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Don't take this the wrong way
The prospects for health care reform seem to be dimming. If I were a progressive I would be wondering right now whether Medicare was a tactical mistake. The passage of Medicare meant that most old people get government-provided health care coverage. Yet the way to get things done in this country, politically, is to get old people behind them. Further health care reform doesn't now seem to promise much to old people, except spending cuts on them. Given their limited time horizons, old people don't so much value system-wide improvements, which invariably take some while to pay off.
If Medicare had not been passed, might this country have instituted universal health care coverage sometime in the 1970s?
Posted by Tyler Cowen on July 21, 2009 at 05:33 AM in Medicine, Political Science | Permalink
Comments
If reform is the goal, it sure isn't happening. If benefiting median-income voters at the expense of low- and high-income voters is the goal, "reform" is proceeding apace. Is there any incremental change proposed so far that doesn't cozy to this motive? I would love to hear specifics.
Posted by: C at Jul 21, 2009 7:09:00 AM
Tyler Cowen,
I would bet money at even odds that a healthcare bill, which claims to "provide coverage to all Americans," gets passed into law before November 2010.
How much would you like to bet?
Alternatively, you could just take me and Yana and Natasha to dinner at L'Espalier the next time everyone is in Boston.
Posted by: ck at Jul 21, 2009 8:12:37 AM
This is the best argument for Medicare that I've ever seen.
Posted by: Alan Gunn at Jul 21, 2009 8:14:42 AM
This post could have been titled, "Mutual assured destruction privatization strategies."
Posted by: Bob Murphy at Jul 21, 2009 9:08:36 AM
I love how the commenters over at EV are shocked - shocked! - that the health care industry will influence their beloved health care bill.
Posted by: MrTuttle at Jul 21, 2009 9:27:33 AM
ck,
That bet is on offer at Intrade, current price 48.5:
A federal government run health insurance plan to be approved before midnight ET 31 Dec 2009
Posted by: Noah Yetter at Jul 21, 2009 9:39:02 AM
"Yet the way to get things done in this country, politically, is to get old people behind them."
False. That is in fact one way to do things but hardly the only way. Politics like much else rests on supply and demand and while seniors are an important part of it, they are not always the whole story as we saw with civil rights advances.
Your average working class joe didn't cost a lot to insure back then so the demand for universal insurance was fairly low. But since insurers didn't want to touch the senior population the demand for something that looks like Medicare was relatively high and would have increased every session until they passed something like medicare.
OTOH the demand for universal coverage is now high and increasing. The long term economic realities will demand real action sooner or later. Are we there yet? I think we may be. At any rate it will be interesting to watch and find out.
Posted by: Steko at Jul 21, 2009 9:50:49 AM
Tyler,
There's still a way to make this happen: let the scheduled cuts in Medicare reimbursement rates go through. Once this happens, doctors will stop seeing Medicare patients, and perhaps the Medicare population would get on board.
Posted by: Jacob at Jul 21, 2009 10:11:34 AM
Jacob:
Yes, but when the Medicare cuts occur, and even fewer doctors (and nursing homes, etc.) accept Medicare patients, then even the most naive partisan of universal health care may extrapolate to other future government-run health care plans, and even -- perhaps -- start to suspect there is no free lunch.
Posted by: enoriverbend at Jul 21, 2009 10:18:55 AM
Oh I think that Medicare was a mistake in many ways.
Posted by: Floccina at Jul 21, 2009 10:21:16 AM
I didnt think the reform proposal was that interesting anyways. I did get a good laugh reading the comments section over at Thoma's blog though. I think if you told those people we were passing a reform bill in name only, they honestly wouldnt mind. If you want to talk about a DO SOMETHING bias, then that crowd over there certainly has it.
Posted by: john pertz at Jul 21, 2009 10:24:55 AM
It's hard to say. When Johnson passed Medicare and Medicaid, he was at the height of his Presidency (after winning an overwhelming re-election), and he had the backing of a massively democratic congress behind him.
Democrats wouldn't be so lucky in the 1970s, although since Nixon proposed universal health care, you might be able to work out a compromise.
Posted by: Brett at Jul 21, 2009 11:07:56 AM
President Prepares Army of Bloggers
Posted by: Gerald at Jul 21, 2009 11:08:20 AM
The surprising thing to me is that the near-death of the domestic auto industry isn't increasing support for the more progressive versions of the health insurance bill now making its way through Congress. I live in Michigan, where a substantial portion of the industrial working class is enduring a transition from the kind of health insurance formerly provided by the Detroit auto manufacturers to what workers get in service industries. I would think that people in their situation would turn to the Federal Government for help, just as they did during the 30's. Yet they aren't. I don't know if this indicates a true shift in public attitudes, or is simply an example of the political skill of the Republican party.
As far as Tyler Cowen goes, I understand his ideological desire to keep the status quo. I just don't see his economic rationale, and I can't understand his love for the medical insurance industry.
Posted by: Stan at Jul 21, 2009 11:10:49 AM
tyler: "If Medicare had not been passed, might this country have instituted universal health care coverage sometime in the 1970s?"
If Medicare had not been implemented, it seems unlikely that medical costs would have risen as much as they have. In that case, would there even be a push for universal health care?
Assume medical care for seniors were not guaranteed. Would private corporations have invested so much developing drugs and treatments specifically for illness which disproportionately affects seniors? I doubt it.
Would emergency rooms be filled with bored seniors who view the trip to the doctor as a social event? (That was the opinion of my late brother-in-law, an ER physician for 30 years.)
Would the cost of senior health insurnace cause seniors and their children to push back at state legislative initiatives that imposed insurance mandates?
