Years ago, as the story goes, Britain's Parliament faced a difficult choice. On the European continent drivers use the right lanes, while the English remained on the left. But tunnels and fast ferries were bringing cars and drivers back and forth ever more frequently. Liberals in Parliament thought it time to change lanes. Conservatives resisted; after all, Brits had been driving on the left since William the Conquerer's charriot. Parliament's compromise was to move from the left to right lanes -- but incrementally, on a voluntary basis. Truckers first.My attitude has long been that in terms of health care policy, incrementalism is public policy's version of Zeno's Paradox. If we forever resist universal coverage in favor of measures to insure part of the uninsured population, we never reach the point at which everyone has access to quality health insurance. In environmental policy by contrast there's no particular desired end point, so we can always hope to achieve better environmental outcomes, and can pursue those by increments, a small positive step here, a small positive step there and we always make progress. In health care on the other hand all progress towards universal coverage that falls short leaves some other group still lacking in coverage, and as we cover progressively more people in reforms, those left out become ever more vulnerable to moralistic claims about the lazy poor that the United States is so prone to.
Friday, August 28, 2009
Robert Reich's incrementalist parable
Robert Reich has a good piece on the need to fight the desire to be incrementalists on health care reform. This is great parable that I thought was worth repeating in as many places as possible.