As best I can understand it, Conor Friedersdorf supports all the main points of the House health insurance reform bill. He’s in favor of universal community rating (everybody pays the same regardless of pre-existing conditions), ending rescission, health-care exchanges, and increased subsidies to enable those who can’t afford health insurance to get it. So why doesn’t he just say that? Instead he says Democrats have made a mistake by trying to pass this all at once. Less on the gamesmanship, please, more on the substance.
Substantively: the reason one often can’t pass individual planks of the reform in isolation is that taken individually, each plank generates perverse consequences that will lead to strong opposition from a particular constituency. Universal community rating, for instance, will make health insurance for the young and healthy more expensive. That creates adverse selection, as the young and healthy will drop out. And adverse selection threatens private insurers’ revenues: they lose their best customers. So to kill such a bill, private insurers will trade on young people’s fear that they’ll lose their health insurance. And they’ll be correct!
To pass universal community rating, you also have to have subsidies to keep low-income healthy people in the system, and you probably ultimately need a mandate that everyone has to buy insurance. That’s a deal that satisfies the insurance companies. But a deal like that also includes a couple of things that can be used to scare people: government subsidies, out of my taxes? A mandate that I have to buy insurance? And so your bill gets more complicated and easier for the political opposition to demagogue. And that’s how we wind up where we are.
Lay the blame where the blame belongs. It’s true, as Friedersdorf says, that lying demagogues will always be with us. And it’s also true that our mission in life will always be to denounce them as scum, and try to tell the truth. It’s a fallen world, baby, and the tzaddik’s task is to gather up the sparks of light.
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