Jacob S. Hacker is Professor of Political Science and Co-Director of the Center for Health, Economic, and Family Security at U.C. Berkeley. He is also a Fellow at the New America Foundation in Washington D.C. His most recent books are Health At Risk: America's Ailing Health System--And How to Heal It, and The Great Risk Shift: The New Economic Insecurity and the Decline of the American Dream.
In tonight's final presidential debate, Obama is likely to be pressed (as he was by Jim Lehrer in the first) to say which elements of his agenda he is going to have to put off in light of the depressing new deficit numbers and the massive (hopefully temporary) outlays necessary to save capitalism from itself.
Many commentators seem to believe that the answer should be "health care." (It may be indicative of how much credence they're giving McCain's proposal for enormously costly new tax credits for private coverage that few of the calls for fiscal probity on health care have been hurled his way--or maybe it's just that they think he won't win.)
Cautious words on health care seem superficially appropriate. After all, health care is exorbitantly expensive, and aren't we already in the hole with Medicare and Medicaid? But the standpatters have it exactly backward. To the extent that we're worried about the budget and the future of our economy, health care reform is more vital, not less so.
For starters, as Henry Aaron has nicely shown, our long-term deficit problem is really a health care spending problem. If you take health care programs out of the equation, there is literally no other long-term federal budget problem. None. No Social Security crisis. No out-of-control-earmarks catastrophe. No deficits as far the eye can see.
And the health spending problem is a private crisis even more than a public one. Federal and state coffers are suffering, but the pain is arguably even worse among families and private businesses--which lack the government's buying power. Even a modest slowdown in the rate of increase of health spending would help public and private budgets immensely. Put simply, we can't afford not to tackle health care.
It would be one thing, of course, if we didn't know how to do this. But there are plenty of programs both here and abroad that show us how to provide much broader coverage and actually spend less than we do now. By way of illustration, I have developed a proposal called the "Health Care for America" plan that builds on the best elements of our present system while addressing the key deficiencies. This proposal, which informed the Obama plan, is projected to cover everyone without costing an additional dime in national health spending; it will also produce a far-from-modest $1 trillion in national savings over ten years.
But there's an even more basic point: Health care is at the epicenter of economic insecurity in the United States today. As this useful interactive map from the Economic Policy Institute shows, nearly every state has seen big declines in the reach of employer-based coverage since 2000, and the system was already on life support in 2000. If we are going to bailout Wall Street, shouldn't we providing decent health care to Main Street?
Let's not close a golden of window of opportunity before it even opens.
--Jacob S. Hacker