Do we aid in its demise?

Ezra's got a post up asking an important question:

There is a serious question here: should Democrats be fighting to strengthen the current health care system because it's better for folks in the short term? Or should they allow it to collapse, hastening the switch to a more equitable, affordable, and sustainable structure? The two are not necessarily mutually exclusive, but they may well be. So while the spectrum of options is larger than Newman and Sklar, there's a basic, legitimate point of contention here. Do you sacrifice long term gain to avoid short term hurt and allow the system to limp along indefinitely? Do you burn the village to save it? Or is there, in fact, a viable middle way?

Burning the village is a terrible horrible very bad no good idea.

The issue at base here is whether Democrats should advocate for ending the employer tax break for health benefits in favor of a program to strengthen health benefits for the poor.

What makes Democrats think that they can successfully do this? There is no way, until 2008, that this is even possible. Do backers want the Democratic candidate in '08 to have this as an initiative? How unbelievably poisonous would that be? This conversion isn't feasible, period. Even if the deduction was eliminated, there's a slim to none chance that it go toward health care for the poor. Americans around the country will say, "they have Medicaid!" and efforts to the contrary will be killed.

Further, it's unnecessary to ask if Democrats should hasten the collapse of the status quo -- Republicans are doing it for them! Consumer Directed Health Care, HSAs, High deductible health plans, all the "market oriented" fixes experts currently tout are going to be nothing but another dip in the graph (see below) in five years, followed by the inevitable rise in spending. Everything policy makers have tried before has failed -- CDHC changes aren't nearly as intense as managed care. Thinking their impact will be greater is just silly. The system is working itself to implosion already.

Now, onto the Machiavellian ethics of burning the village. Progressives should never advocate for policies that hurt large numbers of vulnerable people as a means toward a desired end. As a commentor over at Ezra's wrote:

Here's the thing:

Politics and policy are not games.

There are real people who get hurt when people in positions of power decide it has to get worse before it gets better. And, guess what? The people who get hurt the most are the poor and working poor.

There are many workable plans for universal coverage. But it will require a political fight. And doing it on the backs of the middle class is no way to build a long term progressive future in this country.

It's as simple as that. This isn't a political game about the hurricane, the war, or the deficit. This is people's health. If we're going to make major changes in the structure of health care delivery, it's our responsiblity to ensure a smooth transition. People are already hurting because of the current system. It's important to work to ease that pain in the interim, while pushing for changes to make it better for everyone.

In the meantime, Democrats should absolutely not be advocating for ending the deduction without a viable policy for major reform.

Comments

[Abby]

I'd like to see a deduction (or preferrably a fully refundable tax credit) for individually purchased health insurance. Then I would make all employer provided healthcare subject to income and FICA taxes. This requires community rating and means that the FEHB needs to be opened up to everyone. Absent that deal I'm against it, but I do think that employer-provided healthcare is a bad deal for a lot of reasons.

[Kate]

Abby -- I agree that employer-provided health care is a bad deal and FEHB is a fabulous program. I guess it depends how deep you want your changes to run.

Ideally, we'd get reform that standardizes treatment, compares the efficacy of pharmaceuticals, utilizes HIT (especially EMRs), and cuts down on administrative costs, along with insuring everyone. I haven't decided exactly what that looks like yet, but if we're doing smaller-scale fixes, your suggestions are a great way to go.

[Abby]

Kate--

I'd be happy with single-payer too; I just think that politically opening up FEHB might be an easier sell.

Another reason that employer-provided healthcare is so bad is that the benefits are not standardized. You really ought to look at the wacky world of ERISA. People who are covered by self-insured plans often don't realize how limited their legal protections are.

[bangvap]

I dont belive this "The people who get hurt the most are the poor and working poor"