[Essentially right and left both agree: single-payer health care is a foundation for a broader social democratic worldview. That's why we think it's so great and why they think it's the devil's work.]
[The only reason it seems more confusing is because the debate is usually mired in the vast slough between us, the no-man's non-single-payer land. On their side, they simply oppose every intermediate measure it because it might lead to single payer. But on our side it's more of a mess. Dominant liberals prefer half measures because they can enact them on their watch. But more infuriatingly they refuse to ever say they are for single payer even in principle out of a mixture of venality, veneration of beltway verities and simplistic economics -- the last two doubly infuriating because they are not only ignorant, they're smugly ignorant. The result is two sides fighting over half measures, one clearly covertly meant to kill everything, and the other unclearly meant to accomplish something real and partial, but sacrificing from the get-go the most exciting thing: the capacity to change people's worldviews. And thus the ability to ever really win.]
[People have often complained that when the right was rising it had exciting new ideas, and the left doesn't. Single payer is the left version of a new idea of that class: a practical vision, simple to grasp, hugely popular and hugely encompassing.]
[Anyway, IMHO Krugman's entry here is one of the rare interesting interventions into the slough of half measures where he has good answers to both the particular and the larger claim.]
http://select.nytimes.com/2007/07/30/opinion/30krugman.html
The New York Times
July 30, 2007
An Immoral Philosophy
By PAUL KRUGMAN
When a child is enrolled in the State Childrens Health Insurance
Program (Schip), the positive results can be dramatic. For example,
after asthmatic children are enrolled in Schip, the frequency of their
attacks declines on average by 60 percent, and their likelihood of
being hospitalized for the condition declines more than 70 percent.
Regular care, in other words, makes a big difference. Thats why
Congressional Democrats, with support from many Republicans, are trying
to expand Schip, which already provides essential medical care to
millions of children, to cover millions of additional children who
would otherwise lack health insurance.
But President Bush says that access to care is no problem After all,
you just go to an emergency room and, with the support of the
Republican Congressional leadership, hes declared that hell veto any
Schip expansion on philosophical grounds.
It must be about philosophy, because it surely isnt about cost. One of
the plans Mr. Bush opposes, the one approved by an overwhelming
bipartisan majority in the Senate Finance Committee, would cost less
over the next five years than well spend in Iraq in the next four
months. And it would be fully paid for by an increase in tobacco taxes.
The House plan, which would cover more children, is more expensive, but
it offsets Schip costs by reducing subsidies to Medicare Advantage a
privatization scheme that pays insurance companies to provide coverage,
and costs taxpayers 12 percent more per beneficiary than traditional
Medicare.
Strange to say, however, the administration, although determined to
prevent any expansion of childrens health care, is also dead set
against any cut in Medicare Advantage payments.
So what kind of philosophy says that its O.K. to subsidize insurance
companies, but not to provide health care to children?
Well, heres what Mr. Bush said after explaining that emergency rooms
provide all the health care you need: Theyre going to increase the
number of folks eligible through Schip; some want to lower the age for
Medicare. And then all of a sudden, you begin to see a I wouldnt call
it a plot, just a strategy to get more people to be a part of a
federalization of health care.
Now, why should Mr. Bush fear that insuring uninsured children would
lead to a further federalization of health care, even though nothing
like that is actually in either the Senate plan or the House plan? Its
not because he thinks the plans wouldnt work. Its because hes afraid
that they would. That is, he fears that voters, having seen how the
government can help children, would ask why it cant do the same for
adults.
And there you have the core of Mr. Bushs philosophy. He wants the
public to believe that government is always the problem, never the
solution. But its hard to convince people that government is always bad
when they see it doing good things. So his philosophy says that the
government must be prevented from solving problems, even if it can. In
fact, the more good a proposed government program would do, the more
fiercely it must be opposed.
This sounds like a caricature, but it isnt. The truth is that this
good-is-bad philosophy has always been at the core of Republican
opposition to health care reform. Thus back in 1994, William Kristol
warned against passage of the Clinton health care plan in any form,
because its success would signal the rebirth of centralized
welfare-state policy at the very moment that such policy is being
perceived as a failure in other areas.
But it has taken the fight over childrens health insurance to bring the
perversity of this philosophy fully into view.
There are arguments you can make against programs, like Social
Security, that provide a safety net for adults. I can respect those
arguments, even though I disagree. But denying basic health care to
children whose parents lack the means to pay for it, simply because
youre afraid that success in insuring children might put big government
in a good light, is just morally wrong.
And the public understands that. According to a recent Georgetown
University poll, 9 in 10 Americans including 83 percent of
self-identified Republicans support an expansion of the childrens
health insurance program.
There is, it seems, more basic decency in the hearts of Americans than
is dreamt of in Mr. Bushs philosophy.