In a related point to the last post, Harold Pollack offers some righteous fury on all the public health spending being cut out of the stimulus. Towards the end, though, he gets to an interesting, and broader, point:
Conservatives and moderates have successfully framed this week's debate to imply that liberals have larded up the stimulus with special interest pork and spurious, ideologically-driven spending. The real problem is precisely the opposite.As my colleague Jens Ludwig points out, public health measures are vulnerable because they are not porky enough. They do not slide neatly into the grooves of American interest-group politics. Public health policies have an unfortunate tendency to improve health among diffuse, disorganized, or politically marginal constituencies. These policies provide too little gravy to organized and powerful constituencies. Although many interest groups and many politicians claim to support public health and prevention, few care quite enough to support these values once the shoving starts.
I've argued before that what we call health care reform is actually health care spending reform. There's a reason for that: Health care costs arouse powerful interests. Businesses are burdened. Households go bankrupt. Primary care doctors see their fees cut. Pharmaceutical companies want full reimbursement for their products. Health care spending, to use Ludwig's phrases, slides neatly into the grooves of American-interest group politics. But health does not. In fact, it can do the opposite. The pharmaceutical companies do not make more money if there are fewer smokers and less need for cancer drugs or fewer diabetics and less need for maintenance. Indeed, the optimal situation for many of the major players in the health industry is a lot of sick people to treat. Interestingly, this is one space where insurers are actually on the side of the angels, as they make more money if their members don't fall ill.
