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.