I’m like most Americans:  I have employer paid health care with pretty decent coverage and better than average care.  I belong to a doctor run HMO.  I like my primary care doctor who shares my philosophy that less can be more when it comes to drugs, but she makes sure that I get all the necessary tests amd tracks the results which I can see online.  But the cost of my coverage keeps going up and what I contribute to the cost will be a big part of our next union negotiations.

So this whole debate about reform boils down to two things for me.  First, can care be provided more efficiently and at less cost for everyone.  Two, we need to solve the question of the uninsured because we all pay when they use the emergency room for care. 

I live in Massachusetts and we have made a stab at universal coverage which is now under a great deal of pressure given the fiscal situation for the state.  But one thing I have observed is that without national reform on things like Medicare and Medicaid, states will have trouble balancing coverage with cost.  Somehow we have to control costs and improve quality.  I posted about this in my piece on Health Care as a Subprime Mortgage.

So here are a couple of other things to consider.  Nate Silver  did an analysis of where the largest concentrations of uninsured are living. 

Throughout last year, Gallup included a module on health and well being in their standard tracking surveys. This meant they had tens of thousands of interviews between all 435 Congressional Districts. One of the questions on the well-being module was about whether or not people had health insurance. Eric Nielsen at Gallup was kind enough, a while back, to send me these results broken down by Congressional District.

The median Congressional District has an uninsured population of 14.6 percent, according to Gallup’s data (the average is slightly higher at 15.5 percent). Of the 48 McCainocrat districts, 31 (roughly two-thirds) have an above-median number of uninsured. A complete list follows below (actual Blue Dogs are denoted in … you guessed it … blue):

 

So why are the blue dog Democrats so unwilling to vote for reform? 

 The second thing to consider is the Dennis Kucinich amendment.  Joshua Holland writes on Alternet

No time today for a lengthy analysis of the Tri-Committee health bill. My quick-and-dirty take is this. Those who think the bill is a wonderful progressive victory with a robust public option are wrong, and, on the flip side, the charge that it’s a “bailout for the insurance industry” is totally divorced from what the bill would actually do if passed.

 It is the most progressive, comprehensive and significant health care legislation to come down the pike since Medicare was passed in 1965. If it were enacted as written, it’d go a long way to solving a lot of our problems (but by no means all) and wouldn’t break the bank in the process.

 But it also fails some of the basic criteria that most progressives have long said is a red-line that can’t be crossed. First and foremost, it doesn’t have a public option that can compete with private insurers and result in significant cost savings. 

Enter the Kucinich Amendment,

Obviously, a public insurance plan for which 10 million are eligible to enroll isn’t going to serve as an example of the efficiency that comes with a single-payer type system. And the fact that they designed a pretty good public option for which most of the public will be ineligible to enroll (and that wouldn’t have as much potential for cost savings as one would hope) was enough to make me consider opposing it. Howard Dean told me recently that he thought a bill without a robust public option wasn’t worth passing, and I agree.

 And that’s where Kucinich, a supporter of single-payer, comes in. He’s trying to save the whole promise of this project.

 On Friday, an amendment he authored was added to the House bill that allows states to create their own single-payer systems instead of adopting the federally-run exchange system. The original bill allowed states only to enact their own exchange system — it was a nod to federalism — with the proviso that if a state (think a deep red one in the South) refused to adopt the plan, the feds could step in and set it up.

 The Kucinich amendment is really key. If it were to survive the legislative sausage-making and be enacted into law, the we might expect a progressive state to take advantage of the opportunity and enact a single-payer system in the coming years. And, if those of us who have been pushing such an arrangement are correct, the result will be greater access and better outcomes at a lower price tag for that state’s residents. 

Health care reform is going to cost us, but I think doing nothing will cost more in the long run.  I am looking forward to President Obama’s Wednesday press conference where this will probably be topic A.  Stay ‘tooned.