September 8, 2009

The Washington Post presents another in a series of op-eds urging liberals to be reasonable about health-care reform. Today they have this from Matt Miller, a former Clinton aide who's now a McKinsey consultant, a senior fellow at the Center for American Progress and the host of NPR's (aka "Nice Polite Republicans") "Left, Right and Center." He's someone who's made a virtual cottage industry out of Broder-like "centrism":

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I respect those in my party who seek the single-payer system into which the public option might eventually evolve. But I don't agree that it's the best answer for the United States. Though single payer has merits, especially in administrative efficiency, it is also likely to freeze in place our fragmented, uncoordinated system of fee-for-service care. It would encourage providers to goose volume (to boost their incomes) rather than improve quality and would offer greater rewards for providers of acute care when we need a fresh focus on chronic disease management. Single payer also asks government to do things I don't think it is competent to do, such as setting prices across a large swath of the health sector in ways that seem certain to create damaging rigidities or resource misallocations (as happens in Medicare).

Finally, if government is the sole payer, provider payments will become even more politicized than they are today. On the eve of beneficial innovations in drug therapies, devices and cost-effective ways to deliver better care, it is ill-advised to make the government's hand too rigid. Private health plans have many flaws, to be sure, but if sensibly regulated they're likely to respond more nimbly to disperse medical innovations.

Liberals should make peace with the notion that a regulated market of competing private health plans can be the vehicle for getting everyone covered. Yes, it means that unlike some other advanced countries, we'll have billions of "health" dollars siphoned off by middlemen and marketers. But if liberals think of it as a jobs program, they'll learn to love it. If everyone's covered and insurer "cherry-picking" is dead, health insurance will come to look more like a regulated utility.

Those on the left still seeking incentive should consider: In 2006, Sen. Ted Kennedy urged Massachusetts Democrats to support Mitt Romney's plan for universal coverage via a competing system of regulated private insurers, paired with an individual mandate and subsidies for low earners. Kennedy knew this would become a model for a bipartisan fix for the country. Now, a Kennedy-approved model is within reach. Liberals, far from resisting it as a setback, should celebrate it as a triumph.

I hardly know where to begin.

Our current system isn't about health care, except as a peripheral matter. It’s about profits, protecting those profits for the very wealthy concentrated at the top of the industry, who pay protection money to selected Congress critters for the privilege of maintaining their lucrative and occasionally criminal enterprises.

So to start a statement with "liberals should..." really rubs me the wrong way. A "regulated" market could be the vehicle for getting everyone covered? Sure, in the land of unicorns and rainbows! As we've seen with Wall Street, the vigor with which a market is regulated changes with the political winds.

Are we to assume an "industry-friendly" administration would still enforce those regulations? I'll just sit right here and hold my breath.

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