system.

This really is a question of incremental progress. Clinton's plan is more aggressive than Obama's. But, obviously, the new president will not be writing any laws; that's Congress's job. The best plan may not be the one that looks best on paper, but rather the plan that will be the most painless to get passed through Congress. Once either of these plans is passed, we will set in motion a march towards real universal health care: a single-payer system. Clearly, the current state of our health insurance system is abysmal, but it is unrealistic to expect it to become perfect overnight. If the next president can at least get the ball rolling, the public will stop seeing universal health care (or "privatized medicine," as the health insurance industry calls it) as an albatross.

The insurance companies tell us that "privatized medicine" means that we will have exorbitant wait times at hospitals, that we won't be able to get prescription drugs, and that the sky will fall. When people realize that universal health care won't stop the planet from turning, we will really turn the tide against the health insurance industry and better laws than either of the plans proposed by Obama and Clinton will be possible.