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【社会人文】增加的挑战
Rising to the Challenge
By Roger Hickey | bio
What a rich, provocative discussion! We at the Campaign for America’s Future are working to promote a widespread citizen debate about health care for all – modeled after the successful coalition that stopped Social Security privatization. And this forum, sponsored by Josh Marshall and provoked by Jonathan Cohn’s new book, has fostered a very important exchange. We are going to be linking people into it for some time.
Several participants have rightly insisted on focusing us on a large order question: what kinds of fundamental reforms are necessary to get a health care system that will cover everyone, improve health and make the health care system much more efficient? And the big debate is over the role of the private health insurance industry: can we regulate and “incentivise” big health insurers to get them to achieve these goals, even though their business model has produced many of the very problems the public wants solved?
A few others have plaintively insisted that all this talk about systemic change and the model of single-payer is politically unrealistic and therefore irrelevant.
Mark Schmitt and others rightly ask if we can combine our long term vision with a constructive participation in the messy realities of the political process. As I noted earlier in this conversation, the public has signaled to the politicians that health care is priority issue, and the politicians (at least on the Democratic side of the presidential race) have responded with a generalized pledge: “I will make sure that everyone is covered by the end of my (first or second) term.” Since they are all scrambling to figure out how to do that, we have an enormous opportunity before us.
I submit that one of the best things we on the “progressive” side of this debate can do this year is to engage the nation – and the politicians – in a public discussion about the private health insurance industry:
about the many ways the industry deforms and cripples our health care system – and about how they actually kill people.
I reported (via the OurFuture blog and Huffington Post) about Hillary Clinton's masterful presentation at the Las Vegas presidential debate on health care. Edwards was of course, specific and eloquent, embarrassing Obama for lacking details. But Hillary took out after the health insurance industry like Don McCanne or Maggie Mahar. Take a look at this short exerpt and tell me it doesn’t sound like she’s getting ready to cut private health insurance completely out of her health care plan:
I am in favor of universal health care coverage. [And a system] that begins to guarantee coverage to people who already have insurance, because, let's not kid ourselves, there are a lot of people who think they have insurance except when they need it. [She tells a story about a woman excluded from insurance because of a pre-existing condition.] Now, I don't want to wait until I'm president to begin. I'm going to introduce legislation while I'm in the Senate to end insurance discrimination. Guaranteed coverage. No more cherry picking. You cannot eliminate people on the basis of preexisting conditions, because that's what we need insurance for. And, you know, we've now met the human gene. We're going to find out we're all susceptible to something. So none of us are going to be insurable if we don't change this system. And I think we need to start now in order to make sense out of it and get people the coverage they deserve to have.
Now this kind of populist rhetoric is also useful if she is planning to go for a wimpy and dangerous Wyden-style plan that essentially gives all our public subsidies to the insurance companies – while pretending to regulate them. The point is that Hillary is aware of the public anger at insurance companies among the voters, and she is determined to make it work for her.
We should be doing the same thing -- but with the goal of channeling that anger to some productive conclusions:
Insurance companies distort our health care system at great cost, and therefore
• We should demand politicians tell us how they would make insurance companies change their business model – now based on insuring the well and the wealthy. or
• We should build our health-care-for-all vision around a public system – like Jacob Hacker’s Health Care for America – not the private insurance companies.
Even if you are one of those who believe the next President will have to capitulate to the insurance industry in order to get anything passed, you’ve got to see that having the companies publicly on the defensive – explaining that they don’t want to cut off peoples’ insurance or charge outrageous premiums – has got to give us an advantage even if our goal is getting a plan for America that is marginally better than Massachusetts or California.
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作者:admin@医学,生命科学 2010-10-01 05:11
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