The Problems With The Employer Mandate
Tyler Cowen wants to know whether I support a mandate on employer to provide health insurance or pay some sort of tax. The correct response, I guess, is define "support," kemosabe.
The employer-based system is a dumb beast. I don't support policies that entrench it. I support policies that blow it to smithereens and build something better atop its ashes. But we're not going to get that sort of reform. So the question, then, is whether I support the employer mandate in the context of this system.
I try to keep a simple principle in mind when I'm tempted to oppose mediocre policy because it doesn't fit into my normative view of the world: I don't need help. Thinking of health-care reform as a fascinating policy puzzle is a luxury. There are, however, a lot of people who actually need help. They don't need the "right" solution to their plight. They need a solution, full stop. Meanwhile, the system that is supposed to develop solutions seems to me to be irrevocably captured by partisanship and special interests and anti-majoritarian institutions. It's not clear to me that, under the circumstances, actual "change" is possible. But improvements might be.
So I welcome Wal-Mart's support for an employer mandate, irrespective of its motivations. I welcome CBO's score showing that an employer mandate cuts costs and increases coverage. I welcome all this because it makes it a bit likelier that we're going to spend a shade over a trillion dollars helping people protect themselves from illness and bankruptcy. And I think we might, on the margins, do some good for the health-care system along the way.
But probably not that much. Improvements now, however, don't preclude change later. In fact, they might accelerate it. And if, in a couple of decades, we all sober up and decide we need to do something about the health-care system itself, I'll support those efforts, too.
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