Framing Health Care Reform
posted by Michael Kang
Washington is giving national health care reform its most serious attention since 1994, when the Clintons’ Health Security Act went down in flames. Gordon Smith highlights a salient political consideration in the political debate over the years—high levels of personal satisfaction with one’s own doctors and other providers. There’s no question that Gordon is right that a major obstacle to reform has been that “[p]eople in the middle class tend to be more or less satisfied with their own health care.” From my research on public opinion about health care reform, I can vouch that the public has reported satisfaction with surprising consistency over the years about their personal health care. Surveys over the last thirty years through today find that roughly four out of five Americans are satisfied with the quality of their medical care. Given that the middle class has been reasonably happy with many aspects of their health care, it has a lot to lose, and as Gordon summarizes from his personal perspective, “reformers have not made a case that health care reform will do anything other than make my life worse.”
A problem for Obama and Democrats in favor of health care reform is that Gordon’s view is not only winning out right now, but it assumes away one of the strongest arguments for reform of some form—that health care costs are increasing at unsustainable rates. In other words, part of the pro-reform response ought to be that doing nothing is also likely to make Gordon’s life worse. The main reason that increased government involvement in health care has gained new support from business groups is that their health care costs are rising rapidly, with little reason to expect any improvement in the absence of reform. Insurance premiums for family coverage have already more than doubled on average over the last decade, and the Congressional Budget Office projects that total spending on health care will account for almost 40 percent of the national GDP by 2050. In other words, if Gordon thinks his health care is manageably expensive today, any successful argument for reform may depend on convincing him that it will be unmanageably so before too long.
It is worth noting that Gordon’s view won the public’s collective mind in 1994. The Clinton initiative was doomed when the middle class, though unhappy with certain aspects of the health care system, decided that reform would give them rationing of care and less freedom of choice over providers. What happened in the absence of reform? Using managed care to slow down cost increases, private insurers instead of government restricted choice to the point that a political backlash ensued and inspired HMO legislation to curb unpopular, at times unethical insurance practices. Once insurers squeezed the cost savings they could find through managed care, costs resumed steep annual increases. Today, fifteen years later, the public finds itself worried again about spiraling costs and the uninsured, with the middle class again worried about government restrictions on choice. The pro-reform argument might be that if reform fails again, we’ll end up in an even worse place in another fifteen years. My point is not a partisan one that any particular plan will or will not limit per capita costs over the next fifteen years, but a short-term framing of the issue might doom even a plan that would.
Of course, even if doing nothing is bad, there’s no guarantee that current proposals for reform actually offer an improvement over doing nothing. As its critics allege, reform could be even worse. A criticism of these proposals is that they would exacerbate, not limit the annual increases in health care spending. Arguments matter about how much health care reform might increase total spending on health care, how well it would limit per capita costs, the value of universal coverage, and so on. These are the fine points of a debate that is getting increasingly heated. But if Obama and Democrats in favor of reform hope to fare better than their counterparts from 1994, then they’ll need to persuade the middle class that the status quo will be really bad in another fifteen years and that health care reform therefore offers something “in it for them” over the longer term.
August 11, 2009 at 5:04 am
Posted in: Current Events, Politics
Print This Post
Responses (5)
Vladimir - August 11, 2009 at 10:31 am
Nice post! What about, also, the fear that most people have (or ought to have, unless they are tenured) that they will find themselves out of work and stuck on the crappy individual insurance market, where the horrors run rampant? Can’t this be used to sell reform?
A.W. - August 11, 2009 at 11:35 am
A little fisking…
> one of the strongest arguments for reform of some form—that health care costs are increasing at unsustainable rates.
Well, the left has claimed that from the beginning of this debate and as mickey kaus has pointed out they then roll into “therefore we will ration care.”
> The main reason that increased government involvement in health care has gained new support from business groups is that their health care costs are rising rapidly, with little reason to expect any improvement in the absence of reform.
You are so naïve. Take Walmart, for instance. Why do they support reform? Because their competitors get better plans, cheaper, especially Target. This is a classic example of one business using the government to hobble a competitor.
> Insurance premiums for family coverage have already more than doubled on average over the last decade, and the Congressional Budget Office projects that total spending on health care will account for almost 40 percent of the national GDP by 2050.
Right, of course when things become more expensive, we just pay it. There is no such thing as a customer refusing to pay ever increasing prices. /sarcasm
Meanwhile, the way to reform health care and keep it cheap is by having… the government… run it. you know the same cost-conscious people who gave us the $500 hammer and the million dollar port-a-potty. The same cost-conscious people who pay millions of dollars to get one job and call it stimulus. They same people who spend more money per student in Washington, D.C. than the tuition of any of the private schools around and fail to educate these kids. They are going to control costs? Well, color me skeptical.
Hey, here’s a thought. How about you figure out how to do the things you are already trying to do first, and then when you show you can run those things, then maybe we will talk about you running my health care? sound like a plan?
These are the two horsemen of the government’s healthcare apocalypse: out of control spending and rationing. It’s the Scylla and Charybdis you have to maneuver between. But one gets the feeling that we are more likely get a camel through the eye of a needle than see efficient government control of health care without running into those problems.
> The Clinton initiative was doomed when the middle class, though unhappy with certain aspects of the health care system, decided that reform would give them rationing of care and less freedom of choice over providers.
So this time the left promises us… rationing, which probably also entails less freedom of choice.
By the way, given that the constitution demands, according to the left, a right to an abortion, how can the left square that with the government potentially denying you the right to a kidney transplant? It seems deeply at odds with the basic notion of privacy to turn around and say the government can control all of your medical decisions.
And as one more aside, the most embarrassing obstacle to reform: they have proposed something that they don’t think they even need to bother to read or understand. Its not even “trust us, we know what we are doing.” Its “trust us, we don’t know what we are doing, but its something called health care reform.” Its like door number 2 on “let’s make a deal:” it could be a sports car, it could be a goat. And Monty says, “okay before you came on the show, you owned a 2000 Neon. Now are you willing to trade that car for whatever is behind door number 2?” Only a fool would say yes.
m l d - August 11, 2009 at 2:45 pm
President Obama’s heath care promises won’t be kept. Costs will rise exponentially, NOT fall. Therefore, our taxes will be the ones to pay for it. We need to support the goal of covering all individuals through private health insurance. We are NOT prepared to turn our health system over to the government.
http://www.friendsoftheuschamber.com/issues/index.cfm?ID=300 .
jimbino - August 11, 2009 at 4:06 pm
If healthcare costs are “increasing at unsustainable rates,” they will perforce cease to do so. What’s the problem?
Solid Wood Furniture - August 31, 2009 at 10:53 pm
The sad truth is money is spent on advertising and not on treating sick folks. Same with all the high priced ads for drugs. If all the waste and excesses in health care were used to treat folks the cost could go down and maybe every one could have some kind of insurance coverage. The power companies do not advertise yet I have electricity. Doctors prescribe medications so why is all the ads necessary. Educate the Doctors and put the rest back into new drug development or send dividends to their stock holders.
Leave a Reply