Posted by: John Dewey at Jul 21, 2009 11:32:54 AM
stan: "the industrial working class is enduring a transition from the kind of health insurance formerly provided by the Detroit auto manufacturers to what workers get in service industries"
Just to be clear, Stan, it was the customers of auto manufacturers who paid for the outrageous benefits and reduced productivity of GM, Ford, and Chrysler. When those customers realized they could get the same automobiles from Toyota, Honda, and Nissan - without paying for such benefits and reduced productivity - they switched in a hurry.
You live in Michigan and probably see things differently. Many of us down here in Texas have eagerly awaited the day when the industrial working class of the Midwest was forced into the same economic choices we face. Nationwide, there's many more votes in the consumer class than in the Midwest industrial working class.
Posted by: John Dewey at Jul 21, 2009 11:53:59 AM
Since nothing else good is on the table, my hope is the Kucinich amendment, which allows states to more easily try to implement a single payer plan by granting a waiver to ERISA, survives the next committee votes. The states rights angle has garnered Republican support and the fact it means some progressive effects has gotten a lot of Democrats behind it.
But since it is logical, has bipartisan support, and is viciously opposed by insurance companies, I fully expect it to die horribly this week.
Posted by: Ben R. at Jul 21, 2009 12:00:02 PM
Ben R: "The states rights angle has garnered Republican support and the fact it means some progressive effects has gotten a lot of Democrats behind it."
Oh, yeah! Texas would love to see more Yankee states enact costly social programs. We've got plenty of room down here for additional industrial and corporate relocations.
Posted by: John Dewey at Jul 21, 2009 12:18:03 PM
In that case, would there even be a push for universal health care?
Since every other Western nation seems to have it, I daresay the answer is "yes."
Posted by: Anderson at Jul 21, 2009 12:25:49 PM
Oh, yeah! Texas would love to see more Yankee states enact costly social programs. We've got plenty of room down here for additional industrial and corporate relocations.
And single payer enthusiasts will argue that you'll have five remaining small businesses when healthcare for their employees exceeds every other cost they have by five fold.
But we'll never know if you are right or they are right. Moneyed interests have turned the federal government into a corporate kleptocracy, this amendment will die within two weeks.
Posted by: Ben R. at Jul 21, 2009 12:44:37 PM
The biggest waste in gov't health care is the fraud. It is massive and if the gov't would get honest auditors in they would save a large portion of money. The gov't should not have created these programs in the first place. And this includes Social Security. They can't run it honestly, it grows and expands costing taxpayers large amounts of money - we are forced to contribute and the money used for illegals. I watch here in NY all the time. Immigrants coming here and getting free education, food stamps and medical. Without having contributed a dime. In addition to demanding bilingual education at citizen taxpayers expenses. Medical costs are high due to gov't meddling and massive fraud.
Posted by: Krystal at Jul 21, 2009 1:11:00 PM
Don't value system-wide improvements? Because of limited time horizons? We need a comparison among:
Those old folks without children or grandchildren,
Those old folks with children or grandchildren who have written them off,
Those of us keenly and deeply invested in their future.
Posted by: Pat Mathews at Jul 21, 2009 1:16:17 PM
Prof. Cowen, you make Medicare sound like Bismark's gambit in Prussia -- offer a public pension system to take the wind out of the socialists' sails. I would not be surprised to see, lurking in Medicare's legislative history of in the public discussion surrounding it, some statement that conservatives may as well support it because some large-scale health reform is inevitable, and Medicare, as opposed to something different, will make it less likely that the United States adopts European-style health care in the future.
Posted by: Steve M. at Jul 21, 2009 1:34:58 PM
Tyler, you miss the fact that Medicare was not merely for the old; it include the young poor, for at the time, once even the disadvantaged black youth reached a certain age he could get a job in a factory that thanks to unions would include health care benefits. Remember that Medicaid is an integral part of the Medicare legislation.
The one group that was most disadvantaged was the poor and middle class in the South of all races.
The tactical error was in fact the failure of Democrats to back Nixon's welfare and health care plans to the hilt. Medicare already represented a massive Federal transfer of incomes from the North East, Central States, and West to the South, and Nixon was proposing an even greater transfer of "wealth" from these regions to the South.
To a degree, Democrats opposed Nixon on principle because he was continuing the Vietnam war, but the more important factor was the realignment of the Democratic and Republican Party membership as the racists moved from the Democratic Party to the Republican Party. What LBJ had done, and that Nixon was proposing to do, was grant the poor, and the white "share cropper class" were dominant, a huge step up in incomes. And with higher incomes comes independence, and self empowerment. Thus, the "blue dogs" and the Republican conservatives who wanted to retain the Southern class structure and its ability to create low wage workers who supplied the neo-plantation economy found common cause in opposing Nixon's Republican approach to LBJ's social movement.
As someone recently noted, the presidents who were most concerned with issues of the poor, whether welfare or health care, were those who grew up poor and had experienced the harsh reality of being poor and sick. Nixon was one such president, so he was quite sympathetic to addressing the needs of the poor. One of his advisers was Moynihan who wrote later of the missed opportunity for universal health care and a guaranteed national income.
While conservatives point to LBJ and FDR as the great Satans, Nixon could be argued did more to create the institutions that conservatives love to hate, and that they blame on Jimmy Carter.
Posted by: mulp at Jul 21, 2009 2:01:32 PM
So, mulp, what evidence can you provide to show that "racists" deserted the Democratic Party? When exactly did this happen?
Posted by: John Dewey at Jul 21, 2009 2:24:13 PM
