Krugman on Healthcare: Aim for Mediocrity
Paul Krugman’s Times column today is disappointing on a number of fronts. He counsels the Democrats to go for the usual mixed bag of government guidelines cobbled together with private insurers on the grounds that
“it’s better to have an imperfect health care plan than none at all.”
But Krugman has to know that the opposition to health care reform will be just as strong against an incremental approach like the one he advocates as it will be against a medicare-for-everyone comprehensive overhaul. The real risk is that a new Democratic administration will go for a watered-down program and will still lose. Sound familiar? See the Clinton folks c. 1993.
Most disappointing, however, is Krugman’s selection of the Massachusetts healthcare reform law as his shining example of how change can happen. He admits that the law “has come in for a lot of criticism,” citing its individual mandates. But he doesn’t mention two of the criticisms that he himself has focused on time again: the weak effort to control costs and the unattractive products-with high premiums and high deductibles- that private insurers have thus far offered.
The low point is the following sentence:
“And its costs are running higher than expected, mainly because it turns out that there were more people without insurance than anyone realized.”
This is downright deceitful. Krugman cannot be ignorant of the criticisms leveled in 2006 of the estimates of the numbers of uninsured people in Massachusetts. The figure of 500,00 was obtained through a telephone survey conducted only in English and Spanish and only of people with landline phones. As a number of critics pointed out at the time, this substantially underestimated those who were uninsured. (The U.S. Census, for example, estimated 748,000.) National survey data available at the time showed that over 48% of uninsured people did not have a landline-type phone.
The costs for the new health law were based on the lower figures, which, of course, underestimated these costs. This helped it pass. Now more people have signed up because there always were more people who needed subsidized insurance. And the law does far too little to control costs, adding to the overall expense. It’s not, as Krugman writes, that no one realized that there were so many un-insured. It’s precisely that proponent of the law wanted to undercount the actual number of uninsured to make their budget projections work.
Now this deception is being touted as “success.” In today’s Globe Scott Allen (Leaders nip, tuck, healthcare policy, August 11) repeats a dubious contention as fact. He writes that
the [healthcare reform] law has been so successful-prompting an estimated 345,000 people statewide to obtain insurance-that it has been far more expensive than expected….
This, I point out, was printed as a straight news story, not an opinion column. The local and national media have been sold-and have bought-the story that “Gosh-more people want to buy in to our nifty new healthcare program, isn’t this just wonderful?” It’s a classic case of bait-and-switch. And this is model for national emulation?
Paul Krugman wants a health reform program that deliberately aims for mediocrity-knowing all the time that we’ll fall short of that mark.