The Politics of Health Insurance Notes for November 19

Main points

We reviewed the history of the US health care/finance system. We compared health insurance with other kinds of insurance, such as life insurance, car insurance, homeowner’s insurance, and so on.

Then we discussed various proposals for reform that are floating around now. Some aim to expand the insurance pool by forcing everyone to pay in, including you young healthy types. Others aim to control costs by paying caregivers to cover people, rather than paying for particular procedures.

Consumer choice

One theme in the article that I found persuasive concerns consumer choice in health care. Professional orgainzations like the AMA squashed this on the grounds that those without professional accreditation are not competent to make choices regarding health care.

The return of consumer choice in the 19870s-80s was a product of agreement between those concerned about costs and those concerned about what they regarded as inferior treatment of particular groups by the medical profession. The idea was that costs would go down if people had to pay more for their own care and could choose between caregivers. Similarly, women, say, could get better care if they could choose their doctors.

The author didn’t tell us whether consumer choice achieved either of those objectives. Instead, he argued that consumer choice leads to inequalities. Some of these inequalities are regrettable, as they reflect inequalities in education, class differences, or cherry-picking by insurance companies rather than simply the choices of individual subscribers.

Of course, there is the reason for the erosion of consumer choice in the first place. We don’t know what we’re doing. We don’t know much about medicine and, even if we did, we make all sorts of, you guessed it, forecasting errors!

Where are the politics?

As I said, I found the article weirdly apolitical. I thought the author rested a lot on “frames” or ways of thinking. For example, he claimed that the market frame excludes policy options that are more likely to achieve equitable results.

Where’s the proof that frames have this kind of power?

I myself am inclined to see them as epiphenomenal.** Philosophy has big words too! That is, they are part of what we experience in political life, but they merely ride along with the things that do the real causal work. In the case of health care, I said, whenever you hear politicians or “policy elites” talking about “market solutions”, try substituting the following phrase and see if the meaning isn’t basically the same: private insurance firms will still get their cut.

In other words, my assumption is that businesses that don’t want to get cut out of lucrative markets are the real political force retarding more equitable health care policies. If you look behind the words, that’s what you’ll find.

Here are two little examples that loom large in my picture of politics. We know that Republicans are opposed to “big government” and Democrats aren’t, right? Well, who put a massive new drug benefit for the elderly into effect? As long as the insurance and drug companies were protected, and the elderly will vote, big government was A-OK.

On the other side, Bill Clinton came into office ready to make good on his pledge to have a massive public spending push to jump start the economy.†† Last two paragraphs added Nov. 20. I can’t recall what he called it; the word “surge” is coming to mind, but I know that isn’t it. Anyhoo, that didn’t last long. Instead, he ran the budget into surplus. By the time he left office, I heard good solid faculty club Democrats moaning about how Bush was going to ruin the economy by running up the deficit. I hadn’t heard that talk since, oh, around 1980, when Ronald Reagan and the Republicans were using similar rhetoric to bash the Democrats. It was as though Dwight Eisenhower had returned and joined the Democratic party!

In other words, the whole economico-politico-rhetorical world went upsie-downsies, without anyone seeming either to notice or care. Except me. I noticed. And that made me care less (about the rhetoric, that is).

Speaking of big words

It turns out that “complexify” is one. A real word, that is. Who knew?

I’m still not sure I should be proud of using it, mind you.

But no laughing, like Kari did about my bad math. Don’t slip up there K. I’m watching. Waiting. Nursing a grudge like it’s the last drink in the bottle. You just be careful.

This page was written by Eleanor Brown and Michael Green for Freedom, Markets, and Well-Being, PPE 160, Fall 2007.
Freedom, Markets, and Well-Being