Health Care Reform As Stimulus
Paul Krugman has this excellent piece
of lessons of the New Deal. Along the way, he takes a well justified swipe at the revisionist version that the New Deal perpetuated the Depression rather than allowing the business cycle to run its course.
Allow me to add an additional note on the idea of stimulus. We need to rethink what it means in 2008. We need to be targeted in how we do it. The idea that simply dumping money into public works projects will save us should be viewed with suspicion. It's not just about creating jobs. It is about making changes in the economy that allow wealth creation and opportunity distribution.
Let me begin with the idea of health care reform as stimulus package. Most discussion seems to be based on the notion that we can do either
a stimulus package or a healthcare reform package, as if the two were not merely unrelated, but mutually exclusive.
But consider, the current burden of supporting health care for insured and uninsured Americans is staggering. It is an enormous drain on our economy. If we follow the logic of the McCain campaign for a moment, fixing health care would be the equivalent of a tax rebate of $5000 for every American. This does not even include the relief in cost to industry -- particularly small businesses. Study after study has shown that our health care system is severely broken to the economic detriment of us all.
We can take some immediate steps that would act as a broad-based well needed stimulus almost immediately. First, we should free Medicare and Medicaid to negotiate directly with drug companies for best prices. This will have an almost immediate impact on drug pricing for everyone, not merely for the federal and state government paying these bills. Along the way, we can get rationalize Medicare D into something more sane. It's current structure is a result of trying to provide affordable coverage for seniors while not cutting into the profit margins for drug companies. There is no reason we can't fix this in the first 100 days, with the result being the equivalent of a tax rebate to the elderly and a significant savings to the federal government.
Second, I recommend the federal government offer basic malpractice insurance. This will reduce another substantial cost to the medical profession, and could be done relatively cheaply. Offering insurance is not difficult, it is just a matter of crunching data and coming up with a reasonable premium based on risk. Eliminate the profit motive and watch the rates fall to something manageable.
Another easy one is expansion of SCHIP. The chief argument against SCHIP has been that it would potentially give relief to children who have some insurance coverage or "should" be receiving coverage. But from a stimulus perspective, so what? Providing such coverage works in a far more efficient fashion to put productive money back in the economy than giving the same people a $600 check they will pay to their medical bills.
These are just the easy ones. There is much that can be done to add jobs -- particularly IT jobs -- in the health care and health delivery field. There is a lot that can be done to eliminate the unproductive aspects of the health care system that derive from cumulative efforts at cost control from conflicting insurance schemes. These take longer to do right, but will have a far better stimulus impact in the long run.
I can point to other fields where the "stimulus v. campaign promise" rests on the same faulty logic. As always, it helps to begin by starting with the problem you actually want to solve, rather than grabbing for the solution you think works. But the fault really lies in thinking that "the economy" somehow lies outside these other issues. It doesn't. "The economy" is the aggregate of how we spend and/or save money. Education reform, health are reform, broadband policy, all of these have huge economic impact in both the long-term and the short term.
It is useful to learn from the experience of the Depression. It is important to study the New Deal. It would be tragic to mindlessly repeat these things as if we still lived in 1933.