In praise of diminished expectations

Paul Krugman makes the case for passing the Senate version of health-care reform:

With all its flaws, the Senate health bill would be the biggest expansion of the social safety net since Medicare, greatly improving the lives of millions. Getting this bill would be much, much better than watching health care reform fail.

At its core, the bill would do two things. First, it would prohibit discrimination by insurance companies on the basis of medical condition or history: Americans could no longer be denied health insurance because of a pre-existing condition, or have their insurance canceled when they get sick. Second, the bill would provide substantial financial aid to those who don’t get insurance through their employers, as well as tax breaks for small employers that do provide insurance.

Assuming it works, this sounds pretty good. And I wonder if there would’ve been less acrimony if the bill hadn’t been sold as a comprehensive overhaul in the first place. Because people were expecting so much more, the current bill looks like a miserable sellout. But as a first step, it sounds promising. Of course, if this scaled-down version had been pitched from the get-go, who knows what we would’ve ended up with?

It’s analogous in some ways to the wildly inflated hopes people seem to have had for Barack Obama’s presidency in general and the ensuing disappointment in some quarters on the Left. If you think of him as a pragmatic, center-left politician, he seems like a dramatic improvement over the previous administration. But if you had the idea of a paradigm-altering progressive superhero in mind when you voted for him, you’re no doubt sorely disappointed about now.

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4 thoughts on “In praise of diminished expectations

  1. Ultimately, Lee, I think the problem is a philosophical one. Do you support an expansion of the social safety net because you are a liberal egalitarian, a believer in using welfare to create more equitable conditions between individuals? If so, then really, there’s very little not to like about the Senate bill. But perhaps, on the other hand, you support an expansion of the social safety net because you see such an expansion as a necessary step towards creating an entirely different set of conditions, a more socialist one, where health care isn’t an individual good that ought to be distributed somewhat more fairly, but rather a collective good that ought to be taken, at least as much as possible, out of the hands of private (that is, market) actors entirely. If so, then that’s where I am. I like much that seems to be heading towards passage, but I sure don’t love it.

  2. Russell, I think I see your point, but I’m a little fuzzy on some of your distinctions. When you contrast health care as an individual good versus health care as a collective good, you seem to me be cutting across the consumer/producer axis. I mean: presumably on the consumption side health care is always an individual good. The individual vs. collective issue is really on the provision side (market vs. government).

    So, it seems to me what we have is a question about ends and means. The end, which I think everyone agrees on, is delivering more and better care (as needed) to more people. The means are market, government, or some mixture of the two. Understood that way, it doesn’t strike me that greater government provision is per se a goal to be aimed at, but only one possible means for expanding coverage. Now, I happen to think that, as an empirical matter, expanded government involvement beyond what is envisioned in any of the current legislation is necessary to sufficiently expand coverage. But I’m not sure I see that as a deep philosophical divide.

    Or maybe what you’re getting at is that, philosophically speaking, health care (or insurance) simply shouldn’t be a market good to begin with. Which is a position I’m open to, but I’m not sure posing it as a matter of the collective vs. the individual is the clearest way to draw that distinction.

  3. [Y]ou seem to me be cutting across the consumer/producer axis. I mean: presumably on the consumption side health care is always an individual good. The individual vs. collective issue is really on the provision side (market vs. government).

    I take your point, and perhaps it would require me to reconsider my conceptualization of the topic, but I think that my terminology can still do some work here. Does covering health care costs provide individuals with goods? Of course–they are the ones whose needs generate those costs in the first place. But covering health care costs also has very significant collective consequences. Healthier environments have peer-group affects on others, you have the issue of free-riders and the way they can weigh down sense of social responsibility and other important ethical considerations, etc. I suppose it’s fairly easy to align the limited topic of covering health care costs with “the consumer/producer axis,” but doing so, I suspect, makes it more likely that “health” itself will continue to be seen solely as an individual, not a social, good, and so I think we should resist that terminology if possible.

    The means are market, government, or some mixture of the two….But I’m not sure I see that as a deep philosophical divide.

    But it is, because the market is made up of hundreds (thousands, millions) of individual transactions, which by and large are not subject to the body politic in any formal way. By leaving health insurance in the hands of corporations and employers, you make it such that the only way politics can get involved is through regulation–which is nice, of course, especially if it is designed to achieve egalitarian results, but it’s still going to mean the strengthening of central regulating bodies. Perhaps that’s an unavoidable consequence in a society much too large to allow collective decision-making in regards to health care, and I’m willing to accept that compromise, but even a minimally different set of reforms (like a Medicare buy-in, at the very least) could have inched in a more democratic, more socially-oriented direction.

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