If I was not a lifelong Democrat used to defeat being snatched from the jaws of victory, I might be tempted to start stretching for a victory lap about now, but I am not a political neophyte, but a veteran of a gazillion disappointments and heartbreaks. It’s tempting, though, because the momentum seems to be shifting toward passage of healthcare reform.
But I am a war-weary political veteran who doesn’t know how to stop fighting, so I keep coming back for another battle, and I suppose I will continue that MO since the fuckers haven’t killed me yet. I’ve wanted to reform the system since I started working in it in the 80s and the first bricks started falling, signaling that before long, the system was going to be coming down around my ears.
Is the Senate legislation anywhere near the system we would have if I was designing it? Oh hell no. If I was doing the overhaul, I would give us a British-style National Health Service, and the healthcare workers would be eligible for the same sort of generous retirement after twenty years that the military gets, because it wrecks your body. (Yoo Hoo over here. Exhibit A is my right knee, with a rebuilt patellar tendon, a reconstructed ACL, degenerative joint disease, severe osteoarthritis, no miniscus, total surgeries: five. Exhibit B is my left knee, with an ACL that has been reconstructed twice, first a hamstring graft then after I shredded that one coming off a chopper, it was replaced with fiberglass. It’s also been opened up twice to clean up miniscus tears, back when I had some, and it, too has DJD and severe oseoarthritis. Total surgeries: four)
But no one is asking me how we ought to do it, and no one in this country other than the small number of people who deliver and consume military and VA medical services would agree with it anyway. That’s because I really would initiate a government takeover of health care. A real one. That is because I know something about healthcare and I have worked in every phase of the system, public, private and DoD/VA. The DoD and the VA are excellent, and in some areas of the country, cities have done such a fabulous job with public health that everyone gets care The systems in Kansas City and San Francisco come to mind. 2005 was a good year for public health – both San Francisco County and City (they have combined operations) and Kansas City/Jackson County, Missouri put it to their voters and funded health levys, and used the money to deliver universal care to their citizens who don’t have insurance. Neither sell insurance policies to their citizens, they just deliver healthcare via robust, efficient public health systems that serve everyone who needs care – and do so by focusing on wellness and keeping the people they care for healthy – which costs less money than high-dollar sick care. Continuing down that path, when someone does get sick, getting them in to see a doctor and make sure they are properly treated assures a lower expense than the same person getting sicker and sicker and sicker, until finally they end up in the ER, where most of the time we just treat ’em and street ’em, most don’t get admitted, unless they are on death’s door.
Failure to pass the Senate bill and improve it later would be the most vivid example of ‘letting the perfect be the enemy of the good’ that we have seen in the modern era.
At the end of the day, I am a realist. I am the person who will use a tampon to stop a gunshot victim from bleeding out, not because I was taught that trick in training, but because there was a kid bleeding to death in front of my eyes and I had one in my pocket and nothing to lose by trying.
I think, realistically, the Senate bill is the best we can do. And setting aside the fact that the Senate needs a serious fucking overhaul, the best we can do is the best we can do. Get the job done. We have been toiling at it longer than I have been on this planet, and even though one of my Grandmothers was nearly 65 when I was born, she had me for several years before she had a Medicare card.
We aren’t going to get a better deal for a decade at least – and anyone who thinks that if we pass on this and let it get worse still, it will get bad enough that you will get that perfect single-payer system…I think you are out of touch with reality to even think about aligning yourself with Jim DeMint and the like, who simply want to see the President fail. I really don’t understand those who want a primary challenger that would simply result in a repeat of 1980 and the trouncing Teddy Kennedy handed Ronald Reagan over Jimmy Carter. If you want President Palin, you do that. (And it’s 1938 again.)
I figured that Kevin and Steve were pretty good company to be in anyway, so I never had second-guessed my “pass. the. damned. bill.” position.
Now a whole bunch more people are saying it, too – and they ain’t bloggers. They are the sort of heavyweight experts who, in a time of sane discourse, would hold sway.
Obviously, not all economists are in favor of the current proposals in Congress. But a pretty impressive list of health economists and other policy experts has released a letter making the following argument:
We commend the President’s pursuit of bipartisan solutions. Yet the summit made plain that it is now time to move decisively and quickly to enact comprehensive reform. We believe that the only workable process at this point is to use the President’s proposal to finish the job. After long debate, the House and Senate have passed two similar bills that do crucial things to improve U.S. health care.
The signers include Daniel Kahneman, the Nobel laureate and behavioral economist; David Cutler and Len Nichols, who have advised Congress on health policy over the last year; Theda Skocpol, the political scientist; Henry Aaron of the Brookings Institution; and Paul Starr, author of a Pulitzer Prize-winning history of medical care.
Just do it. Pass it now and perfect it later. Remember that the strong programs that we all know and love now, like Social Security and Medicare didn’t start out the strong programs they are now. They were passed, and they were improved on. There is no reason to believe that healthcare reform would be any different.