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Some sage words from Kevin Drum:

Let me be clear: I don’t underestimate the political difficulty of getting universal healthcare enacted. I don’t underestimate how long it will take. But if there’s anything the Democratic Party ought to be united on, it’s the principle of loudly and enthusiastically endorsing universal healthcare as a goal.

So how about it, blogosphere? It’s great that we endorse good candidates and help get them funding, but how about also making a difference in the policy arena and insisting that candidates publicly endorse universal healthcare if they want our help in the future? After all, not only is it a big, meaty, progressive goal, but it’s one that we all agree on, not one that we fight over. We don’t have to pick any particular plan, and we shouldn’t expect anyone to commit electoral suicide over it. But we should at least insist that anyone who wants our help has to support simple, genuine, full-blown universal healthcare as a goal — and that they do it publicly. That’s how Grover Norquist turned the Republican Party into the "Tax Cuts Forever" Party, and it worked pretty well.

The reason that universal healthcare has failed in the past has been fear: fear of rationing, fear of lines, fear of bureaucracy. To win, we have to overcome that fear, and that’s a public opinion campaign that will take years. The blogosphere can help by writing about what national healthcare systems in other countries are really like, and we can also help by insisting that candidates who want our support get on board the bandwagon. How about it?

And Matt Yglesias chimes in, with the case against incrementalism, stated clearly as I’ve seen:

The big-picture objection to using private insurance as a method of achieving universal health care is this. What insurance companies do, in all walks of life, is risk assessment. They either exclude bad risks from the risk pool, or else price the insurance for risky cases at a sufficiently high level so as to render the risks good ones. The idea of universal health care, meanwhile, is that there is some minimal level of health care everyone should get irrespective of their personal characteristics. This goal is inimical to the basic insurance company function of risk-assessment. For that reason, UHC schemes that involve private health insurance all involve a series of mechanisms designed to prevent insurance companies from engaging in the risk-screening that is the basic function of an insurance company. Depending on the specifics of the plan, the proposed regulations may be more-or-less successful at achieving that goal. But insofar as the goal is achieved, the private insurance firms aren’t performing a real function since risk assessment is the only function they could be performing. If you’re not going to allow individual assessment of risk, your best bet is to simply get as big a risk pool as possible — i.e., have everyone in the same, government run insurance plan.

My gut tells me that universal health care will have to be a national plan, too. That’s not to put down the work of the legislature in Massachusetts to come up with a mandates-plus-subsidy plan that gets people on the rolls of the insured. Unless I’m missing something, it’s not going to be the sort of plan that ensures efficiency or controls health care costs, but it’s positive as a stopgap measure. (We’ll see how the mandates work out in practice.) But once you start talking about universal health care, state-based programs will face the same problems of private insurers: how to exclude high utilizers and high risks from the pool. It’s not farfetched to imagine terminally ill people moving to UHC states unless some mechanism prevents that.

I’m still not sure what I think of the state health care referendum on the docket, by the way. My initial reservations: 1) I don’t like the idea of policy legislation through ballot initiative - I really don’t want us to continue down the California path; and 2) it continues a Copernican policy approach (the complex rules required to make private insurance and private health provision meet the goal of universal coverage) when a Kepler revolution is needed. Would this plan lock us into a private-insurance system instead of moving us incrementally along? I realize the status quo’s not exactly a rosy picture, and that the compromise bill that just passed in the Legislature has gotten critiques from various quarters for not being sufficient. Your thoughts?