http://trueslant.com/rupertrussell/2009/12/19/healthcare-to-suffer-fate-of-welfare-not-medicare-or-social-security/
Rupert Russell
Healthcare to suffer fate of Welfare, not Medicare or Social Security
Bear in mind also the lessons of history: social insurance programs
tend to start out highly imperfect and incomplete, but get better and
more comprehensive as the years go by. Thus Social Security originally
had huge gaps in coverage — and a majority of African-Americans, in
particular, fell through those gaps. But it was improved over time, and
it’s now the bedrock of retirement stability for the vast majority of
Americans.
Paul Krugman, Pass the Bill, NYT, 12/18/09
The latest installment of conventional wisdom to emerge from liberal
writers who support the current health care bill argues that the best
entitlement programs come from bad bills. This
caterpillars-into-butterflies narrative boasts Medicare and Social
Security as the templates for how this flawed bill could form the
cornerstone for single-payer, or something like it.
Yet, what they ignore is that so many entitlement programs enacted by
Democrats, even the popular ones, are starved of funding, stripped of
their authority, delegated to the states and left to fall by the
wayside. Nothing exemplifies this more than the welfare programs enacted
under the Lyndon Johnson’s Great Society. From the moment of its
inception it was slowly defunded and shrunken down only to be killed off
– or rather ‘reformed’ (sound familiar?) – by the big-government ending
Bill Clinton. A decade later, facing record unemployment, the federal
government is compelled to re-authorize welfare payments to the states
to stave of state bankruptcies and mass starvation.
And the current health care reform package in the Senate looks far more
like a welfare program for the poor than Medicare or Social Security.
Whereas Medicare and Social Security make the middle class stakeholders
in a government run system, and entirely dependent on that system
working properly and delivering results, the current reforms are
selective in their effects, largely sidestepping those with employer
based insurance. Instead, like welfare, the benefits are exclusive in
nature, in this case targeting only those who are barred from the
current insurance market, and thereby don’t give the middle class a
stake in its success. Without bringing these stakeholders into the
policy it is far more likely to likely to follow the fate of welfare
than Medicare or Social Security as services for the poor always become
poor services.
With the Medicare buy-in and public option off the table there is no
‘entitlement’ or ‘social insurance’ program that can grow and expand.
Instead there are subsidies to private insurance for those currently
left out which are more likely to shrink over time than grow. For the
liberals’ argument to hold true, that the bill would get better over
time, Congress would have to vote to increase the size of the subsidies
at a rate higher the inflation of the price of health insurance. Given
that nobody seriously believes this bill to “bend the curve” of costs,
those subsidies would have increase greatly year-on-year just to remain
at parity. The likely outcome is that the growth in subsidies will fall
behind the rising cost of insurance, making health insurance more
expensive, more regressive and less progressive as time goes on.
Without bringing the middle class into a new entitlement program, the
health reform bill is only going to get worse over time, and not better.
Let’s not fool ourselves, this is as good as its gets.
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