Hot sticky weather brings out gardeners’ nemesis: kudzu. The tenacious weed grows and grows, thriving in all soils. If unchecked, it will take over a garden, killing everything else.
This summer the political genus of kudzu thrives. Tired, erroneous ideas about health insurance take root in political discourse. They flourish, soon dominating the discussion – crushing out any seedling truths. Throughout the nation candidates for state offices are mounting daises to tout their “new” ideas.
Some of those brainstorms are kudzu.
Here are a few.
1) Raising employment will solve the problem of the uninsured.
Typically somebody asks a candidate for state office what s/he will do about the uninsured. Instead of saying “nothing,” which is probably the truth, the candidate blathers on that he will bring economic development to the state (the audience cheers), which will bring more jobs (more cheers), which will get people insurance (deafening cheers).
Like kudzu, the blather looks OK. But in the past few years we had record prosperity, with unemployment dipping below the “structural unemployment” levels economists used to think constituted the cellar. And even in those boon times, 40 million Americans were uninsured. Jobs bring paychecks, boost tax revenues, spur entrepreneurs – but don’t necessarily insure workers.
2) Improving education is the key to insurance.
The candidate sidesteps the question: the problem is not x, but y. Or, in this case, the problem is not the lack of insurance, but the lack of education, which keeps people from getting the good jobs that will get them insurance.
This is a rational candidate response: after all, states control education, not health insurance. But this kudzu is a variation of the genus. Education makes a workforce more employable – but an employed workforce is not necessarily an insured one.
3) Small business pools are the answer.
If there is a way to rout this kudzu, nobody has found it. Theoretically, business pools should help. A small business gains purchasing clout by expanding his “pool” as much as possible. But the experience with pools has shown that they are not the answer. Even subsidized pools rarely bring premiums down low enough to bolster the number of people who get insurance.
4) Federal programs will bolster insurance.
This is true, at least for children. The Children’s Health Insurance Program (CHIP) lets states use federal monies to insure income-eligible children whose parents, though employed, do not get insurance at work (in effect, a Medicaid extension). CHIP has bolstered the numbers of children with insurance.
States, though, eagerly seized on CHIP when their revenues were soaring. A candidate’s predecessors used CHIP as much as revenues allowed.
Today, most states confront deficits. Newly-elected solons will be hard-pressed to keep up their predecessors’ commitments to CHIP, let alone expand them.
5) State pools will insure people who can’t buy insurance on the private market.
Candidates offer a health care version of the awful-drivers-pool: in some states where drivers with “poor records” cannot get insurance, those drivers can go to a special pool. A few states have tried these health care pools. The result: the pools attract such sick people that the premiums are so high that few people can afford them. People gain “access” to insurance that they cannot afford – doublespeak for nothing.
6) The best minds will reconnoiter to solve the problem.
The most persistent variety of political kudzu is the promise of a blue-ribbon commission, a study group, the best minds meeting to solve the dilemma. This promise stalls discussion: voters must await the orderly progression from great-minds-meeting to solution. It shows the candidate as thoughtful, cognizant of the complexity of the problem, eager to summon the best-and-brightest. It is also ridiculous: the best and brightest have been studying health care for decades.
In a garden, kudzu shuts off desirable plants; in a political campaign, it shuts off honest discussions.
Joan Retsinas is former executive director of the Rhode Island Health Care Policy and Planning Consortium.
