I am weighing the Paul Krugman vs. Howard Dean approaches to what's left of health care reform, now that Joe Lieberman, the Blue Dogs, and the Republicans have gutted both the public option and expanded Medicare; now that only the mandated maximum 10 percent administrative costs constraint remains as a major handle by which government can pressure private or nonprofit (but not public) insurance companies over their charges for covering the uninsured.
What is left? (No pun intended ...)
1. Banning denial of coverage for pre-existing conditions.
2. Denying coverage because an illness exceeds a policy cap.
3. Coverage is mandated for all by law.
4. A large investment in pilot programs to test and evaluate cost cutting strategies.
5. (so far) A public option trigger by state with federal subsidy.
Whether the rich, or so-called "Cadillac" plans, will be taxed to pay for the federal subsidies (of both the uninsured and the insurance companies!) is not yet determined. But we know where hostage-taker Lieberman will stand on that! By the way, the "Cadillac" plans are mostly union plans criticized for providing first-dollar (or nearly) coverage. But Canadian public plans all provide nearly first-dollar coverage, and the plans are NOT "overused" and not a source of rising costs.
Howard Dean (and others) have proposed killing the bill and doing the pre-existing and benefit cap reforms through a budget reconciliation bill, which would not be subject to filibuster, and leaving universal coverage for another, better day. We are being needlessly robbed by the insurance companies in this deal, they argue. It's going to cost too much and may even generate a backlash if, as likely, working people have to lift even more cash out of their bare-cupboard stores of disposable income. They note as well that the mandated coverages do not include any mandated caps on premiums that the private insurance "market" will charge. Only political pressure from the public, and the supervision of the U.S. Office of Personnel Management - which maintains the existing Federal Employee Insurance Exchange - given expanded powers to manage the reformed one for all uninsured - stands between the insurance industry and the premiums they can charge the millions of newly mandated-insured customers.
Krugman (and my spouse) say "Ugh!" but we must do it for the above benefits, and support Krugman's argument from a historical perspective on the imperfections of previous major steps in legislation that turned out pretty good. Leaving millions uninsured in the spreading recession has arguably even greater costs than a deal which gives the insurance industry much more than it deserves.
I think Krugman gets my vote, even though my gut sides with Dean. I hate kissing Lieberman's behind. A fairly raw class struggle will surely ensue, partly because the universal mandate will compel everyone to line up with their interests INSIDE the new system instead of some being OUTSIDE.
Forward!! To the phone banks!! Before Lieberman and the "Dogs" demand even more!