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.

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.


Abe said...

So are you saying no public option go straight to single payer?

Cwech said...

no, while single payer is a better idea, what I'm saying is that measures that stop short of universal coverage never get us to where we want to be, we cover the elderly, we cover the poor, we cover children, we enact insurance reform, and still we fall short of a health care system that works, and we fall short of universal coverage, until somebody clamps down and says, "damnit we're going to do this," it never happens and we still end up stuck with a dysfunctional health care system that can't deliver anything to a huge number of people.

The public option was a compromise between single payer and a health insurance exchange with no governmental program, it is a very moderate proposal, but its not a half measure, I would of course rather have single payer as I think it would work better, but the public option is not the kind of incremental policy that I'm disparaging. Dumping universal coverage is.

As a side note, I think it would have been a better strategy to go for single payer at the beginning anyway, since most people seem to think that's what's been proposed in spite of it all.