Krugman: 676

[ProSense]

676

Some readers ask why I don’t talk about HR 676, which would establish a single-payer system for health care — similar to Medicare, the single-payer system older Americans already have and love, although they don’t think it’s a government program.

So let me make three points.

1. If I could start from scratch, I’d go for single-payer. Where introducing single-payer has proved politically possible, it’s been a smashing success.

2. However, there are other systems that also work well. The Netherlands, for example, relies largely on private insurers, although they’re tightly regulated and there are extensive cross-subsidies. And they have universal care at much lower expense than we do. So single-payer isn’t the unique ideal.

3. Politically, single payer is not going to happen any time soon. It’s not just the power of the insurance lobby: voters tend to fear the unknown, so that it’s much easier to pursue incremental reform than to make a giant leap into a completely different system. And incremental reform has a good — better than 50/50 — chance of happening this year.

So yes, I’d favor HR676 if I thought it could pass; but I’ll accept something else, even if it’s a bit of a Rube Goldberg device, to get the job done.

Obviously, the U.S. isn't the Netherlands.

[mgcgulfcoast]

1. i agree with you

[galloglas]

2. "U.S. isn't the Netherlands."

You may be right about the U.S. not being the Netherlands.

I do think, however, that Congress is Neanderthal.

[dflprincess]

3. He's willing to start from scratch to build a "Rube Goldberg device"

but he's unwilling to build a single payer system on the Medicare structure we already have.

This is bullshit.

[babylonsister]

6. No, it's not.

This might surprise you:

http://voices.washingtonpost.com/ezra-klein/2009/07/the_195_years_test.html#more

snip//


But it's also worth offering a more general reality check here: The public option is not now, and has not ever, been the core of the argument for heath-care reform. It is the core of the fight in Washington, D.C. It is an important policy experiment. But it was not in Howard Dean or John Kerry or Dick Gephardt's plans, and reformers supported those. It was not in Bill Clinton's proposal, and most lament the death of that. It is not what politicians were using in their speeches five years ago. It is a recent addition to the debate, and a good one. But it is not the reason were are having this debate.

[ProSense]

8. Ezra is not correct on Kerry's plan

Kerry's plan introduced the public option and catastrophic care. The top Democratic candidates for President in 2008 cherry picked from his plan. Obama's plan featured both.

[Uzybone]

4. The practical side of Krugman speaks

[Jennicut]

7. I find his ideas to be both pratical at times and idealistic at times

I have come to enjoy him, I think he does do a great deal of thinking on major issues and does not come down against Obama all the time nor for him all the time. I think he is a straight shooter and he may be right here. We shall see what happens.

[vaberella]

5. This is what Obama has been saying from the beginning. You'd think people would have a clue.

However, they don't. Ugh. Thanks Prosense. BM'd/Rec'd/:kick:

[SpartanDem]

9. We may not be the Netherlands

,but I think it's far more realistic to reform our system to be like theirs than build something entirely new. I'm also glad Krugman pointed out that other systems work well too, much of the single payer or nothing crowd seems to be in denial that there are universal health care systems other than single payer or that they work

[liberalpragmatist]

11. I'm pulling for a strong public option even so....

... because the other reforms being suggested are nowhere near as tight as the regulations in place in The Netherlands or Switzerland, two countries that use entirely private delivery systems.

That being said, I do think the "single-payer or else" crowd misses out on the fact that many European countries do *NOT* use single-payer systems and have constructed perfectly good systems. The French system, for instance, despite many times being mislabeled as single-payer, is actually a non-profit, multipayer system in which independent sickness funds - independent nonprofits that receive a mix of government funds, payroll contributions from employers, and individual premiums - deliver care. Of course, the state regulates the entire system and negotiates prices for treatments and drugs, so in that way it's similar to single-payer.

And frankly, while I'm hoping for a public option, I worry that too many liberals are getting distracted by the public option and ignoring other really important aspects of the reform effort, such as the national exchange. The exchange is critical to introducing choice and bringing down costs. Yet right now the exchange - and the public plan, since it exists in the exchange - is being restricted in both the House and Senate HELP bills. I want a public plan in a national exchange, but I'd rather have a national exchange and no public plan than a public plan in a small, restricted exchange.

[eridani]

12. When dd you start thinking that Medicare was new?

I'd like to hear one good reason why the Medicare age eligility should not be dropped to 60 or 55.

[ChimpersMcSmirkers]

10. Props to Krugman for a dose of reality.