Unhealthy Meditations

OK, I’m ready to make my premature prediction about the outcome of the health care fracas. I feel like I have absorbed enough exaggerated claims to achieve a critical mass of cynical political realism.

Sometime just before the next break, which I suppose is in November, the legislative caucuses will achieve a classic unwieldy compromise. (Unless there is a dramatic international incident or a pandemic by then, in which case all bets are off for a pragmatic compromise; then either they will put it off for a year or they will ram through something stupid, like the USA Patriotic Healthiness Act .)

The major players are the industry leaders, and each of them wants guaranteed income in perpetuity. Doctors and hospitals want to always get paid even if patients can’t afford it, so they want everyone to have health insurance. Drug companies want restricted markets and guaranteed payment, so they want everyone to have health insurance. I’m sorry to tell you this, but both groups don’t care who the insurer is, as long as they get paid enough and on time. They can be bought off with any guaranteed payment plan, public or private.

Labor unions and the fragile coalition of pro-Democratic voters who elected Obama and the Democratic legislative majorities want everyone to have as much health care as they want, no matter the cost. Because they see everything in terms of collective action, “no personal responsibility,” top-down programs, and cost-shifting, they will support any kind of universal insurance system, public or private.

Health insurers want everyone to pay them first and they don’t want to compete on price. Republicans want health insurers to have whatever they want, so unless the labor unions buy a dozen Republican senators, there will be no new public insurance plan, because that would force insurers to compete on price. The majority of Democratic legislators support mandatory insurance for everyone. The compromise position, as we already know, is to force everyone to buy either public or private insurance. In order to appease the liberal Democratic senators, everyone else will agree to stretch the Medicaid and Medicare programs to make them cover anyone who can’t afford private insurance; then they will tack on a massive federal tax credit for everyone making less than $56,000 a year who doesn’t qualify for Medicare or Medicaid.

The idiot table-thumpers won’t get riled up about Medicaid and Medicare, since those words have become very familiar and just don’t sound as scary as “socialized medicine.” The hippies will be happy because everyone will be forced to participate in an insurance group and no one will have to pay directly for health care, kind of like “socialized medicine.” High-wage employers will still be able to keep their HR bureaucracies and offer luxury insurance plans as perks to attract “key employees.” Low-wage employers will be glad that most of their proles will get the federal tax credit to pay their premiums, so the company won’t have to pay for health insurance for anyone who is not a “key employee.”

It is possible that this will result in some loosening of the labor market. If everyone is required to carry health insurance, then there will have to be some kind of affordable transitional coverage available for the unemployed, and so employers will not be able to coerce people to stay in their jobs just for the insurance. This transitional coverage would probably fall under the existing  COBRA provisions, but with an extension of the premium reduction provision that was enacted earlier this year.

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Instigate some pointless rambling

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