Since the gurus of the new global economy tell us that we should expect to have a number of jobs throughout our lifetime instead of the 40 year one-company career our parents had, it's common sense that a system of health care where your insurance is provided by your employer is outdated.

Get rid of this one simple notion; burn it into people's minds, and then figure out what the next step is - honestly I don't see how you can come to any other conclusion than that the government should be in the business of facilitating health care.  This may not mean being the provider of it - but all but the most ardent Nozickean libertarians would agree that societies form governments in order to provide at the least protection from the "other" in the form of military and police.

What we, as progressives and liberals and Democrats, need to remind people is that we form governments to help us live our lives by providing or facilitating that which we, as individuals, cannot provide for ourselves, and which the market does a crappy job of providing.  If you can convince people that the market has failed on healthcare, which shouldn't be that hard to do, it's not far to get them to support reform of one sort or another.  Healthcare wasn't out of control enough in the mid-90s; it is now.

The most coherent argument I've found is that, unlike traditional goods which you can buy or not buy depending on your analysis of their price and quality - healthcare cannot be a market commodity because you are not in a position to turn it down - if you are sick, you will pay whatever price is charged for care (or pass that price along to the general taxpayer through subsidies that already exist in one form or another).  Without the ability to shop for prices, there cannot be a working healthcare market. 

I just sent an email to Josh in response to his opening TPM cafe posts, which seemed a bit too deeply buried to comment on. The gist was that the issue wan't new ideas per se, it's just that Democrats need to have something to say to people who are hurting. And for that matter, to people who aren't. Relevant parts from that email:

. . .I don't really care about new ideas for the
sake of new ideas. But there are people hurting right
now, and Democrats have to be able to speak to these
people, and offer them hope. A few weeks ago, the LA
Times had a story (no longer available) which had this quote:

'The clinic's hygienists are starting to call other
patients who have been waiting for dentures, to break
the news. Their list runs seven pages long.
"It breaks your heart," Redman said, in tears.
"They've been waiting so long to get teeth."'

Putting aside the issue of "opposition versus new
ideas", what do Democrats have to say to those
Missouri Medicaid patients who are waiting for new
teeth?

Likewise, in the opening chapter of his book, "The End
of Poverty", Jeffrey Sachs tells of going to a
hospital in Malawi where 450 people with AIDS lie
crowded in a 150-bed ward, dying for want of anti-HIV
drugs which, in their generic form, cost a dollar per
person per day. What do Democrats have to say to the
people of Malawi?

Now it may be true that foreign aid is politically out
of bounds, though I've seen no real evidence of that.
But even if that's the case, it should still be
possible for Democrats & liberal/progressive
organizations, through private contributions &
grassroots action, to offer hope & help for people who
are hurting.

Every Democrat will be asked 500 times between now and
election day, "Sure, you criticize Bush, but why are
you any better?" What should they say?

I think liberals need to establish two different but
complementary strategies: a pragmatic, outside-in
strategy, focused on winning elections even at the
temporary cost of principles, and an idealistic,
inside-out strategy, focused on solving problems &
helping people, whether in or out of power.

Somehow, liberals need to find a way out of the trap
of "we can't help people unless we win, and we'll
never win if we admit that we have all these
expensive do-gooder plans to help people"

In hindsight, I'm not sure that Kerry could have won the election by being more progressive.  But here we are, and I never magined I'd feel this way, but I think that seven months after the election, the time is actually ripe for a progressive agenda.  Finally.  People are starting to get it, even though it's a year late.

We could match their wedge issues of women's reproductive freedom and gay marriage with real issues of our own... raising the minimum wage and national health care.

It's time to get talking.  Love the Cafe!

There are no market based answers.. We will eventually move towards a French style health care policy.  The only question is how "fast" we move in that direction.  The democratic party should fully embrace this set of policy proscriptions and the budget levels that this entails.

While I heartily agree with the preceding comments on the need for some variant of a single-payer national health plan, one important tactical question remains unanswered:  Given the need for universal health coverage, what is the best practical political vehicle for such a plan?  The best suggestion I've seen recently is from George McGovern:  "Medicare for All."  Extend (amended) Medicare coverage gradually to other age groups, starting with children, to capitalize on the immense popularity of the current program.  What say you, Cafe-goers?

I agree they shouldn't be, but even if they are - don't forget about the millions of homeless families here in the U.S. 

Don't forget about the tens of millions who go hungry each year here in the U.S. 

Don't forget about the infants and children that die each year because our healthcare system is not up to snuff in rural and urban areas. 

Don't forget the children who end up suffering from curable diseases because our government cut funding for neonatal testing.

This is where we, as Democrats/Progressives/Liberals have to make clear that OUR morals, OUR values won't allow us to sit still while these injustices occur.  We have to make it clear that the Republican party is controlled by "Enterprisers" who represent only 25% of Americans who believe corporate welfare is more important than child welfare.  That saving money for millionaires is more important than saving Medicare for moms.  This is where we have to STAND on our morals, on our values, on our religion whatever that may be.  This is where we need to make clear that the common good is served best when everyone has healthcare, when everyone can contribute, when everyone has a shot at the American Dream.

