Sunday, December 20, 2009

Health Care: Bad Politics

Having looked at the policy implications of the Senate plan, let us now look at the political implications. Assuming the plan passes, it is going to create a huge amount of public resentment. Financial companies are already widely hated for their manipulations. The proposed plans will force those manipulations into everyone's lives. I don't see that the outcome of either choice is predictable. Let's break it down. First, suppose the bill passes:
  1. The insurance industry will enjoy a windfall at the expense of the public.
  2. Under the right circumstances, passing the bill could ultimately lead to improvement, largely if the Senate become more liberal, or if economic stresses or corruption lead to the collapse of major insurers.
  3. Under the wrong circumstances (if corporate dominance of the Senate and federal regulatory apparatus continues) it could lead to the destruction of the US middle class. [2009.12.21: Addition, at the suggestion of a correspondent. The health insurance companies have every incentive to raise their rates to soak up the cash that their policyholders would otherwise save. With a mandate, an oligopoly, and poor regulation, there is nothing to stop them from doing so.  In this scenario, a family has to have a very high income in order to save, and money to save is what makes a family middle-class.]
Now, suppose the bill fails:
  1. Under the right circumstances, a better plan could be passed, or introduced in reconciliation.
  2. Under the wrong circumstances, matters could continue as they are, with the US health care system deteriorating to the level of that of an impoverished country.
There is no certain choice. Personally, I would prefer not to participate in this disaster, and my intuition is that not passing this bill is the wisest course of action. Still, while my intuition is good, it is not perfect. I only hold against my political opponents the will to be persuaded by false hope, as with Ezra Klein, who is now seeing things in the Senate bill which are not there. (Cites: 1 2)

The Democrats are going to get the blame for the huge charges the bill imposes. Even though the bill probably will lead to an improvement in the quality of life of many Americans in the short term, the negatives will expand in the public mind, and the public will resent the cost. It will be seen as direct proof of government corruption. People who personally know people ruined by the mandates will speak their minds, and we may be sure that their voices will be heard. What will the public finally do, I wonder?

Well, they're going to be ornery, that's for sure. The US public hates and ignores politics, mostly. But this is politics that will push directly into their lives and cost them money: the public will both resent the demand on their attention and the thing itself. I think the loser here will be the Democratic Party, since this bill is their bad work. But I don't think the Republicans will be winners—the public has by now figured out that Republican politics are even more corporate than those of the Democrats. Since the largest group most directly affected by the mandates is young, there will be plenty of energy among the opposition. I don't think they'll just stay home, so I suppose this means the emergence of a reform movement. This could lead to greater social justice, or the movement could be hijacked by the radical right, or even stranger political factions that have yet to emerge. An even more powerful coalition would emerge if strong anti-abortion language is in the final bill; a large number of older women would join. Young people and older women are the coalition that elected Obama. I think there would be little such a coalition could not do.


[minor changes made on day of publication and one clarification added the day after]

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