Monday, March 22, 2010

A health-care reform thought

The rightward shift in crime policy and welfare policy of the mid-1990s-- basically, welfare reform plus all the Giuliani-era policing improvements-- ultimately benefited Democrats. They stopped the fearful exodus of whites from the party by undermining the two great pathologizing narratives about blacks.

I wonder whether something similar could happen with health care reform. One important source of working-class and middle-class resistance to creative destruction and freer markers over the past couple of decades has been the terror of losing health insurance along with a job, especially but not only for those whose families include someone with a preexisting condition. If a period of unemployment or self-employment lasted longer than COBRA benefits, it became very frightening regardless of savings in the bank or the profitability of the new self-employment; and any job turnover at all was very problematic for those with pre-existing conditions.

I wonder whether health care reform will take some of that fear away, and so make the prospect of turnover seem less like a potentially-mortal threat. No one's going to welcome losing their jobs! But the intensity of opposition to, say, free trade agreements might diminish.

Notice this is not a story about Republicans benefiting because of a backlash against the bill; rather, it assumes that the bill, like all entitlements, will be untouchable and will therefore fade into the background.

Update: Another, ;largely-unrelated, thought, about the relationship between the new law and the insurance industry's self-interest.

This turns the US health insurance industry into something a lot like the water, gas, phone, and electricity utilities in the US between the Progressive era and 1980. They're private and more or less guaranteed a rate of return to capital, but the terms on which they provide service is much more tightly regulated, and will approximate being universal. This is a somewhat unappealing model for lots of reasons; it manages to be pro-business and pro-capital while also being anti-innovation and anti-entrepreneurship. The moves of the late 70s and early 80s away from this model were largely desirable. But the utility model has its (so to speak) utility; it provides private capital for the industry, provides widespread coverage for consumers, and provides at least a little competition and innovation. Indeed the health insurance version will have somewhat more competition than the post-Progressive Era version, since it will lack the enforced protection of allegedly-"natural" monopolies. Insurance industries will still be in competition with each other, albeit in a more constrained way.

1 comment:

Anonymous said...

Nice point with the utilities comparison. But the advantage that you cite--the ability to access private capital--is not applicable to health insurance, a much less capital-intensive service. I see no real justification for private health insurance at all--it looks like the worst sort of PPP, with public money going to a completely useless and wasteful middle-man.

The unappealing aspects that you cite also strike me as being appealing with regard to health insurance--innovation is generally a bad thing in health insurance. (It is like innovation in finance. In the 2008 debacle, we Burkeans were finally shown to be sensible.)
And competition among insurers is not really a good either--in the big picture, it doesn't lead to efficiency, but simply leads to more administrative waste (think of how much Canadians save by not having to advertise their health insurance programme).

PS: I enjoy your blog very much.