Public options.

I suppose on some level I must be an optimist because I can’t seem to dispel the notion that something good might come out of the health care debate, even when confronted with such a hopeless legislative clusterfuck as the Baucus bill. Maybe it’s our recent experience with the topic of global warming that nudges me in that direction. Think of it – a few short years ago our leaders were disputing the science of climate change with some confidence. Now that skepticism is the province of the tin hat patrol and the policy debate is over how much (or how little) to do about the problem. Too little, too late? We did lose precious years during the Clinton and Bush administrations (particularly the latter) when fundamental changes might have been set in motion, but were stonewalled. Those changes will come harder now, and perhaps to insufficient effect. Nonetheless, there was a kind of sea change in 2007 and I suppose something like that could happen with health care in America. If we could all recognize the existence of the problem and its fundamental nature, that would be a big step forward.

The reason I think of this as a possibility, albeit a remote one, is the fact that right now the only real alternatives are some kind of have-measure hybrid (like what Baucus coughed up) and single payer. What else is there, aside from meaningless modifications of what we have right now that won’t stop the eventual breakdown of this for-profit system? I think there’s fairly broad recognition right now that the current situation is unsustainable and will not remain as it is, even if now legislative measures are taken. Everywhere you look, companies are changing up their health insurance or dropping it altogether. So we’re left with some ineffectual public-private partnership or expanded Medicaid for all. Looks as though we’ll get the former in some respect; when (and I do mean when) that fails abysmally and millions more find themselves unable to hold on to adequate coverage, there will be only one alternative: the same one used by every other industrialized nation in some form. Single freaking payer.

This is similar to the experience of the early nineties in that we are starting out with a watered-down solution and compromising right-ward from there, as if the “magic of the marketplace” still holds a great deal of promise in the wake of last year’s economic meltdown. The rhetoric, by and large, has been anything but inspirational. A lot of talk about “bending the cost curve” – whoa, there’s something that will get the rank and file heated up. And yet, single payer is avoided by the liberals and used as an epithet by the right… even when it’s clear that it would be the most cost-effective means of providing health coverage. I’m convinced that the reason why there is so much talk about “choice” in this debate is to undermine the case for single payer… as if “choice” of health plans is the highest value one can imagine. I’m in the goddamned private market, and what choice do I have? One freaking plan that pays for anything. That’s it. And I’m among the luckiest. Seems to me we should concentrate more on giving people security. Seems like we should think of it more like we do about our fire departments or other life-saving services. It’s really about having that reliable resource, not choosing between competing vendors as a value in itself.