Human Nature

[Belacqua]

Democrats have to fight their battles wherever the front line actually is.  Progressives would like a more favorable front line, but so would Democrats.

Wishes, fishes, something, something ...

Yes, this is certainly true. No matter what improvements we want to make to the health insurance system (or any other issue) we have to begin where we are, and work with what we have. 

Not to make a definitive judgment here, but in general I'd say that Democrats are more likely to think that they can work within the existing system. If only we can elect a few more good people, and get those terrible Republicans out of the way, then we can finally get what we want. Help us AOC, you're our only hope!

So they are more optimistic, that you can get there from here. 

I'm not sure if I'd call myself a Progressive. I don't quite know what all positions that entails. But I am less confident that incremental changes made by our current crop of Democrats will ever make much difference. As I say, Democrats get nearly as much money from the insurance industry as the Republicans do. I am skeptical that the motivation is there. 

And the tendency to see everything in a dichotomous way makes it harder to make progress. We say thank you thank you for the small gains we've been given, and re-elect the same people, and give them a pass on not working for something much better. And maybe in a generation or two they'll come up with a slightly better system.

The health care system in Japan is far better than America's. Because the health insurance is single-payer from the government, it means that the health care can be largely privatized. Except for really major procedures (e.g. heart transplants) nearly all of the health care is done at small clinics owned by the doctor in charge. Instead of having an HMO telling me which clinic I have to go to, I can walk into any clinic in the country, show my insurance card, and get seen by a doctor. Given this freedom of choice, patients vote with their feet. A doctor who is good and experienced, listens well, is judicious in his prescriptions, etc., will have his patients come back to him over and over. That way he makes more money. There is financial incentive to do a good job. There are at least ten primary care clinics in my neighborhood, and the local gossip tells me how to choose. Dr. Niita is reluctant to prescribe medicine. Dr. Kodama is really good with kids. Dr. Ito is patient with elderly people. Dr. Tsuya has all the latest machines on premises (MRIs, etc.) but he tends to stare at his computer screen the whole time he's with you and doesn't look you in the eye. 

Japan could get such a good system for a couple of reasons. First, there was some kind of Extremely Disruptive Event in the 1930s and 40s which wiped away the old system and allowed a fresh start. Second, Japan has never had the commitment to libertarianism which is often prominent in the US. A lot of Americans have thought the government should do as little as possible, even before Reagan gave the idea a big boost with his "The government is the problem" mantra. The Japanese government is willing to balance these things in order to assist and protect its economy. So where the big US car companies got in trouble paying pensions and health insurance policies, Japanese car companies are free of those burdens because the government does it. 

"If wishes were fishes, beggars would ride..." is that how it goes? Anyway, Trump has offered few specifics of what he would do. His proposal for greater price transparency seems reasonable, though whether he will work for it or not remains to be seen. 

Anyway, I don't want the argument to boil down to "because Trump is bad, we should be satisfied with whatever the Dems give us." There is huge room for improvement, and there's no reason why we can't be pushing hard for all possible changes.