Balkinization  

Saturday, September 05, 2009

You have no idea

Andrew Koppelman

One of the classic justifications for democracy is that an accountable government will do a good job of looking after people’s needs, because the voters will reward the incumbents if they do that. The present health care reform struggles cast some doubt on this theory. It turns out that government can very publicly make a lot of people a lot better off, and it will not be rewarded, and in fact may be punished.

In a characteristically smart posting at the New Republic website, William Galston observes that a major obstacle to President Obama’s aspirations for health care reform is that most Americans are satisfied with the insurance they have:
Seventy-three percent describe the affordability of basic medical care for themselves and their families as “manageable” or even “easy”; 69 percent say that their health insurance company pays for all or most of the treatments and medicines they current need; and fully 76 percent say they are very or somewhat confident that if they were to become seriously injured or ill, their insurance would pay for everything they needed to get better. According to the Kaiser Family Foundation, the share of Americans who believe that they or their families would be worse off under reform has risen by 20 percentage points since February. Today, fully 51 percent are more worried about the health reform bill they expect Congress to pass than by the possibility that reform will be delayed beyond this year.

This data sits uneasily beside a recent study in the American Journal of Medicine of personal bankruptcies in the United States.In 2007, 62% of all personal bankruptcies were driven by medical costs."Nationally, a quarter of firms cancel coverage immediately when an employee suffers a disabling illness; another quarter do so within a year," the report states.Most of the medical debtors were well educated, owned homes, and had middle-class occupations, and three-quarters of them had health insurance. "Unless you're a Warren Buffett or Bill Gates, you're one illness away from financial ruin in this country," lead author Steffie Woolhandler, M.D., of the Harvard Medical School, said in an interview. "If an illness is long enough and expensive enough, private insurance offers very little protection against medical bankruptcy, and that's the major finding in our study."

In other words, all those people who oppose health care reform because they like the coverage they’ve got really have no idea of the real dangers they face, because they have no idea what their insurance companies would really do to them if they got sick.This poses a real political challenge for the proponents of reform.The people who will most benefit from the consumer protections that Obama is advocating – those who will experience serious illness in the future – have no idea that they are benefiting, and so will not politically reward those who deliver the benefits.The Democrats could give most Americans substantially greater security and receive no reward for it.

It’s in the Democrats’ interest to see that these real dangers are better understood.It would be nice if there were some mention of them in President Obama’s national address on health care this Wednesday.

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