In Friday's New York Times, David Brooks discusses briefly the history of health care and what shifts we may see in the future. He talks about it in terms of a social contract, the explicit or implicit agreement between a government and its citizens about what each will provide the other.
He and others argue that health care will turn into the most important domestic issue for the upcoming election. The existing social contract, the one established during the New Deal and relies on employer based programs, no longer works, and must be replaced with one more in tune with how people work and live.
There are three problems he cites in the existing program: (1) the number of people insured keeps dropping, (2) rising health costs are placing increased costs on employers, (3) the fact that health care is provided by employers ties employees to their jobs and makes it less likely that they have incentives to look for better work.
He points out that the United States has vacillated between a laissez faire system in the 19th century where individuals were completely on their own, to a centralized bureaucratic system that can be traced to the New Deal.
Brooks points to recent work by Stuart Butler of the Heritage Foundation who has proposed policies that provides guarantees that people who contribute to society will be protected in the event that they suffer catastrophic health setbacks, but does so in a manner that ties in the range of social institutions which already exist in America. Butler, by the way, is the guy who thought up Free Enterprise Zones years ago. so he has a bit of a history as policy entrepreneur.
