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One more point that didn't quite fit into the other health care post: Jeff Jacoby's implicit argument is that we should get rid of the employer-based health care system. Agreed. But the impediment to that are not elites. Liberal wants employer-based health care gone, replaced by something like Medicare-for-All or some sort of voucher system. Real conservatives want it gone so people can die in the streets pay for heath care more directly. Problem is that voters don't want it gone. They have employer-based health care. They think it's a good deal (in a limited sense, it is: They're being heavily subsidized by taxpayers). And they're afraid of losing what they have. Mark Schmitt stated this eloquently some time back:
As the employer -paid health care system enters its death throes, people are not necessarily more receptive to a major alternative. They are more nervous about keeping whatever they have, and easily spooked. The suggestion that you might not be able to choose a doctor (not that you can under many employer systems these days anyway) or that certain procedures might not be covered, or that the system will be too complicated are likely to scare people who are already worried.[...]"The Liberal Blogosphere" -- disproportionately young, healthy and childless -- looks at health care as a fascinating intellectual puzzle and a great social priority, and it is both. Politicians, on the other hand, know that the voters most interested in health care are likely to be not young, healthy and childless, but they are likely to be insured in some way, and worried enough about losing that last bit of security. That alone accounts for the paradox.Mark was talking about liberal bloggers there -- me in particular -- but it applies to editorialists, policy wonks, and all the rest. These folks may not be young and childless, but they are comfortable, and economically secure, and certain they could master a new system and come out, if not on top, then in perfectly good shape. The electorate more broadly, however, has a firm status quo bias, and its' why most Democratic plans tend to leave it alone and just create parallel health care structures which they hope people will decide they prefer in time.The big question here, of course, is employers. Why they haven't risen up and demanded an end to the employer-based health care market is one of the questions that I've never been able to answer. Why does GM want to build cars and also provide health insurance? Why does Google want to be both a tech company and a medical coverage provider? It's absurd. But employers, for reasons that are beyond me, insist they have a central role to play in this marketplace. That is, for now, true. But in a normative sense, it should not be true, and in a more concrete sense, it's very hard to say why they want it to be true.
