Hank Aaron and I mildly dissent from the GOP effort to curb American social insurance

What’s at stake goes well beyond “repeal and replace” of health reform.

Two years ago, long-frustrated advocates of national health reform rejoiced as Congress passed the Affordable Care Act (ACA).  Before the act was even signed, opponents began a campaign they described as ‘repeal and replace.’  This label, it is now clear, is misleading.  There is no agreed ‘replacement’ program. “Repeal” would kill expanded coverage for roughly 32 million low- and moderate-income Americans.

There is, however, a GOP program that goes beyond that, to roll back other health protections and roll back federal government activity to levels not seen since the 1930s…

This program has three pillars, which together may be more important than health reform. Thus far, these pillars have received less scrutiny than they deserve.

More here.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

10 thoughts on “Hank Aaron and I mildly dissent from the GOP effort to curb American social insurance”

  1. You are onto it Harold. The three pillars are well-described.
    But what exactly are they holding up? What is the “GOP Program” per se?
    And I mean an answer to my question in terms of evolutionary biology: The 20,000-foot, ice-cold, Thorstein Veblen objective, overview if you will.

    Here is a hint: How do chimps organize themselves? Define that model in a few sentences…
    How do primitive human tribes organize themselves? Define that model in a few sentences…

    Now consider the “GOP Program” in terms of those two models.

  2. The part I don’t get is how, after enacting all this, they avoid massive disaster at the ballot box. It is true that there will be gimmicks–for example, having the Medicare change affect only those under 55–but a
    lot of voters over 55 are closely related to, and care about the welfare of, people younger than that.

    1. a) Some Democrats will rush to be bipartisanly stupid
      b) The media will not know or care enough to analyze what all of this will mean for Americans, so will assure us that both sides do it and the confidence fairies are thirsty.
      c) Selfish old white people (the David Brooks demographic) will vote to preserve their privileges, lower their taxes – and screw anyone who tries to appeal to the national well-being.
      d) Lots of young people are thoroughly turned off by politics and weak Democrats and will not bother to register, much less vote.

        1. c) has been happening for roughly 30 years, Carol. It became critical over the last 12 years. Now, it’s the only thing keeping the GOP viable. Is it incoherent, short-sighted and massively destructive of the national interest? Sure, but that’s never worried conservatives. Just remember all those illiterate signs demanding that government be kept out of “their” Medicare.

  3. The problem is that no one believes in capitalism anymore. In the old days, capitalism meant more than a 10% of being able to retire and have some leisure time rather than working until one drops. Capitalism meant being able to get health care, and the best in the world at that, not a good, solid 50% chance, and then probably Dollar Store grade care, not Walmart or Saks. Capitalism meant being able to educate your children and having that education mean something in their future careers, not provide voucher funds for overpaid charter school executives. Capitalism used to mean something, and that something was better than what the lousy commies were getting. With the commies gone, it has been offering a whole lot less.

  4. The problem is that you’re confused. Capitalism never meant anything more than a system of private ownership of the means of production. Had diddly squat to do with health care, which was provided by employers only as a form of compensation which was cheaper because it wasn’t taxed. Which certainly has nothing to do with capitalism, as such, it’s just a distortion to the market imposed by government.

    1. Stipulate you’re correct about “capitalism.” Confused by “a form of compensation which was cheaper because it wasn’t taxed.”

      The amount paid by employers for health insurance would not be taxed anyway, if paid as additional cash in the paycheck instead of contribution to health insurance. Both are “operating costs” of the employer, fully tax-deductible to the employer. It is not cheaper to the employers.

      Consequently, the “distortion to the market” is the *opposite* distortion imposed by the government–the fact that the cost of health insurance paid by individuals is not fully tax-deductible.

      1. Mild nitpick:

        The fact that health insurance is not taxed as income to the employee may well make it cheaper for the employer than it would otherwise be. Employees will take less compensation if some is tax-exempt than if all of it is taxable.

        Not-so-mild comment:

        Employer-based insurance is inefficient from the employer’s point of view for a number of reasons. You have to administer the whole thing, which increases the overhead burden – HR and so on. Every so often you have to revisit the issue, deciding whether to change insurers, policy terms, and so on. As rates rise you either have to absorb the increase, which employees don’t really see as a raise, or increase the employee contribution, which they do see as a cut. In short, it’s a pain, especially for smaller companies.

        1. One other aspect – there are no payroll taxes on employer provided health insurance, so it is cheaper for employers to provide than equivalent salary.

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