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The Central Problem in Health-Care Reform

Some guy named Ezra Klein has an op-ed in today's Washington Post. I can't help but notice, though, that the beginning echoes things that have been written on this blog. This "Ezra Klein" must be a pretty regular reader:

The central problem in health-care reform is that good policy and good politics point in opposite directions. Good policy proceeds from the understanding that our health-care system is a fractured, pricey, inefficient mess. Good politics, however, proceeds from the insight that a lot of people rely on this fractured, pricey, inefficient mess and don't trust Washington to change it. Good politics means, as Barack Obama frequently says, that if you like what you have, you get to keep it. But put those imperatives together and you have a strange problem indeed: How do you reform a system that you're not allowed to change?

The answer that reformers have come up with is that you don't change the current system. In the short term, you strengthen it with subsidies and regulations on insurers. You make it kinder and gentler. But you also build the beginnings of a new, better health-care system off to the side. You let it demonstrate its efficiencies and improvements. You let the lure of lower costs and higher quality persuade Americans to migrate over of their own accord.

This is what the health insurance exchange is designed to do. It is arguably the single most important element of health-care reform, because it is the bridge between the system we have and the system we want. But amid the clamor over public insurance options -- which, incidentally, would be housed on the exchange -- and employer tax exclusions and all the other points of controversy, the health insurance exchange is hardly being discussed. And there are signs that it, and thus the long-term promise of reform, might be in danger.

What's that? You want to read the whole thing?

By Ezra Klein  |  July 29, 2009; 10:30 AM ET
Categories:  Articles , Health Reform  
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Comments

Can't we just drop the mandate and the subsidy, create a public option and a health exchange, and keep the restrictions on dropping those with pre-existing conditions? It won't insure everyone but it will drive costs down, and best of all it doesn't cost anything other than the initial administrative costs of a public option. Once everyone sees that we can have cheaper health insurance with more choice when we trust Obama's judgment, then we can suggest a taxpayer-funded subsidy to help cover those who still can't afford it.

Posted by: bluegrass1 | July 29, 2009 10:56 AM | Report abuse

It's a good editorial. And I admire your optimism. I don't know what else to say because I am quite pessimistic at this point.

Posted by: luko | July 29, 2009 11:21 AM | Report abuse

If you have such little faith in the political process then why do you want to further empower it?

Claiming that completely nationalizing healthcare is good policy but bad politics is so smug. If it were good policy it would be a lot easier to sell to moderates.

The only reason a public option is even on the table is for the political purpose of pandering to the left side of left. Good policy is only bad politics when it upsets the wacky fringes of both parties not when it makes them happy.

Posted by: fallsmeadjc | July 29, 2009 11:21 AM | Report abuse

Excellent essay, Ezra. My senator is Ron Wyden, and I think you are suggesting here that his proposal for individual consumer choice is the bridge to smart policy. When consumers who are empowered with good information and with access by virtue of a subsidy for low income, then we can really see if the corporate for-profit sector can compete with the non-profit. And U.S. citizens should have that choice.

Is Ron Wyden's proposal getting any traction??

Posted by: cmpnwtr | July 29, 2009 11:22 AM | Report abuse

After a week of posting, and presumably reading, here, surely fallsmeadjc can't still believe that what's proposed in any of the plans coming out of Congress, or coming out of Ezra for that matter, represents 'completely nationalizing healthcare'.

The ghost of Nye Bevan may haunt his dreams, but it doesn't exactly stalk Capitol Hill.

Strawmen are one thing. Straw colossi of Rhodes are another.

Posted by: davis_x_machina | July 29, 2009 11:26 AM | Report abuse

Why aren't crazy leftist organizations that want to nationalize everything considered to be evil special interests? They raise funds, run ads and pressure lawmakers too. Why aren't their efforts seen as harmful to poor individual voters? Why is it that only corporate interests and libertarian interests are seen as being anti-democratic? Why are leftists so quick to criticize their right to political speech?

Posted by: fallsmeadjc | July 29, 2009 11:30 AM | Report abuse

He pretty clearly says that he would prefer to scrap the whole system and replace it with a single payer system but that political realities make that impossible so the next best option is a trojan horse public option. That's what Obama and Krugman think so that's what little Ezzie thinks.

Posted by: fallsmeadjc | July 29, 2009 11:37 AM | Report abuse

Some guy named Ezra Klein already had an op-ed in the Washington Post on July 26, titled "The Ghosts of Clintoncare". I can't help but notice, though, that the main argument, "Whatever Bill Clinton did, do the opposite", echoes things that had been written at OpenLeft weeks ago...

Hmm, maybe I should have expanded my comments into an op-ed and sent it to WaPo...

Posted by: Gray62 | July 29, 2009 11:40 AM | Report abuse

Ezra: "The answer that reformers have come up with is that you don't change the current system. In the short term, you strengthen it with subsidies and regulations on insurers. You make it kinder and gentler. But you also build the beginnings of a new, better health-care system off to the side. You let it demonstrate its efficiencies and improvements. You let the lure of lower costs and higher quality persuade Americans to migrate over of their own accord."

Yes, this seems to be the thrust of the REFORMERS (having given up on root and branch reform as not passable in the Congress).

Therein is a major problem. The reformers have already compromised away very large parts of true reform, and the weak kneed Dems and almost every Repub. are now emasculating the only remaining reform parts: The exchange and the public option. They don't want real change. Their preferred change is inNOvation. Just say No, they cry!

This tragedy in 3 acts is about to play out and we can see the ending. After all, it is labelled "Tragedy", the actors wear frowning faces, and the black hats are in charge of key committees - negotiating with fellow nay-sayers and ignoring yes-sayers.

Meanwhile the President swings like a pendulum, acting as though he were a swing legislator or backroom advocate instead of the executive/leader. This doesn't end well. We don't even have a Shakespeare to make this play entertaining or morally uplifting.

Posted by: JimPortlandOR | July 29, 2009 11:42 AM | Report abuse

I can't decide what to make of fallsmeadjc. Is he serious but disingenuous? Is he just lacking in facts? Is he somebody that just thinks riling up liberals with random asinine comments is fun? Is something like that actually fun?

I don't know, but he's clearly either not really reading or understanding liberal positions on healthcare. Or maybe he's just not taking time to really put forth a cogent argument.

Posted by: MosBen | July 29, 2009 11:49 AM | Report abuse

Why do you need to set up a Government run exchange with Government options to create a market for health insurance? Target isn't part of a Government run exchange and there aren't Government options at Target.

How can you claim that this statist rubbish is a market oriented reform?

They could pass market oriented reforms that separate health insurance from employment and remove regulations that restrict the purchase of insurance between States. They could also remove regulations that mandate one size fit all policies and restrict the use of risk adjusted premiums.

Healthy clients aren't more profitable if their premiums reflect their risk. Their only more profitable if their high premiums are subsidizing riskier clients. If the Government allowed risk adjusted premiums cherry picking would not be a problem.

But alas, real market oriented reforms just aren't politically feasible.

Posted by: fallsmeadjc | July 29, 2009 12:21 PM | Report abuse

You can hardly blame fallsmeadjc for not reading...heck, Megan McArdle has a long rambling post up "Why I'm Against National Health Care" or something. Democrats left National Health Care bleeding by the side of the road way back in the primaries but the myth lives on.

I especially like RedStates 5 things you will lose with Obamacastrochavescommiecare. Thing is, I don't have any of those things now, and I have so-called Gold Plated healthcare through my employer. I mean, wtf. People are willfully and pridefully ignorant about the issues and there's not much we can do about that.

Posted by: luko | July 29, 2009 12:26 PM | Report abuse

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