Montana’s leading journalist on health care, Mike Dennison, sat down for an interview this week with one of the top bloggers and writers on the issue of health care reform in the country, Ezra Klein. The conversation looked at the political feasibility of passing different kinds of reform, and how U.S. Sen. Max Baucus fits into the political push for universal health care.
Klein, who leans left and writes for The American Prospect, predicts Republicans will do their best to kill this initiative. But what they don’t talk about is an idea I’ve heard floated by Baucus that reforming health care can be a pro-business issue, and that many top U.S. corporations are very interested in figuring out ways to reduce the costs of health care for employers. This idea could be a way to get some Republicans on board with the measure, but obviously it remains to be seen how the contours of the policy will actually take shape.
Q: Baucus has said a government single-payer or Medicare-for-all system of universal coverage is not an option for reform. Shouldn’t a single-payer system be considered?
Klein: There is a very strong intellectual case for single-payer. But if Max Baucus woke up tomorrow and said, “It’s on the table,” that’s not going to make it any more likely to pass. It’s not going to happen now. You couldn’t pass a single-payer system. You just can’t. What we found in 1994 (reform efforts) was, when politicians say, “We’re going to take what you have now away, and you can trust the federal government to do this now” — that scares the hell out of people. Whatever is going to happen this year, for single-payer, the case has not been made. It’s still a longer-range campaign. The question is, can (Congress) even stick their neck out far on (other reforms)?
Q: The proposed reforms from Baucus and Democrats in Congress will have some sort of mandate to buy private insurance, such as the plan enacted in Massachusetts. Yet the Massachusetts plan is proving to be much more costly than thought, and still isn’t covering everyone. Why should we follow that plan?
Klein: I think (the congressional plan) will have a lot more cost-control than the Massachusetts plan, a lot more reform of health care delivery. All (the Massachusetts plan) did really was increase money for access. This (congressional reform) is going to be about more; there will be a lot more happening.
Q: What are the important items we’ll see in congressional Democrats’ proposals?
Klein: A real effort to modernize and rationalize the system, such as payment reform. Doctors now get paid for doing more to you. The marginal incentives in the system are towards doing more, in ways that aren’t always useful, and are always expensive. We’re seeing a lot of ineffective treatment happening out there. That is where the system wants to find its changes. Will it? That’s anyone’s guess.