Health care overload: whither inequality?
David Leonhardt’s “Economic Scene” column in today’s New York Times, entitled “In Health Care Bill, Obama Attacks Wealth Inequality,” is a must-read.
Equality, particularly of resources, is a much more popular topic among political philosophers than among politicians. After we get past the idea that all people are created equal, Americans tend to have an ambivalent relationship with equality and what it entails.
Many prize the value of personal responsibility and believe that inequality driven by working harder and better is, in some ways, a sign that our entrepreneurial capitalist system is working.
In debates about social welfare, discussions of inequality are largely veiled. Addressing poverty or promoting economic opportunity garner broader support than “narrowing income equality” or “redistributing wealth.”
Whether or not they arrive at similar conclusions, political philosophers tend to be much more candid about what’s really at stake in these discussions: equality (what kind, how important, by what means?). That’s a good thing. It’s one reason we have political philosophy–to introduce clarity to public debate over values.
Although no one has really mentioned it until now, David Leonhardt makes clear that the health care bill is the biggest, most active federal effort to promote equality in almost 50 years:
The bill is the most sweeping piece of federal legislation since Medicare was passed in 1965. It aims to smooth out one of the roughest edges in American society – the inability of many people to afford medical care after they lose a job or get sick. And it would do so in large measure by taxing the rich.
A big chunk of the money to pay for the bill comes from lifting payroll taxes on households making more than $250,000. On average, the annual tax bill for households making more than $1 million a year will rise by $46,000 in 2013, according to the Tax Policy Center, a Washington research group. Another major piece of financing would cut Medicare subsidies for private insurers, ultimately affecting their executives and shareholders.
The benefits, meanwhile, flow mostly to households making less than four times the poverty level – $88,200 for a family of four people. Those without insurance in this group will become eligible to receive subsidies or to join Medicaid. (Many of the poor are already covered by Medicaid.) Insurance costs are also likely to drop for higher-income workers at small companies.
Love it or hate it, health care reform is a big deal. The real question is whether it promotes the society we want, or erodes the one we have. Or both.