Do the insurers really fear Medicare-for-All down the road? I think a more likely scenario is that Americans will simply get used to having nothing -- we've certainly gotten used to not having pensions or vacations.

And if the more likely outcome in 10 or 20 years is 50% uninsured, would the insurers mind so much? Or would that just be a way to cull out people who get sick and cost them money?

"And on this, there was murmured assent. Particularly because he followed it with a story about a young skier he knew who promised Wyden that, if he did get injured skiing, he'd definitely buy insurance. "That's, uh, not how it works," said Wyden. The crowd chuckled. Nothing gets them like adverse selection humor."

Great stuff.

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We really are at a moment where all the stars are aligning for passing legislation.

Clinton '08

Great post. Wyden is a savvy guy. He's responsible for one of the "Great Moments in US Congressional History" when he was in the House. He gets the heads of all the tobacco companies to say that "Nicotine is not addictive." under oath.
http://www.youtube.com/watch?v=jQUNk5meJHs

No wonder Camp got such deafening silence, following Wyden. Wyden shows he gets them, he knows what their life is, he knows how the situation forces them to do things they maybe wouldn't like to do.

Then Camp comes in with his routine and he sounds tone-deaf. It's the same old schlock they've been selling for 28 years, and it's sounding pretty tired. Is he listening to them? Does he have a clue what their life is like? Or is his message "get with the program"

Nice. Good for Wyden, although I will add that what he is saying is not news to insurers. From my work in the industry, I'd say 70-80% of those at the officer level were only nodding at things they already believed.

This is another reason why the "mandates can't pass" crowd is so out of touch. The majority of the health care industry, across the board, wants it to pass.

One of the advantages of this solution, he promised, would be that “you won’t be the political football anymore. We’ll say we’re in this together, and everyone has to accept some changes.” Nobody likes to be hated, as it turns out. Not even the insurance industry. Wyden isn't merely offering them a compromise. He's dangling a chance at redemption.

Ezra,

I love Wyden's optimism and think its great that you're being just a little more exposed to the industry itself, even if it is just through a conference.

That being said, the above quote just isn't realistic. I'm oversimplifying, but HMOs were villified in the 90's precisely because they started aggressively seeking to control utilization-- doing the "right" stuff insurance companies should be doing. So even if this system gets fixed as Wyden hopes, and they focus on providing high quality care at reasonable cost, they'll still have a problem. No politician, or anyone else, is going to take the PR hit for doing the real tough work of controlling costs. They'll be hated after this round of health care reform, just like they're hated now.

This relates to a long-standing point of mine. Everyone's focusing on the relatively easy issues and ignoring the tough ones. Controlling costs is monumentally more difficult than mandates, community rating, public option-- those are kid stuff. Politicians won't even dare mention a word of what controlling costs would entail, its political suicide. Until we really start thinking this stuff through, and stop with the rosy pictures described above, our system has no real chance at comprehensive reform.

From my work in the industry, I'd say 70-80% of those at the officer level were only nodding at things they already believed.

This was my point on the earlier AHIP post. I hope Ezra and others get this. Industry isn't the automatic enemy here. The market is terribly out of whack. Fix that, and these guys can go spend all of their time figuring out how to make health care more affordable with higher quality-- they just need the right market incentives put in place. Not like politicians making empty assertions claiming their plans raise quality and lower costs (Clinton: guilty, Obama: guilty, McCain: guilty), but actually doing it. Because unlike most people who talk about health care, they actually understand it. Similar to what jd said, if you're in the industry, you've already been thinking about many of the "cutting-edge" ideas for a number of years. It just takes a little while for these ideas to trickle into DC, where folks think they're the ones who created them.

Wisewon, many of us aren't ignoring it, but we disagree on one or two points.

I'm with you all the way on this last comment of yours, with one exception: when costs become intolerable, they will not be tolerated and real reform will happen. Maybe that's when health care costs hit 20% of GDP, who knows.

But one thing I strongly suspect is that as soon as a larger share of tax revenue is used to pay for health care to fund a universal coverage scheme, the pressure for reform will grow. It will grow from the right seeking to curb what they will now interpret as government waste. It will grow from the taxpayer who doesn't want to pay as much (even if the scheme is cost-neutral overall). Hopefully good government folks on the left can help guide these pressures in productive ways to increase the care delivery value proposition.

I say do the easier thing now, as part of a plan to build up pressure for doing the harder thing later. Nothing is automatic, I'm not being a pollyanna. I just think if we wait until real reform of the delivery and cost of care before getting universal access, we'll be waiting a long, long time. I'll be collecting Medicare by then.

Ach, my last comment was in reference to wisewon's 9:24 comment, not his 9:33 comment.

But one thing I strongly suspect is that as soon as a larger share of tax revenue is used to pay for health care to fund a universal coverage scheme, the pressure for reform will grow.

I've heard you make this comment before, and I think you're missing an important point. I agree that with our current trajectory for health care reform, the system won't change until its no longer affordable. But in this country, we won't reach that limit until we've reached debt levels that are no longer sustainable (taxes don't need to be raised just because costs are increasing). If politicians have a choice between forcing a cut in health care, raising taxes or adding to our debt, the choice is easy for a long while, history has proven this to be true. If you look at the additional level of debt we'd likely be able to incur before reaching the breaking point, there's at least several trillion (I think 7-10 +/- is realistic) before we reach that point. How is this the path to controlling costs?

Deficit spending as an option to avoid reform is an important point, and it certainly will blunt pressure to some extent.

However, if you've been following the international credit markets you know that the US is less and less seen as a great place to park your money if you're a foreign government or financier. The cost of credit for the US is going up, and investment in govt securities is drying up. I see good reason to believe this will continue or accelerate for a good while as the dollar weakens. Xenophobia will probably also increase with the recognition of how dependent we are on foreign creditors.

The upshot is that we won't be able to take deficit spending for granted in the future as much as we do now. It will become a bigger issue soon, especially if a Democrat is in the White House.

But yeah, I do agree that deficits will continue to form a kind of escape valve to reduce the pressure for system reform. I still don't think we have an alternative to going forward with UHC before waiting for deep reform.