If I Were a Nihilist…

I am disheartened and disgusted with the current state of play with the healthcare bill. They are so close, and yet the Democrats manage to confirm all the worst suspicions about their cravenness, cowardice, and incompetence. Of course, the nihilists in the Republican party are dancing with glee, as nothing makes them happier than the failure of healthcare reform.

If I were a nihilist myself, I would say – take a lesson from the Republicans. Forget good policy. Focus only on winning and scoring political points. Pass the parts of the healthcare bill that are simple to understand, universally popular, and difficult for the Republicans to oppose. In other words, restrict insurance companies from discriminating based on pre-existing conditions, denying coverage, or tying premia to health status. That would be good, right?

Wrong. On its own, it would be horrible. Without an individual mandate, the healthy would flee from the insurance market, weakening the risk pool dramatically. Costs would rise, and without subsidies, healthcare would become rapidly unaffordable to those most in need. If I were a nihilist, I would relish such an outcome, as it would fatally wound the private insurance system and edge the country closer to single-payer, a system I regard as superior on cost and equity grounds.

But I am not a nihilist. I cannot embrace this cynical position. There is a reason healthcare is complicated. There is a reason why it takes so long to put together, why it runs to thousands of pages of legislation. The Senate bill is now the last best chance for healthcare reform in this country. It is indeed the last best chance for the future of private health insurance. The status quo is untenable. The alternatives are untenable. It is for this reason that 45 leading healthcare experts (including people like Henry Aaron, David Cutler, Jonathan Gruber, and Jacob Hacker) are imploring the House to pass this legislation now, as this legislation would “provide health coverage to tens of millions of Americans, begin to control health care costs that seriously threaten our economy, and improve the quality of health care for every American”. This is not about gamesmanship or politics or point scoring, it is about people’s lives.