In principle even the most ardent conservatives in Congress understand that the 46 million or so Americans currently without health care insurance ought to be covered (”deserve” may be a better word, in our opinion, but it’s also a bit loaded). At least we hope this is true. The issue, of course, is how to pay for it. Or, more pointedly, who will foot the bill?
Broadly speaking there are three ways to pay for universal care:
1. Place a surtax on the “wealthiest Americans” (in the current draft of the bill this means individuals earning more than $280,000 per year, though Nancy Pelosi stated yesterday that she is trying to limit the surtax to invidviduals earning more than $500,000 per year and households earning more than $1 million).
2. Cut payments to medical providers/overhaul the fee-for-service system (Massachusetts is trying to implement legislation that could become a model for Congress).
3. Ration medical care (this idea was nicely if not somewhat academically outlined in a piece that ran in Sunday’s NYT magazine).
There are, of course, other options and various blended approaches. The problem with any of these–and with trying to overhaul the health care system in general–is that they require long term thinking and short term pain, neither of which sit will with politicians or citizens. Everybody wants to do the right thing, but most of us don’t want to have to suffer to get there. So far the President seems to be suffering the most.
Indeed, many are calling health care Obama’s “Waterloo” (this term, first uttered by Jim DeMint, has become a meme bordering on cliche now). We’re as skeptical and realistic as anybody, and Obama is a politician. But what if this time he’s being honest when he says it’s about people, not politics?
Related: Slate’s Jacob Weisberg has a thoughtful piece about why we should move away from a job-related insurance system.
