What's in It for Me?
I'm sort of running out of ways to write "David Leonhardt has a good column today," but David Leonhardt has a good column today. He's trying to puzzle through (a) what's in health-care reform for the average insured American, and (b) how to explain to to them. These are, indeed, separate questions.
Leonhardt, for instance, brings up the employer tax exclusion, which acts as a massive subsidy to employers who offer health-care insurance, and has created a fractured, expensive, inefficient health-care system. But people think they benefit from this subsidy. And why not? It's countertintuitive to say that something that's making your health-care coverage cheaper than it would otherwise be this year is also making it everybody's health-care coverage, including yours, a lot more expensive over time. The key to explaining all this, Leonhardt says, is connecting it to stagnant wages:
The immediate task facing Mr. Obama — in his news conference on Wednesday night and beyond — is to explain that the health care system doesn’t really work the way it seems to. He won’t be able to put it in such blunt terms. But he will need to explain how a typical household, one that has insurance and thinks it always will, is being harmed.
The United States now devotes one-sixth of its economy to medicine. Divvy that up, and health care will cost the typical household roughly $15,000 this year, including the often-invisible contributions by employers. That is almost twice as much as two decades ago (adjusting for inflation). It’s about $6,500 more than in other rich countries, on average.
We may not be aware of this stealth $6,500 health care tax, but if you take a moment to think, it makes sense. Over the last 20 years, health costs have soared, and incomes have grown painfully slowly. The two trends are directly connected: employers had to spend more money on benefits, leaving less for raises.
Of course, then you're in a place where you need to explain exactly how the reforms will make health care cheaper. And the answer is that they won't in the next few years. Take-home pay will not increase in 2014 because of health-care reforms. But they're a start. That's the correct answer. But it's not an exciting answer. And it asks people to endure a measurable short-term harm in the hopes of a speculative long-term gain. That doesn't work out so well.
For that reason, I keep coming back to this idea of choice. When even RNC Chairman Michael Steele doesn't have a choice in health-care insurance, you're dealing with a world in which you could really help them out by giving them access to options. That's why I'm so enamored of Ron Wyden's idea. But there are no silver bullets. It's taken a long time to get health care to this place. It'll take at least a bit of time to get it to a better place. But patience is not one of the political system's virtues.
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