Me, discussing what I think will come from a future health care plan:
Again, the only real question is will we be able to summon up our American ingenuity and in our Solomonic wisdom make a single-payer system that tries to adopt the best of both worlds, does neither, yet still manages to make the members of the gilded class even richer and leaves us with the worst health care system in the industrial and post-industrial world.
All of the problems with the Medicare reimbursement structure–and the problems are large–are a result of a historical legacy that has hardened into a nearly immovable system. You can add to it, but no one has so far had much success with the substantial changes that would be necessary to make the system function better. It’s like trying to maneuver an aircraft carrier in your bathtub.
If we get national healthcare, we will not get anything like the neat little systems proposed by academics who can assume away many of the political problems. I am aware that proponents would rejoinder, that yes, they know it won’t be perfect, but . . . But I’m not making the perfect the enemy of the good. A national healthcare system in the United States will not merely be something sadly less than ideal–it will be nothing like most of the internally coherent proposals. It will be something jury rigged out of Medicare, S-Chip and insurance mandates, ugly and very expensive.
I just don’t see how anything will come out of Congress with enough votes that won’t be a disaster. Most of our elected representatives are entirely too beholden to the special interests that they represent. And I do mean most all of them. You can probably count on one hand the number of people in the House and Senate who genuinely have the best interests of the American people at heart (anyone here think Chuck Schumer and Chris Dodd and Maxine Waters and John Murtha and Diane Feinstein have covered themselves with glory lately?). Joe Biden voted for the bankruptcy bill in 2005, and probably has his hands as deep as anyone in the protection of credit card company abuses, and we just elected him Vice President (in fairness, there was no choice between Biden and Palin. Palin simply was not an option). Granted, admitting they are all awful plays into the Republicans hand, but the simple fact of the matter is I have very little confidence in Congress. The Democrats are only marginally better, and I never found “The Democrats are worse” to be a very persuasive message the last eight years anyway.
It is sad, but I am that cynical.