Who cares about another do-gooder health insurance plan from tax-and-spend Democrats?

Especially for the general election, when Republicans are going to roll out their “socialism, government bureaucracy, high taxes” artillery against the Democrats’ healthcare proposal, Democrats need to be realizing that they still must make the case to independents in particular that it’s time for a national health insurance program. Every rhetorical skill to attack it, to say the present system is fine if we just give some tax breaks, that your health insurance is fine, that it’s the best medical system in the world, that you don’t want to wait in long lines, will be brought to bear. I can virtually see the “Henry and Lucille” ads right now. More or less could write ‘em myself.

So far, the “issues” statements on Clinton’s and Obama’s web sites basically assume voters are with us, and assume they want what we are offering. That could be right, but I wouldn’t trust any poll on that if it suggests the importance of selling the need for a national health insurance solution has lessened.

What are the objectives? It’s not just covering the 47 million who don’t have health insurance now – the do-gooder part, mostly for the poor, which ought to be good enough in more decent times but has been diminished by the ravages of rampant Reaganism. It's also the 300 million who could lose it tomorrow with a pink slip and need to know that they never again will have to worry about losing their life savings from a health problem that could strike any of us. That means you, buster, and I mean you, and I don’t care if you make $150 grand a year. It’s giving our companies a chance to compete better in the world economy by lifting much of the health insurance burden – and especially the most unpredictable and open-ended costs -- off of them, and back where it belongs, on all of us who can pool our risks together through our government. It’s also giving those companies the chance to hire full-time employees again because their benefits costs are not so unpredictable and open-ended. Not having a national program is a huge drag on our country: on our society in general, but also specifically on our economy.

In the world of advertising, you always promote the benefits more than the features. The candidates have to show the public that they “get it” – and it’s something the whole public has an interest in, not just Democrats or progressives. Our Democratic consultants and agencies don’t always seem to get that. As with Kerry, they still think if you come and say, “I’ve got a plan,” you’ve done the job.

But if we remind them, the American people will instinctively “get” how simply rationalizing the system will result in enormous reduction in national healthcare costs. Candidates haven’t been very specific about this, imagining that maybe it’s some combination of specific-cost control measures like boards of this-and-that for equipment utilization and preventing alleged over-treatment, and some vague "reduction in administrative expenses” with some paperwork improvements partly due to having a national program.

But just consider these very specific cost benefits from a rational, universal health insurance system:

• Eliminating the hugely expensive manpower machinery needed to search for and deny coverage for pre-existing conditions. The interminable wrangling, the lawsuits, the horrible publicity. How many tens of billions are wasted on those efforts?
• Eliminating the costly decision by healthcare providers whether or not to treat an uninsured person. The angry discussions among staff, the news reports, the public relations disasters, the public disgust and loss of good will.
• Eliminating the useless administrative expense of coordinating overlapping benefits if the Federal insurance lays on top of any private insurance. The finger-pointing that drives everyone bananas.
• Reducing the huge debt collection machinery that healthcare providers have to pay for if the national insurance guarantees payment to the healthcare providers. Less frustrating wrangling, the bills that say “Don’t Pay This” (until you hear from us later), but get paid by mistake (and returned) anyway, the bills you still keep getting over and over two years later from a collection agency that won't listen to you, even though it actually was paid long, long ago.
• Reducing compounding stated financing costs for health care bills being unpaid for several months even when there is ample insurance but responsibilities need to be doled out. Let’s see 18% on top of 18% on umpteen trillion dollars, pretty soon you’re talking real money.
• Reducing the costs for uncertain collection of bills that is almost certainly built into healthcare pricing as a form of double-counting in addition to declared finance charges for late payment. “We better build a 20% fudge-factor in there anyway, because the 18% won’t be collectible either.”

One of the things we forget is how much a rational health insurance system will make everything easier for healthcare providers. They deserve to be paid in a timely manner, but even if they didn’t, that’s a big part of the picture that must be filled in for getting a new system in place.

My suspicion, though, is that careful analysis would show that eliminating or vastly reducing those huge administrative costs simply through a rational insurance system will be the biggest single contribution to cost control possible.

It’s the insurance, stupid. After that, lots of things will fall into place.