The Importance of Being Insured

Freddie deBoer writes:

Personally, I think denying people adequate health care coverage because of their economic condition or employment status is a practical and ethical failure equal to Jim Crow or similar regimes of racial inequality. Now you can know me by my extremism. And so the meticulously curated pose of believing in a theoretical regime of universal health care while opposing all real reform seems to me to be dishonest and worse.

There have been no real efforts at reform emanating from the right. The closest thing was the Wyden/Bennett bill to which Bob Bennett hung his name and and for which he subsequently lost his long-held senate seat. That, in any case, was the brainchild of Ron Wyden, a real champion of the healthcare debates. I’m glad several Republicans were willing to sign on to it, even if they did so knowing it would never pass. Certainly no Republicans would now.

Dave Weigel reported recently on a new bill Senators John Barasso and Lindsey Graham have introduced in the Senate, The State Health Care Choice Act, which essentially allows states to opt out of the new healthcare law. It’s important to note that Senator Wyden already had something like this included in the original law (indeed, under Wyden’s amendment states can easily set up their own plans even without individual mandates, which sort of takes the wind out of the sails of all these lawsuits if you ask me…). The difference between his and Barasso/Graham’s legislation is that Wyden allowed opting out if states were able to meet or beat federal criteria. The Republican version is simply an opt-out, no strings attached.

Weigel reports Graham saying, “You didn’t listen to us when we had ideas.” Right. Republicans had control of the government until 2006, and of the White House until 2008. No healthcare reform bill full of Republican ideas was forthcoming – only the hugely expensive senior-citizen bribe known as Medicare Part D. Perhaps Graham means we didn’t listen to all the Republican ideas on how to obstruct healthcare reform.

More importantly, the State Health Care Choice Act is not intended as a way to expand or improve coverage in any way, but rather a “third front” against the new healthcare law. This is not surprising. So far the only policy prescriptions for healthcare reform coming from the right have been entirely based on free markets, something even Hayek recognized was not exactly a plausible solution to health coverage. There’s no doubt that some free market mechanisms could help improve healthcare efficiency, access, etc. The employer-based coverage system we have in place now is widely agreed to be a monumental mistake, and letting individuals choose their own insurance would be a step up from where we are today. Getting rid of regional monopolies in favor of national competitors would increase the size of risk pools and drive costs down, while still allowing for consumer choice. But this won’t magically lead to those with pre-existing conditions finding adequate, affordable healthcare (if they can get any to begin with). This still leaves the poor and the old-but-not-old-enough-for-Medicare crowd uninsured.

I don’t like some parts of the Affordable Care Act. I don’t like the fact that it’s a huge handout to corporate insurers for one thing. But it creates a system that is more fair than the status quo. It helps insure millions of Americans. It raises the level of eligibility for Medicaid which in turn helps the poorest among us. It creates standards for health insurance that are reasonable and uniform. These are achievements on their own merits.

Here’s Freddie again:

When does intellectual seriousness compel people to present a real, actionable, and plausible plan that covers the uninsured, or else abandon the pretense that they want them covered? We have been debating health care reform that is like Obamacare since well before the ’08 election. We’ve been debating the actual legislation for years now. So: when does it become incumbent on those opposed to PPACA to present a viable alternative or else abandon the pretense that they want coverage for the uninsured at all? Is there a specific date when I should expect a viable, realistic plan to emerge from the Republican leadership, one that actually could be passed as the “replace” part of repeal and replace? Is the time horizon literally endless? Ross Douthat, to pick just one, has written for ages about endorsing a conservative alternative to Obamacare. How long is he willing to wait? When can we fairly call him on it if such an alternative isn’t forthcoming?

Me, personally, well. I think what is taken for libertarian or conservative economic policy is flatly incompatible with the goal of covering all people. The “free market,” as conventionally defined, can’t provide adequate, affordable coverage to the sick or the old or the infirm. I’m happy to be proven wrong, though. So ante up. Show me your version. I don’t love Obamacare. I think it’s a weak, insufficient compromise. But I had to set aside my dissatisfaction in order to support a qualified improvement. I think others can do the same.

I agree. The usefulness of the market critique ends when you start talking universal coverage. It can be a good way to think about improving efficiencies, controlling costs, fixing anti-competitive practices, etc. but when it comes to actually achieving full coverage of every American citizen, the free market isn’t helpful at all. The very nature of markets is to pick winners and losers. This is a very good way to allocate resources, to gauge a shift in consumption trends and organically shift the labor force and capital into new industries. Indeed, it works quite well for selective health procedures like plastic surgery or laser-surgery for vision. These have actually become cheaper over time. But they are selective. Markets will never be the answer for necessary or unexpected health services.

When ideology becomes so important that people no longer realize the limits of their own ideas, good ideas are drowned in favor of purity, the perfect becomes the enemy of the good, the abstract becomes the enemy of the tangible. The ACA may be weak tea – Wyden/Bennett would have been better, single-payer would have been better, both would have been cheaper and more effective – but the ACA is certainly a step up from the status quo. Anyone with a pre-existing condition could tell you that.