Why Not Bigger

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Matt Stoller thinks he disagrees with me about health care but really we’re more-or-less on the same page. I think these mandate-and-subsidize plans are badly flawed compromises. Democrats tend to embrace them because they think they’re more practical than even more ambitious schemes. But there’s really nothing especially practical about them. Their best elements — and you see this especially in John Edwards’ plan — tend to be efforts to trick congress into putting the country on a slippery-slope to a single-payer health care system. But the idea that you could pull a fast one on AHIP like that is silly. With all due respect to the cleverness of left-of-center wonks, nobody’s that clever.

Under the circumstances, the plans will either fail or else, as Matt says, “the best parts of the plan get removed in a compromise” and you wind up with something that’s not really worth passing. I would much rather see people trying to build support, directly, over the long run for single-payer health care and the marginalization of private sector insurance.

Incremental interim measures should be genuine increments — steps in the right direction — not efforts to square the interests sound health care policy with the financial interests of major insurance companies. John Kerry’s 2004 plan, which involved having the government step in to cope with super-catastrophic medical expenses, was good in this regard — a quite small measure that might have passed, but which created the sort of thing that could have been scaled up (or, in this case, down in terms of the threshold) over and over again, just as SCHIP expansion is a well Democrats can keep returning to until all children are covered, and then there can be efforts at expansion to parents, to college students, etc., etc., etc.