Negotiating With Ourselves


Paul Krugman’s arguments on behalf of universal health care are well known and widely agreed upon by progressives. Then he gets controversial:

But now is the time to warn against plans that try to cover the uninsured without taking on the fundamental sources of our health system’s inefficiency. What’s wrong with both the Massachusetts plan and Senator Wyden’s plan is that they don’t operate like Medicare; instead, they funnel the money through private insurance companies.

Everyone knows why: would-be reformers are trying to avoid too strong a backlash from the insurance industry and other players who profit from our current system’s irrationality.

But look at what happened to Bill Clinton. He rejected a single-payer approach, even though he understood its merits, in favor of a complex plan that was supposed to co-opt private insurance companies by giving them a largely gratuitous role. And the reward for this “pragmatism” was that insurance companies went all-out against his plan anyway, with the notorious “Harry and Louise” ads that, yes, mocked the plan’s complexity.

I tend to agree with that. I’d happily take something like Wyden’s proposal as a compromise measure, but it takes two to compromise. I’m not sure it makes sense for liberals to be pre-emptively offering concessions to the insurance industry with no guarantee that the insurance industry will support the measures being contemplated. To me, it makes more sense to just try and build as much support as possible for a single-payer system and then be prepared to compromise if special interests come to us with alternative universal schemes they’re happier with.