The Lincoln Plawg - the blog with footnotes

Politics and law from a British perspective (hence Politics LAW BloG): ''People who like this sort of thing...'' as the Great Man said

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Saturday, October 23, 2004

Nation endorses Kerry, trashes his health care plan

Health care is a mass of technical detail - legal, administrative, medical - so impenetrable that specialist journos tend to rely on gee-whiz or scare stories and generalist political hacks stick like grim death to the talking-points du jour.

Everyone feels so much happier - journos and readers alike - spending man-aeons on bits of nonsense like Kerry's wild goose chase (did he kill a bird or not? answers on a postcard...).

The Nation offers a sidelight on the candidates' proposals as they affect the poorest Americans - and finds Kerry's plan for health care woefully inadequate - though nowhere near as bad as Bush's: both plans
do nothing to slow the cost of new drugs, treatments and machines, the major cause of healthcare inflation. Kerry does want the government to negotiate drug discounts for Medicare beneficiaries, a small step toward eventually imposing price controls on pharmaceuticals. But the plans include no mandates, no requirements, no enforcement teeth. Doctors' incomes would be safe; employers wouldn't need to provide coverage; insurers could still profit from selling policies; and drug companies could still reap a return that's the envy of every industry in the world.

At the same time, the mag endorses Kerry, supposedly as something better than the ABB candidate.

Transpondians, of whatever political hue, notoriously find inexplicable the stigma attached to universal state-provided health care in the US [1] - if socialised medicine is evil, how can socialised education be fine and dandy?

The supposedly French Kerry's health care policies would find favour nowhere this side of the Atlantic: eating Swiss cheese on one's cheesesteak [2] does not a European make.

Heigh ho...

  1. There is, of course, massive state provision in the US, in the form of Medicare and Medicaid - running at around 4% of GDP for Fiscal Year 2005 ($506 billion on $12.3 trillion - CBO numbers). (A useful October 21 New England Journal of Medecine article on Medicare funding.)

    And, to be fair, state provision is no panacea (a San Francisco Chronicle piece which compares the US with the Canadian health system, as part of a series on US health care, identifies shortages of cash - exacerbated by split Federal/provincial responsibility - and of personnel.

    But, despite universal coverage, health care costs in Canada absorb only 10% of GDP, compared with 14% in the US.) And a recent poll had 62% of Americans favouring moving to a Canadian-style system.

    Which suggests (druther alert!) that a Dem president with the right stuff might have been able to appeal to the American people over the heads of Congress and the healthcare industry. He might even have considered it a wedge issue with which to win back the House in 2006 (assuming it stays a GOP fief for the 109th). Perhaps, as with desegregation after World War 2, universal health care in the US is an idea whose time has come.

    As it is, we have the Kerry plan...

  2. If he did (it's a gag...).


A key difference between health care today and Jim Crow in the late 1940s and early 1950s is that the law was available as an engine of change to work towards desegregation - once the Federal courts decided to use it.

There is nothing external to the political process which the most powerful president could use to overcome the wall of money that the insurance companies, Big Pharma and the HMOs have at their disposal.

After Hillarycare, no president wants a failed health care plan on his resumé when re-election time comes round: so small is beautiful. And a second-term president is a lame duck walking - which would encourage the special interests to play for time.

Only - the NRA was fantasy on a par with Saddam being involved in 9/11 [1], but contained the substance of reforms - like the Wagner Act - which were eventually enacted and which passed constitutional muster.

Perhaps substantial progress towards universal health care in the US can only be made if a president is bold enough to propose the thing itself.

  1. Such that the Supreme Court could be unanimous in holding the National Industrial Recovery Act unconsitutional - liberals and Four Horsemen together (in the Schecter case).

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