No One Knows

This I know: no one knows. I support better healthcare. That's easy. I support universal coverage. Another easy one. After that, I have no clue. We are overprescribed/Europe is underprescribed. We have cruel deficiencies that punish the poor/the Europeans have to wait years for their procedures. If you have insurance, it's fairly easy to see a specialist/in European systems, seeing a specialist means more waiting.

In order to cover the poor, must those with the best coverage disgorge some of their coverage? If we went to a single payer system, this is what would happen. Less healthcare for the well off, and more for the poor. That's socialism right there (*everyone gasps*). And that's never going to happen here. For one, the political will is not there. For two, bringing those with no medical insurance into the fold need not mean the end of Mr. Monopoly seeing a specialist every time he has a tickle in his ear.

Obama's plan, as I (I am sure poorly) understand it, tries to fill most of the coverage gaps while ostensibly allowing everyone to keep the insurance they already have. I guess that's a political necessity, but I'm not sure it's s a viable solution. If there is a public option that employers can choose that is cheaper than private, then companies will go public. Remember when HMOs came into fashion? Most of us working folk ended up with HMO insurance although technically, we all (our employers) had a choice as to what type of health insurance to purchase. I suppose the competition could drive the private insurers to offer more reasonable plans, but it also seems possible the private insurers would be obsolete.

What seems most likely is that we will end up with a two-tier system that is an incremental improvement on the present lack thereof. Professionals who demand premium perks will still get premium health coverage through their employers. So too will members of unions still powerful enough (and in industries still viable enough) to demand premium coverage.

It's true that those in the lower end of the earning spectrum will not be able to see a specialist. But they can't do it now. Crappy government insurance is presumably better than a trip to the emergency room. Those in the upper echelon will continue to enjoy the quality of care they already have. As long as we have rich people willing to pay, the service will be there for them.

So it seems to me that the present plan may decrease the quality of coverage for a portion of working people who receive coverage through their employers. But if the competition drives costs down, it could put more money in the workers' pockets' and keep their employers' financially healthier. Perhaps more small businesses would be able to provide healthcare as a benefit and more people will be covered overall. So while the individual quality might drop for some working people, the overall quality would spike dramatically by virtue of so many people going from uninsured to insured.

So we have a compromise healthcare bill. Of course. It's the only thing we could have. Obama is a law professor who comes out of the Chicago political machine. He knows how sausages are made. He knows the legislation game. It doesn't mean he'll win the game, but he seems to have a much better chance of succeeding than Clinton did.

I think the biggest question is: where is the funding coming from? New taxes. I support more taxes to achieve 100% coverage, but most people don't. We are a nation that demands reward without sacrifice. And, from the richest to the poorest, we want others to do well, so long as it doesn't impair us in the least.

Which brings me back to the title of this post: no one knows. We can know the basic premises and we can understand the basic contours of proposed reform, but the legislation is so complex, as is the universe it attempts to redress, that a layperson cannot begin to understand what the truth of the matter is. We are forced to rely on experts, pundits, and politicians, who overestimate their expertise, twist facts to meet their agendas, and lie outright for money and power.

So I am left with this (weak) conclusion: we need coverage for the poor in this nation. I am willing to swollow the bloat and inefficiency that must come with it, as part of a higher tax burden, and perhaps even lowered quality of my personal coverage, because this nay be the only chance for some time that any legislation, no matter how flawed, has a chance to pass. I also don't see how to overcome the insurance lobby and staunch opposition from free-marketeers without leaving private insurers largely intact. I don't see a better way in this political climate.

I hope that the present wrangling over the bill will improve it, though it seems to me that the more time the money has to pound away at the bill, the weaker it will get. I just hope something happens, and that the something that happens is even slightly better than the nothing so many have now.