Friday, April 3, 2020

Could it be?

A nice column by Paul Waldman at WaPo ("How this crisis could help us get to health-care reform") asks a question I've been thinking about a little bit, whether the pandemic crisis might not stimulate us in in the US to do something about the inequities of our health care system. It's easy for rightwingers to say that socialized medicine in Italy and Spain is proving just as ill equipped to handle the logistic demands of the thing as our marketized approach is, but what can't be denied is that we're going to have a much harder time paying for it, as Waldman says:
untold numbers of people are going to get huge bills from being treated for covid-19. Insurance companies made a big deal about waiving cost-sharing for coronavirus tests, but if you get it and have to get treated, you could still face thousands of dollars in costs, especially if you have a high-deductible plan of the kind that has proliferated in recent years.
The number of people facing those costs will be enormous. As bad as the virus has gotten in some other countries, that’s one thing their citizens don’t have to worry about.

There is going to be some huge pressure to do something about it, too, including in the "red" states, not that it's in any way imaginable that Trump's plan to reappropriate some of the hospital assistance money from the stimulus to paying the bills of the uninsured will lead to him running a "single-payer" bill through Congress in the hope of trouncing Biden "from the left", as some of the more performative leftists have been suggesting

(via Scott Lemieux, who has some pungent things to say about the theory).

But it's quite imaginable that congressional Democrats will see the value of giving Trump a chance to keep his more manageable promise, of paying the Covid bills over some fixed period of time, and in my immodest fantasy, focusing as I'd always wish to do on structural elements, this plan starts changing the financial relationship between the federal government and medical care (as Scott notes, "Compensating hospitals who treat the uninsured for specific emergencies is both not 'single payer' and a longstanding part of the American healthcare system", but doing it on this kind of scale in 50 states at a time is not); the other things are that hospitals will increasingly need help providing non-Covid care, and that those demands will be greatly increased by the economic crisis, which will leave many more people uninsured. Just as Winston Churchill's Tory war mobilization government set up the structural conditions that made it possible for Britain's Labour government to move directly to socialized medicine after voters threw the Tories out in 1945, so a Democratic administration (and Senate!!!) elected in November might find itself with a federal establishment that's already playing an unprecedentedly large role in health care.

At the very least, pulling back from fantasy,
if Joe Biden should become president, it will increase the pressure on him to forge ahead with the reform he advocated during the campaign, a surprisingly progressive plan centered on the creation of a public option that could quickly enroll millions of Americans in coverage that would be stable and secure even through another pandemic.
And that need not be all. I'm really interested in some of the other details of legislation that's been passed with Trump's and McConnell's helpless assent, for example making unemployment more like a living wage and extending it to independent contractors and freelancers. What if more people started thinking of unemployment as a right for workers, rather than a convenient arrangement with an employer who wants to shrink the work force from time to time? And the newish ideas about food assistance and day care, and above all the broadening talk about debt forgiveness as a more normal thing.

Are we starting to become better people? Are we starting to detach ourselves from the dreadful concept of moral hazard? (Republicans were getting hooted down for suggesting that enhanced unemployment benefits would tempt nurses and medical technicians to quit their jobs and stop caring for patients—this ancient conservative argument has suddenly become ridiculous.)

Or is this delusional happy talk, a material mirror image of the kind of spiritual good David Brooks hopes will arise from the emergency? I hope not. Still I can point to things that are actually going on at a structural level.

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