January 22, 2008

The problem with health care reform

A coalition of big labor unions today announced its opposition to AB 1X, the health care bill drafted by Gov. Arnold Schwarzenegger and Assembly Speaker Fabian Nunez and pending in the Senate. The California Nurses Assn, long a leading opponent, was joined by the Teamsters, the United Food and Commercial Workers, Communcation Workers, California School Employees Assn. and others, as well as the League of Women Voters, in opposing the bill. Their main reason: It preserves insurance companies and part of the system and would require Californians to buy coverage without stating in advance how much that coverage would cost.

At the same time, a Democratic member of the Senate Health Committee, Leland Yee of San Francisco, said he would vote against the bill in committee, which puts its fate in considerable jeopardy.

The union opposition and their leaders' comments suggest to me that, policywise, maybe we really are stuck with three choices: move toward a more free-market health care system, move to a single-payer plan, or stick with what we have. Attempts to provide universal or near-univeral coverage within the current framework of part-employer-based, part-private, part-government appear to be doomed to failure because either labor or business, or both, will oppose them. Most employers want fewer burdens and oppose a government mandate. But labor unions want either single payer or a system financed predominantly by taxes on employers. Labor, for the most part, is not interested in using new taxes to pay for health care for people who are not in the workplace. They just want mandates on employers to cover their workers. After all that, you still have to deal with doctors, hospitals, drug companies and others who are part of the current system and will jealously guard their position.

If you were to blow the whole thing up and start over, the explosion might be big enough to overcome all of these interest groups. But tinkering around the edges, tweaking, trying to fill gaps in the current system, yields too much opposition, because there are always going to be provisions that some, if not many, of these interest groups oppose, perhaps intensely. Support, meanwhile, will be less intense because the people who stand to benefit most (the working poor or people excluded for pre-existing conditions) don't have a lobby, and interested bystanders who might be inclined to support it have other things to do and don't fight with the same passion as do the opponents.

Posted by dweintraub on January 22, 2008 02:48 PM