August 25, 2007

single-issue voting

Health care is the single most important issue in the primary, and maybe in the general election too. Bar none. More important than Iraq, more important than the environment, more important than education or queer rights or feminism or trade agreements or crime or abortion or immigration or whatever the hell else they're talking about these days.

Here's why: it's urgent, and it's distinguishing.

All the Democratic candidates are pro-choice and have sort of moderately pro-environment positions. None of them are going to do a damn thing for education as far as I can tell - and I don't blame them, since I've never heard of a president doing much that's useful for education other than funding it. I sincerely doubt any of the candidates will negotiate any kind of trade agreement that improves the world.

Meanwhile, Iraq is going to be a disaster from hell no matter who's in charge. None of them have any kind of environmental or energy position that will really protect us from peak oil or climate change. Queer rights? Who cares what they think? There's not going to be much done for queer rights at the federal level for at least another ten years. These are not salient issues right now, because there's no real national consensus that something must change in a particular direction. Even immigration, which I think is maybe the next issue up, is something around which there's tremendous conflict at many levels - it's more like same-sex marriage than health care in that way, and the next president will most likely not have the opportunity to enact major reform.

Health care is different. Since 1992, the last time we had a go at health care reform, the insurance situation for middle-class people has worsened dramatically. Even many upper-middle-class people are finding health insurance dramatically expensive or difficult to obtain. I've been thinking back to my American politics classes, which strongly suggest that when something becomes a middle-class issue (and especially an issue that affects the professional and upper middle class), there's an opportunity for policy change. Some of the most popular, least politically touchable programs are the housing subsidy for the middle class (home mortgage interest tax deduction) and Social Security, which provides benefits to people at all income levels and thus has a really broad base. We don't have a health care program, but the current conditions give the next president a major opportunity to create one. I think our health insurance system has become so problematic that it will change substantially within the next 5 years; whatever we get is likely to become politically untouchable, so it better be good.

Conveniently, the candidates have very different plans. Put the Republican candidates aside, as they have plans that I generally find fairly repellent (ranging from Giuliani's tax breaks to Romney's unsupported individual mandate1 to Brownback and Thompson with no plan at all) and I wouldn't vote for them anyway. To spell out what I'm looking for: a plan that will provide us with the major benefits of universal health care enjoyed by all other industrialized nations. Those benefits include better public health outcomes because everyone has access to necessary (and especially preventive) care; and lower costs, both because people get treatment before their conditions get too complicated and because the government has negotiating power with the agents who deliver care and supplies.

Let's look at the three major Democratic Candidates. Obama's plan is too complicated, and I think it's unlikely to lower costs or improve public health outcomes in the way that universal health care in other countries does. Clinton doesn't have a [published] plan, which I think is because she got so badly burned organizing the Bill Clinton health care plan in 1992. She's by far the most experienced and knowledgeable of the three about health care, but I'm concerned that she will have the exact same reticence as president that she now has as a candidate.

Edwards has by far the best plan. It would lower the over-all cost of health insurance by spreading the risk through a wider pool (i.e. everyone), and ensure that everyone could get into that pool by mandating that insurers offer coverage to everyone regardless of health history and with no surcharge for previous health problems. He also spells out how he'll support and fund the plan, and dude, it would work.

Go Edwards go!

1. Romney on mandating that individuals buy health insurance: "I think it appeals to people on both sides of the aisle: insurance for everyone without a tax increase." Hey! Does it really matter whether you pay the money to the insurer or the government? Requiring that people buy health insurance is still a government mandate on how my money be used! I don't so much mind the mandate itself - Edwards's plan includes one - as Romney assuming I can't do the math.

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