Sunday, February 9, 2014

Why Do Conservatives Want to Incentivize Workers to Accept Bad Health Insurance?

This is the key question I've seen materialize in the healthcare debate. You could add to it two others, which seem clear to me: One, why do conservatives prefer that health insurance be more expensive, and, two, why do conservatives prefer more and more expensive healthcare, period? But let's look at the first question. It seems implicit in this Ross Douthat paragraph from today's NYTimes op-ed:
At the same time, though, the design of Obamacare — Medicaid expansion, subsidies for comprehensive rather than catastrophic coverage, and then the way the subsidy disappears if you get a raise or take a higher-paying job — makes the work disincentive much more substantial than it would be under, say, a conservative alternative that offers everyone a flat credit to buy a catastrophic plan.
What's obvious in the statement -- and clearly Douthat is not confused in his belief that he represents the "conservative alternative" -- is that Obamacare insists on comprehensive healthcare coverage and conservatives prefer to offer "a flat credit to buy a catastrophic plan." That's a clear theme with GOP pitches, including the attempt to get Obamacare to permanently allow Americans to keep their inferior catastrophic plans, as well as what Douthat finds in the AIE plan, not to mention what's implicit in the Hatch-Burr-Coburn plan that tends to cap subsidies and tax credits, forcing low-wage workers to afford only crappy, catastrophic coverage. (This conservative policy point inflicts bad coverage on the self-employed entrepreneurial class, as well, since they often can only afford catastrophic plans.)

There's the usual moral-hazard, the-poor-are-lazy rhetoric -- with a nice backhanded compliment to John Maynard Keynes -- in Douthat's piece, but I'm not out to criticize that here. Let's look at how Krugman views it in a blog post:
The result [of Obamacare] was to create something like the infamous “notches” sometimes created by welfare state benefits — but in reverse. The traditional notch comes when, say, housing subsidies are available as long as you’re below 150 percent of the poverty line — which means that you have a strong disincentive to move your income from slightly below to slightly above that threshold. What we had here was, instead, a system in which subsidies were available only if you worked more than a certain amount, surely leading some people to work more than they would have wanted to otherwise.
And that’s not a hypothetical — I know a fair number of people in just that situation. I also know some people in “job lock” — feeling trapped in their current job because they aren’t sure they could get implicitly subsidized health insurance if they moved.
Does the reverse notch plus job lock mean that the CBO’s estimate of work reduction (NOT job loss) actually represents a gain in welfare? It might or might not — the traditional tradeoffs surely apply to many workers too. But you don’t want to assume that it’s obviously a bad thing. Health reform isn’t an intervention in a previously undistorted economy; you might say that it replaces one set of distortions with a different set of distortions.
And the one thing that remains clear is that it will be a big plus for the people who most need help.
 Krugman views it as "a big plus for the people who most need help," and Douthat views it as the title of his op-ed states it, "Leaving Work Behind." It's a moral hazard with Douthat to disincentivize work. To Krugman it's a blessing that someone who works full-time for health insurance, even though it's killing his back, needing to get by on massive doses of Ibuprofen all day because he can't afford to retire before 65.

Douthat's reference to Keynes predicting the day would come when people could afford to work considerably fewer hours while maintaining a decent standard of living, actually amounts to a dig at low-wage, low-skilled workers. Disincentivizing work "gives" to the lower classes something they haven't earned. They deserve to suffer because they haven't earned the right to their comforts. It's easy to condemn low-wage, low-skilled workers because they must be members of a rightfully disenfranchised class. You're dumb, you're lazy, you deserve to suffer. But these class distinctions don't come about in the way Douthat assumes. People like him who grow up with all the grooves greased for a trip to Harvard leading to a well-paid job that doesn't involve sticking a mop in a bucket several hundred thousand times until, at the age of 59, a man can barely move without constant pain. This man Douthat dismisses as someone who is disincentivized to maintain the "dignity" of work.

If this janitor was lucky enough to work for a school district with decent health insurance and, even better, a chance at a pension, he might be lucky enough to afford to retire early to alleviate the constant pain, knowing he can afford decent healthcare -- because of Obamacare -- until he reaches 65 and Medicare.

