Here I agree with Ezra Klein:
We have an unfortunate tendency to think of policy reform as episodic rather than continual. The process of reform is sold as a legislative Big Bang rather than an ongoing effort with lots of different policies all building on one another. This is as much the fault of reformers, who need to increase public support for their policies, as it is of reform's opponents.
But it doesn't make much sense. There's a lot of commentary about whether the health-care reform bills under consideration will do everything that's required to repair our health-care system. There's not a lot of commentary about whether the the bills under consideration will be a step forward in reforming our health-care system and thus make positive changes easier in 2013, and 2019, and 2022. But that's probably the more important question.
To me that's key. Will this reform lead to more? Is it heading in the right direction?
Obviously Klein does. He even cites Massachusetts' push away from fee-for-service payments to a "coordinated care strategy" as evidence that the stirring of reform, even if imperfect, necessarily leads to more. (See this link [pdf] from Steve W for a challenge to the idea that Massachusetts health-care reform actually works.)
That said, I think a lot of opponents on the left oppose this push for reform because they think of reform as "episodic." Or worse, that the reform is leading us the wrong way. At least, that's what I interpret, say, JC to be saying when he writes, "Is it worth it for 40 million more to get insurance, if that results in the insurance industry getting a larger stranglehold on healthcare? That is a fair point to debate, and a necessary one."
The other day, I essentially posed the question whether the reform proposed in Congress - such as it is - should be supported, or killed. Naturally, as health care topics do on this blog, it engendered a lot of...er..."discussion." Whatever. I think we can all agree that the reforms as being proposed in Congress don't go far enough. The question is, would a health-care bill from this Congress lead to more? Or will it effectively blacken the idea of reform and cause corporate capitalism to entrench into our health-care system even further? And to me, that's the key in whether this effort should go on, or should die a slow and gruesome death.
For me, the bottom line is this: the reform's popularity. If reform is packaged so that it helps only a few, but disturbs the many, we're screwed.
Change the employer mandate to an individual mandate? Screwed.
Adopt reform that doesn't have near-universal access to the Health Insurance Exchange and a public option? Screwed.
You? What do you think? |
