December 16th, 2010

I apologize for not writing for some time; been so involved with so many things. I have a lot of thoughts to share, and some strong opinions which I just haven’t had time to write down here; but I promise to start up again on this.

One of the topics I’d like to touch on is health care reform. Many on the left have criticized it as a capitulation; I agree with Paul Krugman that it is, in fact, a very big step forward. Let’s take the fact that the law doesn’t include a public option — but how important is this? A public option was not possible to get through the Senate, because it had no support from Republicans and Joe Lieberman also came out against it. What people don’t realize about the law is that it mandates, instead, that every state which runs an insurance exchange must include a non-profit cooperative, run by majority vote of the insured (the members), which by law must put all profits towards increasing benefits or lowering premiums, and if such a cooperative does not exist the Federal government will set one up. In many ways, such an arrangement is the best of both worlds: it’s accountable to the public, these cooperatives could compete with private insurers even in the employer market, and yet they cannot be accused of being “government control” of health care.

What did we get with health care reform, in exchange for this relatively minor compromise? We get the end of medical underwriting: denying coverage or varying rates due to preexisting conditions. We get health insurance exchanges to give individuals and small businesses large group purchasing power. We get the end of rescission on technicalities when you get sick. We get subsidies that will cover on average at least half of the cost of insurance if you are poor or a small business. We get mandated minimum benefits. We get much stronger regulatory oversight. We get cost control experiments such as Medicare experimenting with non-fee-for-service arrangements. And on and on.

I’d say this is a massive, historic achievement. Yes, it involved some compromises, but much less than people seem to think. I believe this is one of many examples of Obama and Congress doing a better job than people give them credit for.

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