• Reform behind its time

    It’s really a shame we didn’t achieve comprehensive health reform in the early 1990s. Economically (though not politically), the decade of the 90s turned out have been an ideal time for expansion of government. GDP was growing and government revenue with it. Moreover, because of the strong economy, employment was robust, which means employer-based health insurance was relatively high and stable. Managed care had not yet wrung some inefficiency from the system. There was plenty of slack upon which to build a new program.

    I’m not suggesting Clinton’s plan was the right one for its time. In fact, because it failed, it clearly was not. I’m saying that if one wanted to choose a good time for health reform, one could not do much better than the 1990s.

    In contrast, the current decade is a horribly difficult time for reform. That’s not to say reform is not needed. Of course it is. It’s just hard to pull off in a climate of austerity, very low growth, and (it seems) maximally dysfunctional politics. Rather than riding a wave, as we would have in the 1990s, we’re swimming against a swift current.

    Kenneth Thomas reminds us it gets even worse.

    Using the Gallup data since it is more recent, fully 70% of the increase [in the percent of population uninsured] (1.4 of 2.0 points) came from 2008 to 2009, when the full-year unemployment rate rose from 5.8% to 9.3%, as mentioned in the Kaiser article. Yet unemployment peaked at 10.1% in October 2009 and is down to 9.1% in August 2011, so it isn’t simply unemployment since the uninsured rate has continued to rise. The other main cause would appear to be reduced employer provision of health care, whether through plan suspension, unaffordability, or of course job loss. According to Gallup’s data, the percentage of adults with employer-provided insurance declined from 49.2% in 2008 to 45.0% in January-May 2011.  The figure in 2010 was 45.8%, meaning that employer-based insurance fell even though there was no increase in unemployment.

    Obviously provisions of the ACA that won’t go into effect until 2014 will help stop the growth in the rate of uninsured. But, really, we need them now. Heck, we needed them two years ago, if not before. Though we’ve finally passed something like comprehensive health reform, it’s reform that is behind its time.

    • Not to argue with you main point here, but just a comment. The “unemployment rate” is defined relative to the population that wants to be working whereas the percentage uninsured is relative to the whole population.

      So you’d expect the correlation to change as workers get discouraged and stop looking for work, as unemployed workers accept jobs without benefits and lose insurance coverage, and probably a bunch of other phenomena that don’t come to mind just now.

      • It’s a great point. I thought of making it myself. I wondered how long it’d take for it to come up in the comments. I did not expect it so soon. I underestimated TIE’s readers. 🙂

      • Perhaps I’m missing your point, but I’m not sure why we would “expect” the positive correlation between unemployment and uninsurance to change. As more people get hired, some percentage should gain health insurance. But in fact, we see that more people were losing insurance, for whatever reason, than gaining it.

        The point of my post was to say that, even though it’s not guaranteed, our best chance of insuring more people before 2014 is still to give more people jobs.

        Note that in the Gallup survey, the denominator is adults (age 18+), not the entire population.

        • It’s possible David was thinking of something else. Speaking for myself, I was thinking that it is possible for the unemployment rate to go up even if the number of employed individuals goes up. Conversely, the unemployment rate could go down even though the number of employed individuals goes down. The correlation between unemployment rate and access to ESI is not perfect. I didn’t bother to mention this in the post because I didn’t think it relevant in the points either of us were making.

    • ” our best chance of insuring more people before 2014 is still to give more people jobs.”

      Agreed. Period. I’m just quibbling about how you _count_ those people and jobs: I think it’s the employment to population ratio, not the unemployment rate, that we need to look at. Between people giving up and people taking jobs without benefits (which you mentioned), it’s not surprising that the unemployment rate no longer tells us how many people have insurance.

      • David,

        Okay, thanks. Looking at the employment/population data, it does indeed look like it correlates better with the uninsurance rate: big drop in 2009, smaller drop in 2010, even smaller drop in the first half of 2011, but most of it in June 2011, which matches the Gallup findings very well.

        Thanks for pointing that out!