God forbid that same man might be working for a private restaurant in California wine country for minimum wage with no healthcare coverage at all and no likelihood that he can quit for a better-paid job that doesn't exist. This man works on in Ross Douthat's world with subsistence wages but at least is experiencing the "dignity" of work.

More than likely that man washing dishes and scrubbing kitchen floors is part of that very special class called the Hispanic undocumented worker who, in Douthat's world, doesn't deserve the protections of a more enlightened nation. He deserves this back-breaking work because his status as low-wage, low-skilled and even illegal leaves him with no rights and even less sympathy.

Though these are the people that do our back-breaking work, they are those that conservatives are willing to spend billions on higher and higher border fences to keep out, we need them in our current system, one in which we have what we should openly admit we have, and that's a permanent new slave class, same as the old, only less black and more brown.

At least, though, they have the "dignity" of work, work that conservatives strive to keep at $7.25 an hour because the slave class doesn't deserve the "dignity" of $10.10 an hour. That would be coddling, that would be class warfare, that would be one fewer Rolex in Thomas Perkins famous "six-pack of Rolexes."

But back to my point: Conservatives don't want the American employee -- legal or otherwise -- to have decent pay and decent healthcare, they only want to coddle the rich, who just happen to be the conservatives' true cause, that of incentivizing the massive campaign contributions they need to maintain their power. Any claims about the dignity of work or of makers-and-takers and welfare-cheats or poor people who have the nerve to own a cell phone or a TV is only so much hooey. It's the indefensible talking points of the master servants of the master class.

The fact that income inequality perpetuates a moral divide is lost on Douthat, or he simply doesn't care. If you were able to capture all the ponies, you deserve to ride with the king. The peasants, not so much. Have I misunderstood Douthat? I don't think so:
But it’s also possible to argue that as a rich, post-scarcity society, we shouldn’t really care that much about whether the poor choose to work. The important thing is just making sure they have a decent standard of living, full stop, and if they choose Keynesian leisure over a low-paying job, that’s their business.
There are hints of a division within the liberal mind on this issue. Across the left and center-left, there’s agreement that an unequal society requires a thicker social safety net, and that as technological changes undercut low-wage work, government should help those left behind.
But in the Obamacare debate and elsewhere, it’s not always clear whether this larger welfare state is supposed to promote a link between work, security and mobility, or to substitute for work’s gradual decline. On the left, there’s a growing tendency toward both pessimism and utopianism — with doubts about the compatibility of capitalism and democracy, and skepticism about the possibility for true equality of opportunity, feeding a renewed interest in 1970s-era ideas like a universal basic income.
On the conservative side, things are somewhat clearer. There are libertarians who like the basic income idea, but only as a substitute for the existing welfare state, not as a new expansion. Both “rugged individualist” right-wingers and more communitarian conservatives tend to see work as essential to dignity, mobility and social equality, and see its decline as something to be fiercely resisted. [Boldface mine.]
 No, I don't misunderstand Douthat at all. Keynes proposes leisure while conservatives resist the decline of work, if only for the dignity it affords the poor, which is as it should be because the poor cannot, or should not, afford the leisure.

This discussion has come full-circle even though I tried and failed to concentrate on access to quality healthcare versus the conservative policy preference for inferior coverage for the plebeians. What I didn't cover here was the mistaken assumption that Douthat makes that it's the poor who are ready to ditch work or cut hours because of Obamacare's disincentives to work. It's just as likely or even more likely to be a middle-class mother who stays in a full-time job for healthcare for her and her family who will then choose to cut back for the sake of her children or her elderly parents. Douthat finds it easier to pick on the poor because it's implicit in the conservative worldview that it's the poor's fault they're poor because if they weren't lazy they'd be working hard and counting their Rolexes.

Update. Almost right on cue, Senator Roy Blunt Jr. (R-Mo.) goes on Fox News Sunday this morning to issue the new GOP talking point that Obamacare encourages people to be lazy.

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