This effort holds as much promise as any I've participated in over the last decade, probably more," said Kate Sullivan Hare, the executive director of health care policy at the United States Chamber of Commerce
Well, I've got mixed feelings about this one. Upside? A mixed group is talking. Downside? It's all Washington groupies. I've been part of such "strange bedfellows" efforts at the state level and even brought a couple of them together myself. From time-to-time, they're effective and those are very gratifying, but they're mostly not. Personal good will and scholarly interest are not enough. And think tanks are definitely not enough. There's got to be some real grassroots juice.
Here's what such groups can do:
- Provide cover for elected officials who want to do something anyway. But that certainly doesn't apply in today's Washington
- Push elected officials to act. Works sometimes, but very, very rarely on an issue of this scope.
- Coordinate messages from disparate grassroots groups. Who knows whether that's going on here and how much heft they have.
So it's continued discussions are a good sign, but don't get your hopes up.
Moreover, this group is already deep into wonk-think:
People are uninsured for different reasons," said Dr. Mary E. Frank, the president of the American Academy of Family Physicians and a participant in the talks. "No one solution will work for everyone. We need different solutions for different groups of the uninsured."
With all due respect to Dr. Frank and AAFP, which has been quite good on coverage issues, one point does not follow the other. "People are uninsured for different reasons" is true, but only narrowly - within the current mixed bag system. As soon as you begin thinking like this, you've given up universality. And as soon as you begin talking like this, you've given up political ground to those who don't really care about the issue, but don't want to get burned politically and to those who are actively resistant.
Some conservatives may truthfully embrace expanded coverage but due to ideological constraints, confine themselves to limited proposals. Some may use false sympathetic rhetoric to protect themselves politically, but then say that if we fail to reach universality, well that's just unfortunate. The more important principle to them is that there is no legitimate role for government (George Bush, for example, in responding to an uninsured woman during his first Presidential campaign, saying he "wished he could wave a magic wand" but ...).
This is not the first Times article on these discussions. Steve Lohr wrote in the Times business section on December 6 of last year, "The Disparate Consensus on Health Care for All". I didn't buy the headline then which is why I didn't bother posting on it.
Lohr cited Peggy O'Kane, head of NCQA ("no one wants to touch it"), Dr. William McGuire, CEO of UnitedHealth Group (who supports mandatory insurance and focuses more on what's covered), and Dr. David Himmelstein of the Harvard Medical School, who's a single-payer advocate.
Maybe there's a consensus among "experts" (think of the folks who show up at an APHA meeting) on the need for universal coverage of some form, but there's certainly none among elected officials or the public.
The article didn't even keep up with the then current news:
The Bush administration and conservatives say the way to cover the uninsured is to make insurance affordable mainly through tax subsidies (emphasis added) for companies, especially small businesses, and encouraging them to offer high-deductible insurance plans that cost employers less. Individuals, under this approach, are encouraged to set up tax-free health savings accounts to pay for more of their own care.
Hard to make insurance affordable through tax subsidies when you're proposing eliminating tax subsidies.
The inconsistency aside, what was meant by "tax subsidies"? The answer is crucial. Is it the Bush Administration's
ever ready solution to everything, tax cuts? Or were they actually
talking about something akin to the Earned Income Tax Credit, a refundable credit? Such credits generate, through the tax system, a net transfer to the lowest income people, but they have increasingly been the butt of conservative criticism? (Check here and here.)
Lohr's article goes on:
Newt Gingrich, the former House speaker who is the founder of the Center for Health Transformation, a policy research group, recommends a package of federal and state tax incentives and programs that go beyond the Bush administration proposals. He estimates that his approach could result in more than 95 percent of the population's being insured. "We could radically change the current discussion about the uninsured," he said.
Well maybe. But there there are legitimate questions about the robustness of any approach that leaves a door open to seepage. Yes, there might be an increase in the number of people covered, but absent a structure that's designed to sweep everyone in (or if it's a big deal to you, every citizen), it's not only not going to happen, it's not going to get close.
But assume for the moment that Gingrich is correct. Getting to 95 percent would be a striking change. But why is it that so many Republican leaders are satisfied with that? What's wrong with 100 percent?
We can all speculate and much of our speculation would be about motivation which is always a iffy venture.
And don't get me started tonight on the single-payer proposals.
Now if the Christian Coalition was part of this "emerging consensus," that would get my attention. That would truly make for strange bedfellows.