HCAN can't, and furthermore they won't
In Xanadu did Kubla Khan
A stately pleasure-dome decree :
Where Alph, the sacred river, ran
Through caverns measureless to man
Down to a sunless sea.
On waking from an opium-induced sleep, so the story goes, Coleridge hurried to capture on paper the fantastical world he had dreamed [or hallucinated, depending on who you ask]. He was rudely interrupted while at this task, and when he returned to it, all was gone but the fragment we have today.
I can't help it. There's a little tiny video running in my brain, of a person from Porlock knocking at the window, frantically motioning to Sam, enticing him away from his scribblings whenever I read this portion of Richard Kirsch's preamble to his Will it be Deja vu All Over Again?
To my surprise, the writing led me to a fresh understanding of the paradox of achieving universal health care in the United States: the political debate about health care reform is turned upside down once the debate turns from the problem state to the solution stage. At that point, people become more scared about what they will lose from reform than what they will gain.
This seems both logical and intuitive [which is why I defended truthiness as a communication technique in an earlier discussion] and there may even be real actual studies demonstrating this, but nowhere in his 16-page lauding of Medicare the idea and Medicare the word does Kirsch actually test his conclusion, or even reference someone else's work on fear of change. Instead, the notion has interrupted Kirsch in the midst of his writing something else, in kind of a reverse of Coleridge's Xanadu vanishing when his writing is interrupted by RL.
That's okay, I'm inclined to give everyone the benefit of the doubt, especially since he seems to have penned this piece as both cautionary and inspirational tale. And he does say lots of nice things about single-payer in general and Medicare in particular and even why expanding Medicare to cover all of us is The Way. But in the end he comes to Medicare for all, na ga happen and so I took a little trip through Google Land to see if I could find out why.
After several hours, over several days, of poking around the ether, the evidence I found was scant, but it looked like Kirsch had taken his twin ideas Medicare = bad word and change >> fear as Truth, and set out to look for A Better Way.
And comes up with GAC -- Guaranteed Affordable Choice. Gak. See pages 5-7 for the bad words and the good words, determined, apparently, by a few focus groups in Orlando, Florida; Columbus, Ohio; Concord and San Diego, California; and Denver, Colorado.
Ooooh! They let Floridians in on the decision making! That should scare you.
So, anyways... it all sounded like hand-waving to me, but I'm being kind compared to one Krisch's critics over at the PNHP blog, Kip Sullivan:
(In 2006, a group that Richard helped form called the Herndon Alliance began cranking out junk science that allegedly supports Richard’s claims. Obviously, given the timing of Richard’s decision to abandon single-payer—either 2003 or 1993—the Alliance’s junk science could not have played a role in that decision.)
Sullivan goes on, at length, to rip Kirsch up one side and down the other but you should read it all anyway. While you're there, you should read the other 4 essays critiquing HCAN from all angles.
A few quotes that I'd like to highlight:
Nicholas Skala --
The core of Richard Kirsch’s argument is that reformers should forego advocacy of a proven and effective reform — single-payer — in favor of policies which have already been demonstrated to be failures, because the latter are politically expedient. In other words, because failure is politically achievable, failure should be advocated.
Kirsch purports to dispel the “myth” that all European nations have single-payer by replacing it with a new one: that these systems preserve — as he and HCAN would — a substantial role for U.S.-style private insurance. Nothing could be further from the truth. In reality, all of these systems work only because they have regulated U.S.-style insurance companies out of existence.
Oliver Fein --
Under the HCAN plan, private health insurance would remain a nightmare for consumers and physicians with continuing co-pays, deductibles, delays, and denials of coverage. The cost of what is already the world’s most expensive system would continue to climb, with no effective cost control mechanisms in place. Those who think they are insured will still find, when they are sick, that their insurance has failed them and that they can’t afford the care they need.
David Himmelstein --
This approach reprises the format of Medicare’s ongoing privatization. Despite promises of strict regulation and a level playing field that would allow the public plan to flourish, private insurers would (as they have done in Medicare) predictably overwhelm regulatory efforts through crafty schemes to selectively recruit profitable, lower-cost patients, and avoid the expensively ill. Like the Medicare Advantage program, originally touted as a market-based strategy to improve Medicare’s efficiency, the HCAN plan would evolve into a multibillion dollar subsidy for private insurers whose massive financial power (amassed largely at government expense) would prove a political roadblock to terminating the failed experiment.
Unfortunately, proposals like HCAN’s that cede a central role to private insurers can only add coverage by adding costs. They promise savings from computerization and chronic disease care management. Yet the Congressional Budget Office has warned that there is little or no evidence for such savings.
The HCAN proposal forgoes most of the $350 billion annually in administrative savings possible under single payer national health insurance (NHI). Administrative waste is a natural byproduct of the private insurance firms that would retain a central role under HCAN’s plan. Private plans’ overhead is 12-fold higher than under NHI; the excess is squandered on marketing, underwriting, utilization reviewers and profits, and for the billions paid to executives.
Gee, thanks for all the ponies, HCAN.