Quotes From Around Yon Blogosphere

Political autopsies of the failed campaign for universal health care in the 1990s frequently focus on the activities of special interests who opposed it. Not that many people saw the infamous "Harry and Louise" ads, in which an average-looking couple sat at their dining room table worrying that the Clinton health plan would take away their choice of doctor. But the ads came to symbolize the misleading, and expensive, lobbying campaign waged by small insurance companies, the pharmaceutical industry, and other conservative groups. Perhaps no less important, it gave the opposition to universal coverage a visible and sympathetic face (or, to be more accurate, set of faces).

But it wasn't just the lobbying against the Clinton health care plan that killed it; it was also the lack of lobbying for it. Proponents of reform had hoped that like-minded interest groups would push back against the anti-reform lobbies. But the unions, famously, sat out most of the health care debate because they had spent so much time and money fighting the North American Free Trade Agreement in 1993. The AARP, meanwhile, had to hold its fire because leaks about possible Medicare cuts had spooked seniors.

This time around, progressives seem determined not to make the same mistake.

-- JONATHAN COHN

There is no question that America's health-care system is in crisis and that extends to all 50 states. But if you want to see where U.S. hospitals may find themselves sooner or later, consider the number of hospitals in New Jersey that have closed or are on life support and how Democratic politicians have put themselves in a straightjacket that is exacerbating this perilous situation.

-- ME

The Commonwealth Fund estimates that about 14 percent of the population was underinsured in 2007. That sounds about right, and it's a useful reminder that insurance isn't binary, wherein you have it or you don't. Rather, it exists on a continuum, with some folks being totally insured, some folks being half insured and half uninsured, some folks being totally uninsured but having access to emergency rooms, and so forth.

This is how American rationing actually manifests. Canada might have waiting times for non-essential treatments, but we have cost barriers to all manner of treatments. Some can't afford the care, and so they go into debt, or have to sell their home. Others can't afford the care, and so they never get it. We count that waiting time as zero rather than infinity, but that's just a bad faith numbers trick meant to make us feel better.

-- EZRA KLEIN

Some health insurer stocks fell sharply Thursday after Goldman Sachs downgraded Aetna and Health Net from neutral to "sell," stoking broader investor concern about how much and how soon profit margins will shrink in the industry's current downturn.

Health Net shares fell 12 percent in a rising market and Aetna slid 6.7 percent after Goldman Sachs analyst Matthew Borsch issued a note to clients headlined "Expecting more casualties from the underwriting cycle." The cyclical industry is deep in price competition while still dealing with rising medical costs — a recipe for a profit squeeze. Many companies have already had to lower their earnings forecasts for 2008 at least once, but Hartford-based Aetna has not done that this year.

Borsch said Aetna "cannot remain immune from the [profit] margin pressure impacting other carriers in the price-sensitive commercial risk business" — the regular fully insured health plan business.

Competition among insurers could help control the size of premium increases on employers' health plans. But workers are still likely to see their own premiums go up or their benefits go down — or both.

-- DIANE LEVICK

Sixty years ago, British health minister Aneurin Bevan officially inaugurated the National Health Service. Entirely free to patients and financed through taxes, the NHS was the first system of its kind – and its overnight success spurred similar reforms around the world. In Canada, these reforms started in the 1950s and culminated in the Canada Health Act, our own guarantee of health care based on need rather than ability to pay.

The British were ahead of us then and they are ahead of us now. In the past 10 years, the NHS has undergone a variety of reforms designed to improve the quality of health care and reduce waiting lists. Not all of these modifications have been successful, and some have been “rubbished” before the wrapping paper could be torn off. Yet, there is a growing sense that the British are doing many things right.

On the 60th anniversary of the NHS, there are a number of lessons Canada can learn from the British experience.

-- IRFAN DHALLA