7-31-09, 10:06 am

'If dogs run free, then why not we Across the swooping plain?
My ears hear a symphony
Of two mules, trains and rain.
The best is always yet to come,
That's what they explain to me.
Just do your thing, you'll be king,
If dogs run free.' Bob Dylan,  New Morning, 1970

I am trying to get  more info on the blue-dogs – white-house – senate health care negotiations. Are we headed to a supportable bill, or not?     'If we were starting from scratch, I would favor single-payer,' the President has said.   So he gave the single-payer movement more than just a tip of his hat (I think), even though he shortly backed up to a public option plan where not-for-profit medicine can compete and help drive much needed health care reforms, including universal coverage. It is beginning to look like the administration is backing up from a straightforward 'public option' – essentially a national health service to lead the non-profit sector – to a position that amounts to smuggling in a public option under the guise of a heavier federal funded and regulated coop system modeled on rural cooperative non-profit health providers. 

Thus the negotiations appear to be moving more toward the Netherlands-like solution: eventual universal coverage, private insurance, but many public mandates.   Frankly I need to be convinced that subsidized, regulated coops will have the market power sufficient to restructure costs and reform health care delivery in a system as huge, complex and varied as the current US one. A public plan would seem to garner greater administrative savings, and greater market power to drive change, cover everyone, and backstop cost control efforts. People may justly complain about Medicare defects, but it is far more efficient and popular than ANY OTHER insurance provider.   A public plan could more easily control overall savings and level of quality. It is true that in some rural areas – not an accident that all of the blue-dogs are from rural states – coops function well and certainly at no worse cost than the Canadian National Health Service does in its remote rural areas. However, it's hard to see this model scaling well. The US market is many times the size of Netherlands. 

In addition, eliminating employer mandates from the House legislation and replacing them with individual mandates seems like replacing a lousy hodge-podge of subsidies and taxes with a worse one. At what income level will working people have to pay a penalty – fine – for failing to purchase health insurance – when their employer declines to provide coverage, but you do not qualify for assistance?   Individual mandates seem like an open door to nail workers' disposable income. Any solution where the cost of benefits under reform is deducted from the current take-home pay of any worker under 80K should  be rejected, in my view. This crisis is fundamentally a consequence, in large measure, of long term flat or declining median income  alongside skyrocketing wealth accumulations in financial services corporations. Working people are not getting enough of the pie to play their usual role of saving the economy by starting to spend again. Adding more inequality to the US economy, even if it were in the name of universal health care, is a bad idea.

So, are the Blue Dogs taking just barking? Stinking up the lawn? Or should we lie down with them on the beach, and assume some beers and a philosophical attitude can get both of us thinking about taking care of everyone, taking the profit out of medicine, AND able to say 'National Health Care' and 'Down with socialism' with equal, respective enthusiasm?