As the historian Nancy Tomes outlines in a seamless and utterly fascinating narrative, the good old days never really existed. (Read an excerpt). For more than a century now, American health care has been a fraught marketplace, hosting a power struggle among consumers, providers and regulators that may have escalated over the decades but is otherwise remarkably unchanged.
My guest this week is Michael Hiltzik, a columnist with the Los Angeles Times and the author of The New Deal: A Modern History, now out in paperback.
Michael has been doing great work covering the rollout of the Affordable Care Act and we spent a good deal of time in this multi-part interview discussing those efforts. In our first segment, though, we briefly discuss the far-reaching social insurance programs undertaken by President Franklin Roosevelt and the landmark health reform legislation embraced by President Barack Obama.
Rational Irrationality and the Political Process of Repeal: The Women’s Organization for National Prohibition Reform and the 21st Amendment by Michael Thomas, Nicholas Snow :: SSRNJanuary 20, 2013
The theory of rational irrationality suggests that voters are biased and do not face sufficient incentives to choose rationally; instead they vote for various private reasons. As a result, socially and economically destructive policies can receive widespread public support. Furthermore, because there is no private benefit of learning from experience, such policies can persist over time. We argue here that despite this otherwise dismal outlook on public policy, the theory of rational irrationality leaves two avenues for economically sensible reform: First, when the ex post costs of irrationality are higher than expected, rationally irrational voters will reduce their consumption of irrationality and demand more rational policies. Second, rationally irrational voters can be convinced to rationally update their policy preferences through the use of appealing rhetoric and persuasion by experts. We discuss these two avenues for reform using the example of the repeal of the 18th amendment, which, as we will show, relied on both updating as well as persuasive campaigning.
When Roosevelt proposed Social Security in 1935, he envisioned a contributory pension plan. Workers payroll taxes “contributions” would be saved and used to pay their retirement benefits. Initially, before workers had time to pay into the system, there would be temporary subsidies. But Roosevelt rejected Social Security as a “pay-as-you-go” system that channeled the taxes of todays workers to pay todays retirees. That, he believed, would saddle future generations with huge debts — or higher taxes — as the number of retirees expanded.
Hospitals, Finance, and Health System Reform in Britain and the United States, c. 1910 – 1950: Historical Revisionism and Cross-National ComparisonFebruary 14, 2012
Comparative histories of health system development have been variously influenced by the theoretical approaches of historical institutionalism, political pluralism, and labor mobilization. Britain and the United States have figured significantly in this literature due to their very different trajectories. This article explores the implications of recent research on hospital history in the two countries for existing historiographies, particularly the coming of the National Health Service in Britain. It argues that the two hospital systems initially developed in broadly similar ways, despite the very different outcomes in the 1940s. Thus, applying the conceptual tools used to explain the U.S. trajectory can deepen appreciation of events in Britain. Attention focuses particularly on working-class hospital contributory schemes and their implications for finance, governance, and participation; these are then compared with Blue Cross and U.S. hospital prepayment. While acknowledging the importance of path dependence in shaping attitudes of British bureaucrats toward these schemes, analysis emphasizes their failure in pressure group politics, in contrast to the United States. In both countries labor was also crucial, in the United States sustaining employment-based prepayment and in Britain broadly supporting system reform.
Waging War on ‘Unemployables’? Race, Low-Wage Work, and Minimum Wages: The New Evidence by Harry Hutchison :: SSRNJuly 2, 2011
Capturing both popular and academic imaginations, recent literature contributions contest the standard treatment of minimum wage statutes as vehicles that enlarge the economic and social dislocation of vulnerable workers. A persistent strain of the current scholarship dedicated to progressive labor ideology implies that minimum wages or, alternatively, living wage statutes are necessary to preclude the degradation of low-wage workers. The publication of Simon Deakin and Frank Wilkinson’s recent article, Minimum Wage Legislation, constitutes yet another effort to destabilize the neoclassical consensus that emphasizes the adverse employment effects of wage regulation. Prescinding from orthodox economic analysis, Deakin and Wilkinson insist that there is a good efficiency-based case for minimum wage legislation. If the authors are correct, and if efficiency standing alone supports their normative viewpoint, then the contention that such legislation ought to be seen as a societal good might become tenable.
Unfortunately, their claims are highly doubtful. Perceived through the lenses of American labor history, classical liberalism, Critical Race Theory and neoclassical economics, the authors’ allegations signify the capitulation of reasoned analysis to ideology. Rather than supporting the interest of the public or of vulnerable workers, their starkly conventional and progressive approach to labor law reform recalls John Stuart Mill’s embrace of Social Darwinism and consequent exclusion of inferior classes of workers. The authors’ approach also verifies Mill’s observation that modern liberal democracy – operating consistently with the goals of exclusion – is insufficient to protect disfavored groups and individuals from the coercive power authorized by a majority or its hierarchs. Since Deakin and Wilkinson’s credulous claims are in harmony with more than a century of progressive policies, and since the normative and prudential case for raising or retaining the minimum wage remains weak, marginalized members of society have much to fear from their analysis.