Enacting Healthcare Reform Could Have Been Much Easier for the President

One of my favorite podcasts is BusinessWeek, Behind the Cover. In each episode, Jim Ellis, who is the assistant managing editor of the magazine, interviews the writer on the magazine staff responsible for that week's cover story. I recommend that you listen to the episode from 2/12/2010 (follow link above), in which Ellis talks with the magazine's editor, Josh Tyrangiel. Josh had been responsible for a cover story that  focused on the administration's attitude toward business and had interviewed Barack Obama in the White House. One of his most interesting comments in the podcast was that Obama could have had a much easier time with healthcare reform, and avoided all of the political drama, if he had only couched the initiative, at least in part, as a way to create more jobs.

Current estimates place healthcare spending in the U.S. at about 16% of GDP and may reach 19.5 % by 2017. This is far more than other capitalistic democracies (see: Five Capitalist Democracies & How They Do It). Many economists claim that such an expenditure is not sustainable. It is certain, however, that healthcare is an economic pillar in many U.S. communities. This is one of the reasons why so many of our politicians supported the recent healthcare reform bill with its expansion of the number of Americans who will become paying customers for the industry. It will bring more revenue into most of our towns and cites.

I had an ah-ha movement as soon as I heard Tyrangiel's comment linking healthcare reform to jobs. The question immediately popped into my head. Such an approach was so obvious, how could the administration have missed this opportunity to have greased the skids for the legislation? Two reasons came to mind but I would be interested in hearing your ideas about this question. The first is that we may have reached a point of "spending fatigue" as a means to stimulate the economy and create more jobs. The majority of Americans may be fed up with this issue, but certainly not those still looking for work nor perhaps politicians. My second idea is that the major rationale for healthcare reform and coverage of the uninsured among most Democrats, and certainly many Republicans, was fairness and equal access to care. I think that it might have been viewed as unnecessary camouflage to use job creation as a reason for supporting the bill.

Comments

[Mark Pool]

A good point--the healthcare industry is a major employer but has dispersed political clout. But I'm not convinced about the reality of the job creation angle, at least in a direct sense. We have reached "spending fatigue." And, despite a collective amnesia/denial about the failure of massive Keynesian spending to rescue us from the Depression (which one could argue was made "Great" by the Hoover/Roosevelt attempt to spend our way out of it), the majority of common(-sense) folk seem to intuitively grasp that it won't work. If it doesn't work in your own house, it's not going to work with government, right? If a more modest and targeted reform had been passed that focused squarely on making the "system" more efficient, provided protection for already insured people, tried to cover the most vulnerable of the uninsured that show up in ERs, then I think a strong argument could have been made that reducing the overall expenditure for health care would indirectly result in job growth simply because more capital would be "freed up" for more productive investment. I agree that "fairness" and "equal access to care" were camouflage. Who wants to argue against these terms (and not come off sounding or being made to sound like a shrill)? While there appears to be broad agreement that unfair business practices by health insurers should be stopped, "equal access to care" is more difficult when one parses it out. What is meant by "equal" (and I do mean equal in the sense of "exactly the same") care? This is personalized medicine?! While it may be desired that everyone have equally optimal care (the best docs, hospital, nursing, etc.), is it desirable that everyone have equally mediocre care (if that's all we can afford)? What do we mean by "access?" Do we mean by that "Take a number and we'll call you"--which applies to everyone, no matter who you are or know? What do we mean by "care?" Again, do we mean something basic that handles the basic needs of the patient or best practices or what? These terms were totally unnecessary to drag out and only heightened the drama. I'm not saying that we mustn't address these questions straight-up, but, at this point for the purpose of passing needed reforms, it was and is a distraction.