The Economics of Being Kinder and Gentler in Health Care

By UWE E. REINHARDT,

In his speech accepting his party’s nomination as presidential candidate on Aug. 18, 1988, George H.W. Bush proclaimed that he wanted a “kinder and gentler nation” – kinder and gentler, I suppose, than he thought it was in 1988.

In the late 1980s, about 35 million respondents to large nationwide surveys declared that they lacked health insurance of any kind. The comparable number now is close to 50 million.

Then, as now, the endless “national conversation” went on and on, pondering ways to achieve truly universal health insurance coverage, a feat most other developed nations accomplished long ago.

… if the desire to take care of one’s poorer or sicker fellow citizens were the same in the United States as elsewhere, a Martian might observe that fewer kind acts are bestowed on the (uninsured) poor in the United States because of the much higher price of American health care.

Now, it may be argued that opposition to the Affordable Care Act is not primarily driven by reluctance to share the blessings of our pricey health care system with low-income Americans who cannot afford it, but rather by misgivings over particular features of the law — for example, community rating and the mandate on individuals to be insured.

I am not persuaded by that thesis, because — as has been pointed out time and again in news coverage — the law largely embodies ideas and features that were quite popular during the 1990s among today’s most vocal critics of the law, including Mitt Romney, President Obama’s opponent in the 2012 presidential elections.

My interpretation is that opposition to the Affordable Care Act largely reflects the age-old reluctance among many of the nation’s haves and the healthy to help purchase for America’s lower-income families and the chronically ill the super-expensive health care that the haves enjoy themselves. That attitude is all the more striking because of the generous federal indirect subsidies enjoyed by many of the haves, especially high-income Americans.

Some people on both the extreme left and right seem to believe that the current travails of implementing the Affordable Care Act and the possibility of a so-called “death spiral” in the market for individual health insurance may usher in single-payer health insurance in the United States – say, Medicare for all. (But on the likelihood of the death spiral, see this commentary from the Kaiser Family Foundation.)

I do not find that a likely prospect.

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