May 18, 2005

Health Care Coalitions

Speaking of CAFTA, reading about how Bush has had to make all sorts of protectionist compromises to gain support for his bill, brings NAFTA back to mind. Ah, NAFTA. Lots of people argue that that much-discussed trade deal was either a smashing economic success or a miserable failure for the United States in the '90s. On this, eh, I'll stick with Richard Freeman's analysis: there were so many other important economic factors affecting the United States and Canada and Mexico in the '90s, that if you can disentangle them all and say "NAFTA did this grand (or devastating) thing," etc., well, you deserve a serious prize.

But NAFTA did have one very concrete effect: namely, it alienated the labor unions from the Clinton White House in 1993-94. And that hurt where it counts: on health. Before the election, recall, Lane Kirkland had promised "storm troopers" to help Clinton get national health care passed. But when it came time to do health care, the AFL-CIO was too busy fighting hard against the free trade deal. Well, NAFTA got passed, but the Health Security Act flopped, in no small part due to lack of union support (the delays over NAFTA also gave Clinton's opponents time to organize against his health care plan). So thank free trade, and Bill f'n Clinton's lack of labor tact, if you're running around uninsured.

(Okay, yes, there were other factors too—although interestingly, the historical failure of national health care to catch on in America actually has much to do with labor's reluctance to join the fight at various points, for various reasons. The one fight they did truly join was the battle over Medicare. And hey!

Also, this leads to another point: if and when Democrats ever regain control of government and decide to go full throttle on health care, the key is going to be to divide and conquer various groups opposed to national health insurance. The doctors, it seems, have shifted to the side of angels after decades of recalcitrance, though Clinton never courted the AMA; big mistake. Meanwhile, there are the various business groups that should support national insurance, though again, they have to be wooed with the right measures. And obviously the insurance industry is the big end-zone blocker, but even here, some insurance companies—Aetna, MetLife, Prudential, Cigna, etc.—have said before that they'd like to see national health care, and maybe they could be enticed if the plan involved managed competition and no government caps on nationwide spending. Or something.

Basically, it's extremely tricky to thread the needle here, and it's certainly something to keep in mind when designing health care policies. The optimal policy, I think, will be an incremental reform that helps the uninsured for now, but also has some sort of ticking time bomb that eventually explodes and clears the way for a more sensible health care overhaul. Much like, um, the GOP's sneaky Social Security phase-out strategy, only hopefully this one wouldn't suck as much. Jacob Hacker's thinking along the right lines with his plan for extending Medicare to the uninsured—setting aside the merits for now, that's the slippery slope we want to be paving! But also, you don't want to give the game away, which is why I'm writing this all in parentheses. Shhhh.)
-- Brad Plumer 3:29 AM || ||