UPDATE: Obama has changed his mind and will put off health care until February. Wow ! If that’s true, there are some Senators who will plucking flak out of their asses for weeks over this and now they get blindsided. Way to go, big guy !
There are lots of post mortems going on this morning. Did the Republicans do the best they could to stop this bill in the Senate ? I think they had a terrible problem and probably did the best they could. They did delay passage until a lot of the public got a good view of the sausage factory. There is another question. Did the Republicans leave the door open by failing to produce an alternative the past 15 years since Clinton failed ?
The choices that they made, or didn’t make, across the last fifteen years are what made all the difference. Between the defeat of Clintoncare and the election of Barack Obama, the Republicans had plenty of chances to take ownership of the health care issue and pass a significant reform along more free-market, cost-effective lines. They didn’t. The system deteriorated on their watch instead. And now they’re suffering the consequences.
There are others who think the bill may still fail in the House but let’s look at the question about the past 15 years. The left, of course, thinks they made a huge blunder. I don’t accept his premise.
At the outset of this debate, moderate Democrats were desperate for a bipartisan bill. They were willing to do almost anything to get it, including negotiate fruitlessly for months on end. We can’t know for sure, but Democrats appeared willing to make enormous substantive concessions to win the assent of even a few Republicans. A few GOP defectors could have lured a chunk of Democrats to sign something far more limited than what President Obama is going to sign.
What ??? I don’t see that at all.
What about Douthat’s charge the Republicans missed a chance for an alternative ?
I think he is wrong. The Republican alternative was always The HMO. In 1973, Nixon signed a bill making HMOs mandatory as an option for all businesses with more than 25 employees.
In more recent years, “managed competition” was the model with other alternatives to HMOs created, like PPOs. These organizations enlist doctors and hospitals who agree to follow rules, chiefly rules about utilization. They may also, especially recently, include discounted prices for services. Those discounts have gotten quite large in recent years so that, in California, a state with heavy managed care, most medical groups were insolvent in 2008. It wasn’t just California as predatory practices left many doctors high and dry.
Managed competition was an aggressive strategy to control costs. It didn’t work. Why ?
The basic failure of all medical insurance the past 30 years is the inclusion of routine care making “health insurance” into “prepaid care.” People would know better than to buy auto insurance that included routine maintenance in the policy benefits. Why ? Because, instinctively, they understand moral hazard. They know that, if your insurance covered oil changes and the damage that might be incurred for failing to change oil, people would be less likely to take good care of the oil in their cars. Not everyone. But enough. Why doesn’t everyone buy one of those home maintenance policies ? Have you tried to get anything fixed under one ?
Now, it looks as though we may get a chance to see if the Democrats’ way is any more effective than the Republican way. I don’t think it will be but it does provide lots of jobs for Democrat functionaries. At least until the money runs out.
Tags: Democrats, economics, health care, Republicans