Third World America

Nah, America doesn't need national health insurance:

It was 3 a.m. at the Wise County Fairgrounds in Virginia — Friday, July 20, 2007 — the start of a rainy Appalachian morning. Outside the gates, people lay in their trucks or in tents pitched along the grassy parking lot, waiting for their chance to have their medical needs treated at no charge — part of an annual three-day “expedition” led by a volunteer medical relief corps called Remote Area Medical.

The group, most often referred to as RAM, has sent health expeditions to countries like Guyana, India, Tanzania and Haiti, but increasingly its work is in the United States, where 47 million people — more than 15 percent of the population — live without health insurance. (link)

In sickness and health (but mostly sickness)

Paul Krugman explodes some health care myths. As the presidential campaign gets serious, it's important not to let opponents of universal health insurance define the debate.

Pot pouri

Rudy has a bad idea for reforming the health care system, and the death penalty ain't such great shakes either:

My recently completed study of the 124 exonerations of death row inmates in America from 1973 to 2007 indicated that 80, or about two-thirds, of their so-called wrongful convictions resulted not from good-faith mistakes or errors but from intentional, willful, malicious prosecutions by criminal justice personnel. (There were four cases in which a determination could not be made one way or another.) ...

The malicious or even well-intentioned manipulation of murder cases by prosecutors and the police underscores why it’s important to discard, once and for all, the nonsense that so-called wrongful convictions can be eliminated by introducing better forensic science into the courtroom.

Even if we limit death sentences to cases in which there is “conclusive scientific evidence” of guilt, as Mitt Romney, the presidential candidate and former governor of Massachusetts has proposed, we will still not eliminate the problem of wrongful convictions. The best trained and most honest forensic scientists can only examine the evidence presented to them; they cannot be expected to determine if that evidence has been planted, switched or withheld from the defense.

The cause of malicious unlawful convictions doesn’t rest solely in the imperfect workings of our criminal justice system — if it did we might be able to remedy most of it. A crucial part of the problem rests in the hearts and souls of those whose job it is to uphold the law. That’s why even the most careful strictures on death penalty cases could fail to prevent the execution of innocent people...

Whether they are guilty or innocent, executing people is not the mark of a civilized society.

A healthy solution?

Massachusetts Gov. Mitt Romney touts his state's landmark health care reform on the conservative op-ed page of the Wall Street Journal. I haven't had time to study the fine print, but it appears not unlike the Swiss system in which individuals are required to purchase health insurance, and those with low incomes will receive subsidies to do so. It also includes a mechanism for automatically enrolling those eligible into Medicaid, because as Romney explains, 20 percent of the 500,000 or so uninsured Massachusetts residents are eligible for Medicaid but are not currently enrolled. It's a good idea, but it makes me wonder if it might make the plan more expensive than Romney lets on.

For Romney, a likely candidate for the Republican nomination for president in 2008, it's a smart move politically. The plan is centrist, offering something for everyone--expanded Medicaid coverage and insurance subsidies for liberals, health savings accounts for conservatives. It was passed by a Democratic-controlled Legislature, with the support of a conservative think tank and the backing, it would seem, of at least some of the business community. Granted, die-hard fiscal conservatives and libertarians won't like it, and it falls way, way short of the kind of universal health care favored by much of the left.

Nonetheless, as a Republican, Romney has co-opted what promises to be a major issue for Democrats over the next several years, perhaps allowing the pro-life Mormon to compete for swing voters. The plan may be a disaster, but it will be too soon to know by 2008. This is a good reminder why governors tend to have a clearer path to the White House than senators and House members.

A right, not a privilege, cont.

Michael Kinsley suggests, wisely, a more moderate approach to health care reform than what these guys suggest. (I linked to the latter article in the comments to this post earlier in the week.)

If you're not as hopeful as Krugman and Wells about being able to avoid rationing, you face the question: Should people be allowed to opt out of rationing if they can afford it? That is, if the system (private or single-payer) won't pay for the $100,000 pill, should you be able to pay for it yourself? Fear that this would not be allowed helped to kill the Clinton health-care reform 13 years ago. But explicitly granting some people life and health while denying these things to others is hard, even though this disparity has existed throughout history and is probably unavoidable. In fact, a serious defect of single-payer is that it makes all sorts of unbearable trade-offs explicit government policy, rather than obscuring them in complexities.

There are the makings of a deal here. Better-off or better-insured people could be told, individually or as a group: Give up your health-care subsidy, and you may opt out of any rationing-type restrictions that the system imposes. And if a few smaller reforms like that don't work, maybe, it will be time for single-payer.

A right, not a privilege

The New Republic makes a persuasive argument in favor of universal health insurance, and says it is the issue that can reignite the liberal imagination. Might this not be the kind of thing I was talking about earlier this week, the kind of issue that all Democrats can rally around?