The dialogue on this post about single-payer started out in the predictable manner — with libertarian Doug decrying the very idea that I would want him (which is the way he reads the words "we" and "us") to be a part of what I see as the common-sense sense solution to a critical need we have in common as a society.
But you have to read past that. One of the problems Doug and I have discussing issues is that he likes the "how" of specific proposals, whereas my interest lies more in the broad concept. As an INTP, I intuitively understand his frustration, but that’s the way I approach things.
And once you do get to proposals, the ideology falls away enough for Doug to say things that I agree with. For instance, he set forth these five suggestions for taming the health-care-cost monster in America:
1) Reduce drug patent lengths to allow competition from generic makers
2) Require insurance companies to offer coverage that is portable, not revokable under any circumstance, and restricted in the percentage increases in premiums to a limited range across all policies
3) Abolish HIPAA rules that only add expensive overhead costs to the system
4) If healthcare for all is a national concern, pay for it by cutting government costs in other areas rather than simply adding another tax on top of the waste already built into the government. The money is there already to easily cover every one who doesn’t have insurance.
5) Go back to the days where drug companies could not advertise on TV, radio, or print media. All that marketing cost gets passed onto consumers. I really don’t care if I ever see another commercial for Viagra, Ambien, or any other product that has "oily discharge" as a frequent side effect.
With the exception of item No. 4, which is simply a libertarian article of faith (which is why I initially read right over it), this seems like a list I could go for. (As much as I’d like to have a clean sweep,that one is just a spoiler condition. While you or I or anyone can come up with a list of federal expenditures that we could do without, that’s not how representative democracy works — such decisions are made collaboratively, and one person’s waste is another person’s essential. This fact lies at the root of so much libertarian alienation. Anyway, the bottom line is that in the real world, if you say you’ll only agree to a national health plan if you cut an equivalent amount elsewhere, you are for practical purposes saying let’s not do it at all. But in the interests of furthering dialogue, let’s set that aside.)
I was a little surprised that Doug went for No. 1 even more wholeheartedly than I would, since it’s about property rights. And I always thought that HIPAA (which I hate) was about privacy (another libertarian priority), and specifically about trying to achieve Item No. 2 by preventing insurance companies from knowing your medical history. But fine. I’m all for it. And I prefer the more direct, regulatory way of approaching No. 2 — if you insist on still having insurance companies.
I was even more pleased and surprised when Doug, later in the dialogue, proposed that we just make the plan that federal employees are on available to everybody. I would have to study this a lot more closely (and those of you who deal intimately with that system, please weigh in), but I have to applaud Doug’s willingness to do something that bold, even if it’s not single-payer.
Of course, he threw in the caveat that we could cover the cost by cutting spending elsewhere — once again, a fine idea until you try to do it, and something that can’t be an absolute condition if we want to get anything done.
But the really cool thing is that, when we get down to such specifics, we’re no longer arguing about the need for universal coverage. We’re just haggling over the price.