Hippocrates In San Diego

Gettin’ wonkish…

My friend David emailed me today, asking if I had any interest in working to arrange a local, small scale discussion group on healthcare reform, as part of a call from President-Elect Obama’s healthcare advisory team. I think the idea is to have grassroots groups discuss the local conditions, and to provide some sort of input so that a national discussion can be had. This is exactly the type of discussion that was missing the last time Democrats tried to bring healthcare reform to the national stage: the Clinton plan was ill-timed (in the midst of an economic boom, with sharply decreased numbers of uninsured due to low unemployment) and poorly executed, politically. It wasn’t in the national consciousness like it seems to be now.

Even if Congress ends up implementing Obama’s plan, which I think still allows too many provider decisions to be in the hands of private insurance companies, at least the discussion will be had. In the current economic setting, this is the perfect time for progressives to at least achieve some success in the general direction of a real single-payer system, like every other modern advanced Western nation.

My main concern with Obama’s plan is that, because it still relies on the presence of corporate insurance to pool collective risk, if it fails to contain costs or is too unwieldy for patients or providers to navigate (which is a definite possibility when you’re asking for continued involvement of several dozen plans and companies), it might feed the anti-single payer movement. Although the evidence and economics are strongly in favor of a single-payer plan, it seems to be emotion and fear of costly, tangled bureaucracy that has dictated this national discussion so far. A bungled implementation of a more progressive system might delay needed changes.