Why We’re Summitting About Health Care

Given that there’s no particular health care plan that’s yet got nearly the level of legislative momentum behind it for anyone to be worried about it passing or failing, it may not be immediately obvious to people why the White House is bothering to hold a health care summit today. The reason is that securing agreement on the meta-issue that “there should be large-scale health care reform in the near future” is more important than it might seem. Specifically, the prospects for any particular reform measure passing get much better if the budget resolution can pass with an adequate level of headroom for a plan to fit into. Consequently, there’s not only no need to discuss particular reforms but in many respects it would be counterproductive to do so. Instead, we’re talking about “reform” and the need for it.


Specifically, there’s something of a three-part philosophical divide. On the one hand, there are those who are looking to take action. On the other hand, there are those who just don’t believe it would be advisable to work toward a guarantee of affordable insurance for all. These people tend not to be too clear about what they’re saying, because it’s unpopular, but Cato’s Michael Cannon with his scornful talk of “the church of universal coverage” is an exemplar in forthright advocacy of this position. Some members of this faction are actually somewhat obsessed with the idea that we need to reduce the number of people with health insurance by fiddling with the tax code to try to unravel the large risk-pools that make the employer-backed system viable. I think you actually get a lot of interesting ideas about the details of the health care delivery system from this crowd, since they’re less invested in trying to come up with politically practical proposals and aren’t afraid to offer some real talk to the more-insidious-than-people-realize doctor’s lobby. But if you want to do big reform, there’s obviously not much you can say or do to persuade anyone who’s philosophically convinced that the government role in health care should be minimized and that loose talk of universality is a dangerous stalking-horse for Stalinism.

Then you have people working for major reform. The goal here is to create a system that guarantees access for everyone. You sometimes get into disputes that I regard as mostly semantic about whether you should count as “universal” a system in which a small number of non-sick people don’t necessarily have insurance but are in a position to take advantage of guaranteed issue and community assistance to get insurance should they decide they need it. But this is actually not a particularly gaping policy void, though you may sometimes hear otherwise during primary campaigns. There are a bunch of different goals here. By acclamation, we’re not supposed to talk about the goal of providing health care to the uninsured minority, because they’re a minority of the population and they have low SES, low proclivity to vote, and little political clout. But I’m about the justice, damnit, so I’ll offer this chart:


That number is almost certainly higher today because the economy has lost 3.6 million jobs since the start of 2008. A one percentage point rise in the national unemployment rate causes 2.4 million people to lose employer-sponsored health coverage, according to Urban Institute researchers. Of these people, 1 million rely on Medicaid or the Children’s Health Insurance Program and 1.1 million end up uninsured. […] The number of newly uninsured would be much higher if it weren’t for people enrolling in Medicaid and CHIP. Rising unemployment rates since the last Census report imply that an additional 3.2 million Americans now rely on Medicaid or SCHIP. Congress recently provided more resources for Medicaid and CHIP, but if it had not, states would have been forced to cut eligibility for these programs. Without federal assistance, many people now on Medicaid or CHIP would likely become uninsured as well.

Then we have the people in the middle. These are people, and you find them in both parties, who happily concede the need to reform the health care system. But they think the time isn’t right. Maybe we should wait until we solve the economic crisis, end the war in Iraq, stabilize Pakistan, and balance the budget and then sometimes in the dim mists of the future we can reform the health care system. Maybe we “can’t afford it” right now.

The problem with this view is that we can’t afford not to do it. The problems in the health care sector are not the cause of the current recession, but they are both a drag on the economy’s long-term ability to grow and the primary driver of long-term budgetary challenges. It gets much easier to get ourselves out of the current economic hole if there’s a reason to believe that the foundations for more robust growth and a sustainable fiscal path are being laid at the same time. And those things can’t really be done without health reform. Meanwhile, as the chart on loss of insurance indicates, the recession doesn’t make the health care crisis more avoidable, it makes it more acute. The status quo is bad enough that there are a lot of ideas, including some ideas that aren’t very good, that would be a lot better than indefinite continuation of the status quo. The task of the day is to persuade people of that fact and get a budget in place that creates the possibility of putting something better in place.