A RECENT DISCUSSION OF INCREMENTALISM
This discussion occurred subsequent to Don McCanne reporting and commenting on views put forth by President of Families USA Ron Pollack. You can request daily quotes from Don at firstname.lastname@example.org
This discussion began with the February 21, 2001 Wall Street Journal article, "The Have-Nots" by Rhonda L. Rundle and Shailagh Murray. Don McCanne made comments on this article and Ron Pollack commented on Don's comments (all this is in part one, this page).
Comments by Dr. Ida Hellander
These are from the PNHP (single payer) perspective.
Comments from Ramon Castellblanch
These are entitled "You can't get there from here"
That incrementalism cannot add up eventually to universal health care
On to further comments by Dr. Uwe Reinhardt
Final comments about what the US needs
with a (realistic, pessimistic?) view of the political will
needed to bring about the required change
On to discussion in one state among activists
In this state a committee has been working on legislation. They work as as a Defend Health Care committee
Regarding the collaboration between Families USA and the Health Insurance Association of America the article described conclusions from the early meetings:
It's impossible to do comprehensive reform that will cover everyone. There must be no threat to the current, employer-based system. It's best to build on successful existing programs, rather than to create new ones. There isn't enough money to cover everyone. And the low-income population should be targeted first."
Ron Pollack, Families USA president said: "If you look at the history of health reform, all the stake-holders come in with their first-choice proposal. If they don't get it, they walk away - their second choice being the status quo. It's that dynamic we want to change. We're trying to make a virtue out of second choice."
In response, Don McCanne made the following points:
Point 1 to: "It's impossible to do comprehensive reform that will cover everyone.":
A health care system that is specifically designed to include everyone does, in fact, include everyone. When you begin with that premise, it is impossible to do comprehensive reform that will NOT include everyone.
Point 2 to: "There must be no threat to the current employer-based system.":
This statement is based on the assumption that we will keep our existing
sick system intact, a system that receives a major portion of funding
through employment related health benefit packages. Analysts across the
political spectrum agree that many of the defects in our system are
related to this employment linkage of coverage. A rational health care
system design would surely exclude employment linkage.
Point 3 to: "It's best to build on successful existing programs, rather than to create new ones.":
A system that is unable to allocate effectively our abundant health care
resources can hardly be qualified as "successful." The middleman health
plan industry that has created an intrusive, private bureaucracy,
characterized by egregious administrative waste, stands as an example of
an UNSUCCESSFUL approach to health care management. The structural
design of our system should assure that there will be a very high
probability of success in delivering health care to everyone.
Point 4 to: "There isn't enough money to cover everyone.":
14% of our GDP, far more than any other nation devotes to health care, isn't enough? What is enough? 20%? 30%? 85%? We have excess capacity in our system now. The marginal costs of adding care for those that are left out are almost negligible. There IS enough money now, and more could be added if we decided that we wanted to shift funds from other sectors of our economy.
Point 5 to: "And the low-income population should be targeted first.":
Comprehensive reform should target everyone. Selecting out the low-income population as a separate target will always result in a lower level tier of care for this segment. Designing a comprehensive system that is best for each of us will be the only way that we can assure adequate access and coverage for low income individuals.
Overall: According to Mr. Pollack, all of the stake-holders walk away if they don't get their first choice, and so we need to make a virtue out of second choice. But there is only one stake-holder that counts, and that is the patient. The only ethical mission of all other stake-holders is to serve the health care needs of the patient as effectively as possible. That may result in second choices for the other stakeholders, but that is a compromise that we must make in order to have first choice for the patients. A structural design that promotes this mission should be our common goal. We need to put back on the table the one reform that would lay the foundation for a system that places the patient first, and that is to establish a publicly administered, universal risk pool.
Mr. Pollack responded to Don's quote and comments:
Those of us who toil in the incremental vineyard do not disparage, or even forget to laud, the necessary goal of universal coverage. We do, however, view the much-needed goal as one that is only likely, in the foreseeable future, to be achieved on a step-by-step basis. Thus, the criteria we articulate focus on how to analyze what should happen next in the step-by-step approach, and our strategic judgment is that we must not overreach (at the peril of yet another, empty-handed failure).
One other perspective needs to be emphasized. Movements are generally built on successes, not failures. To the extent that we continually overreach and end up empty-handed, we discourage people from joining our movement; successes, on the hand, build confidence and give people a sense that their work is not in vain. Those of us who are building our efforts accordingly should not be the source of ire from those who are less involved in incremental improvements. We all want to keep the flame burning for universal coverage.