James Morone on MPR's Midday

I caught most of Gary Eichten's Midday program on MPR Thursday. His guest was a political science professor named James Morone (Brown University), who's studied the political processes that led to all the health reforms in the U.S. over the last 100 years or so.

Morone was fun to listen to, and came up with one insight after another into the current situation:

• We're in an unsustainable and increasingly unstable predicament, with an additional percent of our GDP going to health care every four years, yet we have 30 million uninsured, 40 million precariously insured, and 18,000 people dying each year because of coverage problems (like Nora Longley, whom I wrote about a few days ago). Employers are beginning to drop their insurance because they can't afford it, and if enough of them do that the system we have now -- such as it is -- would collapse. "There would be an incredible crisis when well-to-do, well-jobbed people lose their health insurance."
  
• The important thing is to get something passed, because almost anything is better than nothing. Every partial plan that's been passed in the past (Medicare, Medicaid, S-CHIP) is very popular once it's implemented. "Get the benefits out there first, then follow with cost control." And people have to mobilize as a movement to make that happen, because the health insurance industry is a powerful lobby. Only calls, faxes, and emails from constituents can outweigh the lobbyists' money.
  
• Presidential leadership is key, and it has to be done quickly after the election or the mandate is lost. LBJ passed Medicare during a window when he could use his popularity to frighten legislators. (Don't miss the story of how LBJ maneuvered Wilbur Mills into backing Medicare.)
  
• Don't call single payer by that name -- call it Medicare For Everyone. Morone told an amusing anecdote about a University of Minnesota researcher who visited a 600-bed hospital in Canada and asked if he could take their billing department to lunch. He had a nice discussion with the three or four staff members. Then he made the same request at an equivalent-size hospital in Minneapolis, and they said, "Which ones do you want to talk to?" Because there were 125 staff members in the billing department, all chasing down payments from various insurance companies and individuals.
• But single payer will never make it through Washington as things are now, for a number of reasons that Morone explained. So passing mandatory employer coverage with an additional public option is way better than nothing, and over time might lead to single payer. The question is, "Does it move us in the right direction? From what I've seen with the bills in Congress, the answer is yes."
• Finally, Morone said that if some type of reform doesn't get passed or very firmly agreed upon before the August recess, it won't happen. When Congress comes back, they'll begin focusing on the 2010 midterm elections, and then health care reform will seem to dangerous.

I came away from the show determined to call my representative and senators, even though I know they already pretty much agree.

I have the same feeling of anxious hopefulness I had before the election last fall, as if we've reached a momentous occasion in history -- or maybe as if we're living in a house right over a fault line. Like James Morone said, doing nothing could easily lead to a total collapse of the system, in which case it might be an opportunity to build a new house from the foundation up -- if we survive the walls caving in on us in the first place.