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By Jake Blumgart
July 22, 2009
Caption : Ezra Klein rose quickly to become an expert in health care. He told Campus Progress about what’s really standing in the way of health care reform.      
Ezra Klein

Ezra Klein, Reporter at The Washington Post

(AP Photo/The Washington Post)

Ezra Klein is one of the biggest up-and-coming reporter/bloggers in the business and he’s only 25 years old. A blogger employed by the Washington Post in an era of buyouts, formerly of the American Prospect (and an erstwhile contributor to Campus Progress), he focuses on domestic policy and specializes in health care. While health care reform is being debated in Congress, his blog at the Post is the place to go for informative, analytical, and readable updates on pretty much everything you need to know, complete with graphs. Klein also offers occasional reflections on towering robots. He appears regularly on MSNBC to explain the health care debate to the cable news masses. Campus Progress recently got Klein to tell us a little about the impediments to real health care reform, related wonkery, and a bit about his own career.

The United States is one of the only countries in the wealthy, industrialized world that does not have universal health care. Why do we have such a fraught history with health care reform, and universal coverage in particular?

It’s a little hard to say. One part of the answer is race. Another part is that we don’t have a parliamentary system. We have a system that is biased toward inaction, toward keeping the majority from enacting its will. We’ve had seven presidents, some of them elected with grand majorities, who’ve wanted to do it. FDR wanted to do it; Truman wanted to; Johnson wanted to; Nixon wanted to; Carter wanted to; Clinton wanted to. In another country one of them would have succeeded. Our system is built so they don’t, so they didn’t. It’s one of the reasons I focus a lot of my energy on the structural impediments in Congress, much less on what Obama does or does not want to do. It’s what Congress does or does not want to do. That’s where it fails. It doesn’t fail because of insufficient presidential will.

You said that race was a part of the reason. Could you talk a little about that?

This is an argument in [Jill Quadagno’s] One Nation Uninsured. Its part of why our political system was so polarized, why everything got blocked—a lot of hospitals didn’t want black people in them, it’s almost as simple as that. The Southern Dixiecrats were like a whole other party. There are a couple really great books on this, so I don’t want to go too far into it, but I do think race is an important difference that affected our politics in really fundamental ways and gave us a political system geared towards obstruction.

Government funded, single payer universal health care has been declared politically dead. From what I’ve read a big part of the reason single-payer is off the table seems to be the powerful interests working against it. Is that accurate?

Industry is a major part there, God knows. But it isn’t the only part. You can’t underplay the fact that people do not want you to take away what they have. Take polling on the public plan. If you ask people, “Do you want [optional] public insurance?” They support it 72 percent. If you say, “What if that option will drive private insurers out of business and reduce your insurance choices?” Sixty percent are against. People have a very large status quo bias in terms of health care. They like the public plan because they can choose to go into it or not. They can see if it works. But they don’t want to be told “Jump!” The government gets things wrong. It fails, it happens all the time.

There is a reason single payer has failed every time it comes up on a state ballot. There is a reason legislators don’t feel real pressure to support single payer. One thing to always remember about industry is that what legislators are worried about is losing their jobs. They think industry might be able to do that by spending money against them. But there are a lot of things it can’t do. It can’t overwhelm very strong public preferences. But in this situation there isn’t a strong public preference countering industry. There is a grassroots movement for single-payer, but it isn’t that large. It is hard to do radical things like that when the public isn’t aggressively behind you.

Is there anything to the conservative arguments that universal health care in other countries is unwieldy and ineffectual, that they have terribly long lines and so on?

No, I don’t think that is a legitimate argument. There is a legitimate argument to be made that we subsidize [other countries], by paying a lot of money that funds useful innovation that they end up free-riding off of [our research]. I haven’t seen a really good estimate saying that that is the case, but it’s theoretically possible. (I don’t think it really is though.)

But the argument you describe is not legitimate. Satisfaction ratings in other countries are higher than they are here; everybody has health care insurance. We have a very bad system. If I told you that there are two stores in town and they sell the same products and one costs half as much and everybody can afford to go there, while the other costs twice as much and 50 percent of the town can’t afford to shop there, you wouldn’t say, “Well I bet the second one has some really interesting advantages.” You’d go to the other store. It’s simple. The political system, entrenched interests, status quo bias, filibuster, politics, they have a tendency to make simple things hard. They’ve made this hard. But it isn’t. It’s analytically very simple. One thing I like to say about health care is that it’s an interesting issue to be involved in because it is easy to figure out who is right and who is wrong. That doesn’t mean that’s how it will end up.

If there is one aspect of health care reform which people who may not be well-versed in wonkery should know a lot about, but probably don’t, what is it?

The importance of health insurance exchanges. It’s a little complicated and almost better to read about that on my blog. Basically, these regulated markets that, in theory, employers could buy into, individuals could buy into, would [feature] a variety of private health insurers who would be offering their products that you could compare to one another. There might be a public insurer too. It would have a lot of people in it, a very big base, a lot of efficiency as a scale, solid regulations to keep insurers from screwing you over. The hope is that over time it would prove to be more efficient and people would choose it. If it didn’t nothing would happen. But if it did it would be the bridge between the health care system we have and the one we want. It’s how you deal with status quo bias. You don’t move people, you let them move.

What advice would you give to young journalists who are trying to get to where you are?

They should start blogging in 2002. [Also,] ignore old journalists who tell you the industry is fucked, blah, blah, blah. That really sucks if you are an old journalist, but if you are 22 and you try this for three or four years and it doesn’t work, so what?

You need to blog. You need to be fluent in the technologies that are going to dominate the field. You need to make a name. The way you do that is by either being the most brilliant writer in the world, which most of us are not, or you develop some kind of mastery over an issue. You need to think about how to differentiate yourself from the pack. There are a lot of people who can write well; you have to figure out what you can do better than them.

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