We should fight for fully socialised medicine and accept the single payer compromise.

There should be no "anything less". 

Health care should be to Dems what taxes were to repubs, when they were the minority party. We don't have to have a perfect plan right out of the box, because affordable healthcare has such a universal appeal. It should be part of our response to any repub initiative.

Bankruptcy bill? That would be fine, if it didn't cost so much to get sick.

Tort reform? That would be fine, if medical treatment for defective products wasn't so high.

Social Security cuts? If people didn't have to pour so much of their life's earnings into health care, they'd have more money to set aside for retirement.

War in Iraq? How much healthcare could we buy with that amount of money?

Some of that might be a stretch. But, the higher the cost of healthcare, the broader the reach of it's impact. It's an issue that naturally favors Dems. Let's make it issue #1 and part of our rebuttal to every piece of the republican agenda.

We don't have to have a perfect plan right out of the box, because affordable healthcare has such a universal appeal. It should be part of our response to any repub initiative.

But unlike Social Security -- where obstructing Republican lunacy now and making minor changes down the road will work just fine -- the health care system in the US really needs overhauling. Although maybe having a specific plan right this second wouldn't be a good idea, having one by the 2008 election is crucial. We need popular support for the plan, as expressed in election results, in order for Republicans (or at least a few of them) to be afraid to try to block it. If the Democrats go into the campaign saying they'll fix things, but not saying how, that won't be a strong enough "mandate" for a drastic change like single-payer.

When this was mentioned at a recent event, everyone instantly understood that they were talking about bare bones insurance, not "Cadillac Plans".  Granted, it would be nice to eventually have Cadillac Plans for everyone, but the important thing is to get something out there first.

Except that the left has already decided that the debate must be framed as one where health care is a "right"--and this Cadillac Plan vs. bare bones analogy skirts dangerously close to acknowledging that it is a scarce yet quantifiable commodity.  That deviation from the "rights" shibboleth is not acceptable in today's Dem Party. 

Do you see the problem in just assuming, as JMM does, that "health care" is the royal road back to power for the Dems?

The market in the U.S. rations medical care every day by denying it to those without insurance and those with less comprehensive insurance.

Chuckles again with:

I agree they shouldn't be, but even if they are - don't forget about the millions of homeless families here in the U.S. 

Trotting out "the homeless" once more would be a sure-fire way of keeping the Dems in the minority until after, oh, the 2030 census.  The vast middle swath of America we are trying to reach will not be taken in again.  You see, when progressives talked about "the homeless" in the 80s, they were sold on the idea that homeless people are just like you and me--just plain folks who are down on their luck and can't find affordable housing.  When the truth set in, and people started seeing "the homeless" as predominantly mentally disturbed and/or drug-addicted vagrants, progressives lost that fight and a lot of credibility. 

Don't forget about the tens of millions who go hungry each year here in the U.S. 

Never mind that the biggest health risk vector among poor youths in the US is obesity.  "Tens of millions" going hungry?  Please.  Chicken Littleism isn't very good for progressive hopes.

 "makes the Democratic party, progressives, or the just the center-left in general in this country a walking contradiction"

One of the reasons the Dems seem like a walking contradiction is that they focus too much on health care policy-- and less on the over arching value.  We can't argue single payer, cost, or anything else until we  have defined the problem.

In Lexington (MA) we have been working on framing  language for health care, and felt the key issues were protection, and economic opportunity.  So our take is

No duty of government is more sacred that protecting the life and health of our citizens.  When Americans need to change jobs, start a business, or care for family, their life savings must not be suddenly at risk.

When Rove and co. called our response to 9/11 the War on Terror, they effectively took means and cost off the table. 

Health care is basically about protection and security, and that protection is as much a government duty as is protecting us from terrorism.

Secondly, lack of health care is a huge millstone holding back American creativity and ingenuity. The fact that people cling to dead end jobs, or fear change, due to lack of health care is immobilizing our work force as effectively as a series of toll barriers at state lines.

By framing the issue in this way-- a basic government duty of protection, and a basic requirement for economic growth, the dems can avoid the contradiction you speak of, and focus on how to accomplish these shared goals. 

GM, Ford, the airlines, all of the manufacturing industries and, I'll bet, even a lot of the white collar industries, could be brought together to support serious healthcare reform as "pro-business." In fact, we could frame the argument like this: "We think that government has abdicated its responsibility to ensure the health and welfare of the people. We've turned companies that make cars into companies that provide EKGs. We seek to nationalize the healthcare system not at the expense of the private sector, but in order to bring freedom to the private sector. " We sell it as a huge gift to the private sector and we use old industry money to pay for the packaging.

 I like the idea of thinking about car insurance--we don.t think anything about it and everyoone has to have it. how much sense it makes to think about healthcare the same way. Think basic coverage for catastrophic illnesses to cover everyone and  then have different levels.

Then you must be a Republican. 

