Yesterday, I considered the possibility that one might get a law past that covers all of the currently uninsured by that does so on terms that are extremely favorable to the insurance industry -- basically a whole porridge of mandates and subsidies paired with fairly weak regulatory measures. Ezra Klein says a system like that would still be a step on the road to a better health care system overall, since eventually the simple reality that there's a need for cost controls would kick in.

Maybe so. What's more, obviously delivering health care to the uninsured would be a good thing even if it's done in a somewhat wasteful manner. The point is simply that the push among progressives to make universal health care priority number one is not, in practice, the same thing as a push to make fighting the insurance companies priority number one. In practice, if you define the short-term goal as "universal health care" and elevate its priority to the point where you're willing to make large expenditures on its behalf, the easiest way to do that is to buy off the affected companies and it seems to me that, primary season posturing aside, this is the direction in which political strategy is evolving.

And if I were in charge of things, this isn't the direction I would choose -- why not spend the billions on preschool and mass transit? Why not buy off the agribusiness interests instead of the health care ones and formulate a farm policy that prioritizes healthy heating for the public? I'm not someone who accepts the logic of "this money you're proposing to spend on health care would be better spent on preschool and therefore I'll oppose your health care bill even though preschool is not, in practice, on the table as an alternative" -- large social forces have pushed political priorities in this direction and that's the way it is. But America has a screwed-up health care finance system today and is likely to continue to to have a screwed-up system even if Klein-style optimism about the short-term prospects for big-picture reform proves correct.

Photo by Flickr user Waldo Jaquith used under a Creative Commons license

We want to hear what you think about this article. Submit a letter to the editor or write to