Gameplan: HOW to move the USA to Universal Healthcare

One of the areas modern Liberals and Progressives seem to be lacking in, is what I will call Game Planning. Almost all Liberals and the vast majority of Democrats back Universal Healthcare, but since 1993 we haven’t had a Gameplan on how to get there. I decided to pick the issue of Healthcare to illustrate Gameplanning for two reasons: one it’s a core Democratic issue and goal, and secondly it’s an issue where Democrats have show surprisingly little movement in addressing recently.

To illustrate how game planning works first lets look at the three methods of advancing policy. The first is sweeping change, FDR with Social Security, Johnson with Medicare/Medicaid, or Regan with Tax Reform. Unfortunately this type of reform requires not just for the public to view the situation as a crisis, but for them to see the issue as a personal crisis. This is why Clinton Healthcare reform failed, it’s also why Bush Social Security privatization scheme failed. People view both issues as in crisis but a MAJORITY of Americans haven’t personally been SEVERELY affected by the underlying issue.

The second approach is what I will call "incrementilism". This is the world of Centrist and Moderates. This approach attempt to pass small symbolic laws in the hopes it galvanizes the public to address the larger issue. In the wake of the fore mentioned of Clinton’s Healthcare and Bushes Social Security scheme a number of Blue Ribbon committees and small legal changes were enacted. Unfortunately most of these seem more intended to pacify the base, as if in order to say " look at me base voter, I still am working on the issue".

But the third method is what I will call Gameplanning. It involves advocating the passage of a number of "independent" bills. Each of these bills are capable of standing on it’s own merits. Each law unlike in incrementilism is actually hailed as "landmark" legislation by the public at large. None individually would rise to the level of a "major" overhaul, but if all are passed they would cement concrete change.

Conservatives have been attempting this strategy on public education. Pushing home schooling laws, vouchers, public "assistance" to religious schools, all laws pushed on their individual merits, but which are tied to there greater goal of dismantling the public education structure as we know it. Modern conservatism sees the government as a means to redistribute wealth from the public sphere to the corporate sphere. Conservative see the government as a funding source that can compel the raising of tax revenue which would then be paid to private companies. With this as their endgame we can better their strategy on Halliburton running Iraq, outsourcing IRS tax collections, to privatizing Public Education.

So how would Liberal Gameplanning work? The closest modern example was the "Reform Ohio Ballet Initiative" that attempted to change the way government worked in Ohio (redistricting reform, election monitoring reform) by passing four ballet initiatives. But by attempting to pass the four laws simultaneously it allowed opponent of the initiative to gang up together to defeat them. Arnold recently learned the folly of this strategy in California. Dividing Clinton’s Health care law into four bills would have resulted in a similar defeat. Allowing stakeholders of a system who oppose "reform" but who by themselves constitute a minority to unite in a coalition always spells defeat. They way to push reform is to isolate recalcitrant groups.

So again how would liberal Gameplanning work on Health care? This is how I would promote it.

1) Instead of pushing for the Federal Government to negotiate Federal Medicare drug prices under the new law, push for allowing individual states to negotiate for Medicare recipients in their respective states.

This would defuse the "Socialized Medicine scare crowd", because the counter argument "let’s trust local governments to solve their problems" resonates with a broad swath of the American public. Instead of a large single payer/negotiator that Americans see as lurking bureaucracy, 50 smaller more responsive payers would emerge. Offering states the right to "opt in" or chose whether they want to negotiate on behalf of their Medicare patients would be a "killer application" galvanizing voters in the States to vote in local pro-negotiation progressives. Allowing States to pool their Medicaid, state workers, and Medicare recipients would create a large enough negotiation body to hold down medical cost.

2) A Fannie May Style ( HFA) Re-insurer for Health Care

FHA mortgages allow millions of people to obtain home loans by having Fannie-May (a government-sponsored enterprise) buy mortgages from banks and repackaging them as bonds. I propose four government sponsored re-insurer that buy private health-insurance policies and repackages them as tax free-bonds ( limit the four combined to 50% of the market). Corporations get lower cost for their employees by spreading risk over large groups. Government re-insurers would allow individual policies to be written at low cost by combining them and spreading the risk. By having this done by a GSE you deflect critics who say this is a "government take over". Private insurers stay in business, and would support this just like bank’s support Fannie-May. Currently half of all mortgages are HFA’s, and 80% of all student loans are Sally-May’ People are comfortable with this system and wont react to them as they would a single-payer system. This allows the uninsured to buy private insurance at the same rate as large companies.
Millions of the uninsured who currently can’t afford private insurance would be able to do so. This would allow us to market a communal approach to Healthcare are a free market one. It would force Republicans who attack this program to answer the question ""Are you also against Fannie-May?" Not reinventing the wheel is always a wise political strategy.

3) Saving money through mandating an organ donation marker on all Health Care Cards.

A low cost means of saving Health Care money would be to implement a "Willing to be an Organ Donor " form and a corresponding organ donor marker on all Health Care Cards. According to research conducted by Mark Schnitzler, Ph.D., assistant professor of health administration at Washington University School of Medicine in St. Louis, and his colleague, Arthur Matas, M.D. "For the recipient of a living, unrelated donor kidney transplant, the estimated medical expense for 20 years following transplant is $277,600. The expected medical cost for a dialysis patient for that long is $372,179. The difference is $94,579. "
Using Dr. Schnitzler’s numbers, for every one additional increase in the supply of a kidney donor United Sates Health Care providers could save $94,579.00. Because one expiring patient can potential donate several organs, the real world cost savings for each additional donor would be much higher.

In order to capture these cost saving I propose the following course of action
At the time of a new signing or yearly renewal of all Health Care Policies they should include a "Request to be an organ donor form". The filling out of the form would be mandatory. The decision of weather or not to be an organ donor would of course be left to our customers themselves. The form would merely be prompting them to think about becoming an organ donor.

A small inconspicuous sticker or marking could be added to all Health Care Cards. This would signify that the patient is a potential organ donor. The cost to place this marking on all cards would be negligible. By increasing the number of willing donors the potential health care saving would be enormous. Shortening the time our customers who are awaiting donation are on the list would decrease costs for our company and our customers.

Publicizes this decision to all pertinent national organ donor association. This would shine a positive light on the program beyond the cost benefits to the company. I would also advise doing community out reach to religious groups who are opposed to their members receiving organ donation ( many Orthodox Jews are opposed to donation on religious grounds) in order to properly word the donation forms correctly. By co-opting them into the process it would elevate any fears or misconceptions.

Keep all donor information in a company database for any customers who feel uncomfortable with a visible marker on their card. I would attempt to co-opt privacy experts in this area to alleviate concerns by the public on a company keeping records of any organ donors.

Every movement needs a "common" sense feel good bill. This would be an example of one these common sense approaches. Millions of Americans are faced with the donation crisis, winning the support of this group with a low cost method would pay huge dividends. The fact that this group cuts across all racial, regional, ethnic, income, and religious groups makes it a huge winner.

Gameplanning in this way would be they way I would advice progressives to "sell" Universal Health Care. Each bill can stand on it’s own, but they all fit a larger narrative and policy goal. If they all passed they would constitute a serious reform of Healthcare, and bring us closer to the day all American have access to Healthcare. They also constitute a realistic chance of passing in our current political environment unlike Single Payer Health care which I am afraid doesn’t have the support of a majority of American at this time.