Friday, June 29, 2012

On the Affordable Health Care Act

John Robert Behrman is an economist, retired, and was formerly State Democratic Executive Committeeman for SD-13, including the Texas Medical Center.

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The Supreme Court, including Chief Justice Roberts, has stepped back from the brink by not gutting the Affordable Care Act (Obamacare). I guess I should be happy.

But the still conservative majority on this court may have simply recognized that they risked more public support for the President and a move closer to a single-payer system with another radical, split decision. The court majority still have the complexity and unpopularity of the new law working for them. They know that Washington concession-tenders cannot make a relatively simple disability insurance program work for Iraq and Afghanistan veterans.

Democrats at every echelon of government (other than the Supreme Court) have to make this aw work despite (a) its constitutional near-death experience, (b) the very nature of health insurance policy sales racketeers they partnered with, and (c) the actual complexity, from state to state, of our motley institutions of public health and medical care. That is what we have: public health and medical care. “Healthcare” is oxymoronic lobby-jargon. The fact that our party’s national policy elite -- bundlers and consultants -- believe in “healthcare”, the “Latino vote”, the Easter Bunny, and so on portends how hard this will be and how perilous the present situation still is.

Here’s a suggestion:

Oregon and Washington State should opt out of Obamacare, as the president has invited them to do. They can create a system of public health and medical care that is fiscally and actuarially sound. Moreover, this would support them in worldwide competition for jobs and capital for the region: Seattle, Portland, and Tacoma. These two states would even have four senators in Washington, D.C., one of whom, Ron Wyden, actually knows what he is talking about in these matters.

So Oregon and Washington should be proud and can lead the nation.

As a legacy of WWII shipbuilding, aircraft factories, and nuclear ordnance, these two states have comparatively strong institutions of public health and medical care, including Kaiser-Permanente and Group Health of Puget Sound health maintenance organizations, as well as very reputable medical schools. These are embedded in other healthy industrial and commercial institutions. Moreover, public health authorities in these states have to deal with two of the most hazardous occupations in America: fishing and logging. In sum, Oregon and Washington are comparatively proficient in public health and medical care. Their patriotic, liberal, and scientific institutions are not unduly burdened by legacies of “scientific racism”, although they may have been somewhat tainted before and during WWII by anti-immigration bias and eugenics.

In short, these two states have the economic and technical scope and scale –- also every political and economic incentive –- to do a fine job of national health insurance built on other wholesome civic and professional institutions they have. This is something our federal, not our national, system of politics and government can accomplish in a highly regionalized global economy.

Moreover, the success of Oregon and Washington should be a signal to Texas Democrats. We could be the national leader in combining energy, industrial, and environmental policy as soon as 2014. We were once before, “back in the day”. We could swap some tips: Oregon and Washington are not leaders in combining energy, industrial, and environmental policy, quite the contrary.

In the midst or aftermath of huge wars, progressive policy has been dumped by a prestigious, victorious government in Washington on small or backwards states. Lyndon B. Johnson could even play Otto von Bismarck, and did so, by creating Medicare, barely and just before losing the war in Vietnam. However, even though “Obama got Osama”, the old flood-down paradigms of “Military Keynesianism” and post-war progressivism will not work for our beleaguered President or utterly marginalized state party today.

We have to try something new, even if it is actually old.

This post is dedicated to the memory of my childhood friend, the late Cicele Bostrom. Raised in Houston and Gonzales, Texas, she became President of Group Health of Puget Sound and a distinguished member of the Washington State Board of Medical Licensure. The flow of labor, capital, and culture between US states and our overseas trade partners that she epitomized is more progressive than the trickle-down of pork and patronage from state or national capitals.

Our so-called conservatives don’t know that and the so-called liberals have forgotten it.

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