Health care is a big deal. It's a much deal than social security. It's a problem that needs to be solved. It's the kind of issue that if tackled correctly could win you an election *and* let you be a do-gooder. Why not talk about it more here at TPM Cafe?

There are lots of semi-smart people saying semi-smart things about health care. There are also smart people thinking and saying smart things about health care. This would be a good place (or would it) to try to gather some of those smart people (who will disagree with each other -- a good thing) to have a real dialogue about what to do about health care in america.

Why not start with Jon Cohn from TNR? He's a smart guy, he's a good journalist, he's writing a book about health care and he doesn't have his own blog yet!

Health care is already rationed in the U.S.; much more so than in France.  It's not necessarily a bad thing to ration it, but the current higgledy-piggledy patchwork of care is extraordinarily inefficient and frustrating for both providers and consumers.  Unfortunately, health care is one of those items where more is not necessarily better.  I am also a fan of universal catastrophic coverage with some level of chronic care.  However, there has to be some sort of price mechanism to discourage overuse, too. 

 There are also gross inefficiencies in the delivery of health care.  An extraordinary amount of waste occurs due to the difficulty of retrieving medical data.  My chronic complaint has long been that we spend tens of thousands of dollars generating data, hand write it on paper, and store it in manila folders.  It results in errors, loss, and repetition of testing.  The two hospitals where I have had priveleges in the last five years have not had EMR.  The rural hospital did not even have a usable lab value retrieval system.  I have just resigned from a big-city, 350 physician medical group which is planning on rolling out it's first EMR next year.  EMR is a complex user interface design problem, but doesn't require any cutting edge software or hardware technology, it's merely a very large database.  As the field is developing now, there are no standards for interaction among systems from various vendors, there is no incentive for transition to this technology and some pretty daunting obstacles for small groups to overcome in transitioning to new technology.  The savings that could result from defining and developing industry standards would be enormous with reasonably small cost, but that just won't occur without government leadership.

 P.S. Medicare doesn't cover Viagra or, until next year, any prescription drugs.  Secure Horizons just started covering a few branded drugs, but not Viagra.  Medicaid does cover Viagra in some states, apparently.  I don't believe that MediCal covers Viagra, but I could be wrong.

The agenda for the Democrats is simple once they're back: fix Bush's mess. That will more than fill the docket for a 4-year term.

A lot of folks have made this argument lately.  And selling health care reform as a pro-business measure certainly makes intuitive sense given all of the headlines lately about GM and others losing money hand over foot to pay for retirement benefits.

As a practical political matter, though, it's a lot more difficult than it sounds.  Just ask Hillary Clinton and Ira Magaziner.  Like any scheme for universal coverage, the Clinton plan would have been a boon to large employers stuck with huge benefit costs.  And, early on, the Clinton plan enjoyed support from large manufacturers.

But the threat of such a large government intrusion into the private sector economy still spooked business leaders; in effect, they worried about a "slippery slope" effect in which successful govt meddling into health care would lead to govt meddling elsewhere.  In addition, business had lined up with the Clintons bc, for a brief period in the early 90s, govt-run universal health care actually seemed inevitable; business figured they would be better off if they got in on the ground floor and helped shape the plan.

Once the Clinton plan began to falter in late 93/early 94, business lobbies came under a lot of pressure from conservatives both within their organizations and without to oppose the Clinton plan.  One by one, they peeled off.

Manufacturers in particular may come to rue that day, but it happened that way before and, given the strongly ideological posturing of the business lobby today, I'm not sure it wouldn't happen again.

THat's not to say courting business is pointless; in fact, it's essential.  But I think it's a mistake to believe this will really get reform over the hump.  If reform is going to succeed, it's going to be because a persuasive president convinces a wary public that universal health care will leave them more secure.

FYI, John Judis had a terrific article in 1995 (or maybe 96) on the back-and-forth of the business lobby during the Clinton fight.  I'm pretty sure it's available at the Prospect website, www.prospect.org, through their archive.

This is absolutely true and the reason should be clear to all:  you simply cannot search for health care alternatives when you need them most. When someone explains to me how I can shop for emergency, rehabilitative, and possibly surgical care while I am having a heart attack, I will talk about market based solutions.

The main problem with tackling health care is that too many people don't use their health insurance with any regularity. If every family had a medical emergency in the same year, I guarantee we would have health care reform the next year. 

Wyoming did a very interesting thing several years ago, with barely any notice and no real controversy. They took their state employee health care system -- which was in a downward spiral with people dropping out and rising costs -- and socialized it. No other way to explain it. They had paid 100% for employees and nothing for families and they began paying 80% for employee and families. 

This passed through our very Republican legislature with nary a peep. Since then, people have come back to the plan in droves and prices have stabilized. Now I would like to see them open the system to any uninsured person in the state and to small employers.

The more people who share in the risk pool, the more stable the system. It's just that simple. We need to get everyone in and a single-payer system -- financed through a health care fed tax on individuals and businesses -- administered by the states is the only escape I can see. There is plenty of money currently being spent, we just have to redirect it. And, as for waiting and rationing, anyone who is paying any attention right now to the situation in this country knows we are already rationing and waiting.