At 10:08 AM 8/31/99 +0000, Patrick Bond wrote: >Is this true? The small insurance folk put out endless inane >commercials which (U.Penn Annenberg School media researchers >convincingly show) tipped the public consciousness-balance. The small >business lobbyists beat up on wavering members of congress. It was >quite a revealing war; there's a debate between Skocpol and Navarro >about how to interpret it. I think the Clinton folk wanted a >relatively universal coverage plan that would at least have got some >95% into 'coverage,' but under the rubric of a handful of big >national plans marketed by the Jackson Hole group of big insurance >companies (led by Aetna, Prudential, etc). That would have been most >profitable for the Jackson Hole firms, with respect to the mix of >cross-subsidies and access-limited health services that would >maximise both insurance premium/investment profits and health-system >utilisation profits (a completely contradictory mix, of course, which >managed care has brought into the same organisation). The main point raised by Hitchens is that it was not the insurance industry opposition that killed Clinton's health reform, as Hillary claimed. In fact it was written by big insurance companies with their benefit in mind. Consistent with that view is the argumewnt proposed by Navarro that industrial execs did not like Clinton's idea either, mainly because of its byzantine design that would offer few real savings while taking away their important bargaining chip (health insurance) with labor. >>... >> I do not think that cost-efficiency should be of primary concern to the >> Left for a number of good reasons, chief among them being that insurance >> companies can take of that. > >But they don't. They cut access and quality dramatically in the >process of destroying overaccumulated health capital, but the >share for admin keeps going up (to pay for expensive MBAs who sit >between physicians and patients, saying the latter can't get the >specialty care the former recommend because the averages don't >justify it). Surely outrageous CEO salaries are surface evidence of >massive overhead loading? There are plenty of studies on this, >including by the Harvard group who lobby for a national health >system. What they do in practice is another thing. I was really arguing that, at least in theory, efficiency can be taken care of by the "market forces" but universal coverage - not. Even conventional economists admit that (the so called market failures). So from that standpoint, universal coverage is entirely in the domain of political struggle, whereas efficiencly may be taken care of by more conventional economic forces, at least in theory. > >> A much better strategy is to focus on universal coverage - which as I have >> argued - can be achieved by institutional arrangements that are not limited >> to a single payer public insurance scheme. > >Do you want Hillary's big insurance co's running everything? Of course not. But having to choose between a universal health care plan run by a handful of large co's, and cherry-picking perforemed by the "democratic plurality" - I would certainly prefer the former. But I have no problems with central planning and teaching the multi-culti crowd some discipline and the value of work either. Diversity for diversity's sake is liberal bourgeois crap. >Putting them out of business through a single-payer is surely the >first necessary if insufficient step towards more thorough-going >reform of capitalist health care? I certainly agree, but I would not hold my breath to see it happen. Maybe some day during my life time, but not in the foreseeable future. That is almost certainly too long for people who have no access to health insurance now. > >(Sorry I missed you in Baltimore last week, Wojtek... no transport >left me less flexible than I thought.) no problem - perhaps some other time, looks like i'll be stuck in this dump for some time. cheers wojtek
