Health Insurance (Editorial)
I spent Sunday reading T.R. Reid's "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care". It's very, very good. I'll probably base a couple of posts on it. For now, however, I want to point out something he says about the successful efforts in Sweden and Taiwan to overcome the political opposition and rebuild their patchwork health care sector's into national health-care systems:
Both countries decided that society has an ethical obligation -- as a matter of justice, of fairness, of solidarity -- to assure everybody has access to medical care when it's needed. The advocates of reform in both countries clarified and emphasized that moral issue much more than the nuts and bolts of the proposed reform plans. As a result, the national debate was waged around ideals like "equal treatment for everybody," "we're all in this together," and "fundamental rights" rather than on the commercial implications for the health care industry.
Elsewhere, Reid quotes Princeton health economist Uwe Reinhardt saying that "the opponents of universal health insurance cloak their sentiments in actuarial technicalities or in the mellifluous language of the standard economic theory of markets, thereby avoiding a debate on ideology that truly might engage the American public."
This year, however, it's not just been the opponents of the policy who have relied on the "mellifluous language of the standard economic theory of markets." It's been the advocates of reform. Ask yourself what the administration's one-line goal is on health-care reform. Is it "equal treatment for everybody?" Is it "if every American is guaranteed a lawyer, why not a doctor?" Is it even "guaranteed health care for everyone?"
No. It's "bend the curve." And the problem with "bending the curve" is that it's a broadly testable proposition. This is, in part, why the Congressional Budget Office's skeptical assessments pose such a threat to health-care reform. If the White House's primary objective was health care for every American, or guaranteed care that you could keep even if you lost your job, or choice of insurance plans for every American, you could spend a bit more on health care and say you were achieving your goal. But if you say that the point of health-care reform is to save money, and then the outfit charged with estimating such things says it won't, that strikes at the heart of the project.
The economic case for health-care reform requires a really radical version of reform. Single-payer, say, or the Wyden-Bennett Healthy Americans Act. The consensus Democratic health-care plan -- the basic approach that the Obama campaign committed itself to and that Democrats in Congress are pushing -- is primarily a coverage plan. It has some cost-saving features on the margins, but it's primarily a way of getting to universal coverage. You can argue for that plan in primarily moral terms, with some economic arguments around the margins. But the administration has been pushing it in primarily economic terms, with some moral arguments around the margins. And now they're caught in that dissonance.
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