Ellen Shaffer concludes this series:
Recent exchanges have raised important issues regarding how to assess, analyze and address the public's views on health care reform, as well as what might change the equation. It would be great to have a forum that does not overload The Quote of the Day list where these ideas could be pursued. As it is, we can all refer to cited publications, and look forward to promised new ones.
Uwe raised some questions with you all about me, and about my remarks regarding his comments. I have written a detailed note to him, responding to the questions he asked. I don't believe that passing along my new round of comments publicly would clarify much that wasn't clear in my first message, or that others have not subsequently said better. I stand by every word I wrote, and the purpose for which I wrote it. I've sent Don a copy of my message to Uwe, and would be happy to have him pass it along to any of you who are interested, and to hear back from you if you want. A short summary of the point I consider most important follows:
A central concern remains with the policy implications of identifying and addressing in isolation the role of widespread insurance in insulating the public from the brunt of the problem, and undermining activism. It is true that most Americans are healthy, most are insured. This makes the fight for universal coverage in some ways a fight to win over the majority in support of the minority; or, in a different light, to forge an understanding of common concerns about the health care system shared by insured and uninsured alike. This is not impossible, but poses particular challenges. Many economists with powerful supporters use exactly this argument, however, to actively propound as a solution inflicting greater economic hardship on individuals, by making them pay more for health care. To borrow from an earlier writer, there is not a 1:1 relationship between intensifying economic hardship, and activating political resistance. Many people, when confronted with high health care charges, either pay the bill if they can, or go without if they can't. It is gratifying to know that Uwe does not support, for example, defined contributions. Hopefully others who read this list will also be suspect of these sorts of proposals.
Note 1: As mentioned above, Dr. Shaffer sent a detailed message to Dr. Reinhardt, responding to his comments. If you would like to read her response, we can send you a copy. Merely respond to this message with your request.
Note 2: We greatly appreciate the contributions to this discussion, and the responses indicate that this view is widely shared. Our greatest regret is that we were unable to distribute many other excellent responses since that would have violated our self-imposed rule to avoid contributing to information overload for the very busy members of this list. We had considered an open chat room, but we decided that most of you could not participate because of your schedules, not to mention that the open discussions tend to be inundated with non-productive messages from extremists. We will continue to post a limited number of your messages that we believe would be of interest to the members of this list.
Our profound thanks to all of those that have contributed,
Don