on October 16, 2006
In his ethnography (PDF) of Grover Norquist's weekly breakfast meetings, Thomas Medved tells us how Newt Gingrich sold reluctant conservatives attending the meeting on Medicare reform.
The debate up to this point functioned largely as a prologue for the day's special guest, former Speaker of the House Newt Gingrich. Here to mediate between the fiscal conservatives who disliked the bill and the free-market conservatives who saw in it the seeds of health care privatization, Gingrich spoke out in favor of the Medicare reform act. His primary message to the group was that they must start "thinking like a majority" by accepting the logic of incremental progress. That's how the welfare state was built, he said, and that is how it must be dismantled. Citing his own efforts to "stop Hillary-care" and promote the Contract With America as examples of incremental progress, Gingrich said Medicare reform is a step toward a more conservative country because it "moves you toward choice." Gingrich saw other benefits in the legislation as well. He cited in particular a major "shift in plate tectonics" now that the American Association of Retired Persons (AARP), the largest voluntary organization in America, was on the Republican side of an issue and against the Democrats. And there was yet another hidden advantage: Gingrich predicted that the bill's passage would "break up the collectivist language" of union members because when employers adopt the strategy of giving Health Savings Accounts to their non-union employees, the unions would start fighting for them. In general, Gingrich said, we can "migrate Medicare" rather than destroy it by creating choices that baby boomers will take advantage of.
"Creating choices" is an interestingly ambiguous term. As discussed in Jacob Hacker's book, people who have signed up to Health Savings Accounts (which were around before the Medicare legislation) seem to be much less happy than those who have traditional coverage; they presumably wouldn't `choose' them if there were better options on the table. Nonetheless, the number of Health Savings Accounts is growing. Over a quarter of large employers said that they would offer them in 2006, and larger employers such as Walmart are increasingly trying to move away from traditional plans to HSAs, which discourage workers with health problems from staying with the firm, and hence save them money. The choice offered here is to accept a worse deal from your employer, or quit and hope that you'll somehow find something better somewhere else. Not much of a choice. Yet nonetheless, when the mantra of `choice' is invoked by the right, it often refers exactly to choices of this kind. There's something weird going on.
Jacob Hacker wants to unravel this weirdness. He's a political scientist - his major empirical contribution in the last few years has been to describe the mechanisms through which Gingrich and others have deliberately sought to undermine welfare state institutions, inch by inch. In writing about this, Hacker has enlarged our understanding of how institutional change takes place. But this book isn't an exercise in descriptive social science. It does help explain how the right's renewed emphasis on `personal responsibility' is less an exercise in increasing choice, and more a means of transferring risk away from large collective actors (such as governments or firms) to individuals, who typically have far fewer resources to deal with disaster when it happens. But Hacker is trying to change the political debate, to push back against current ways of framing these issues, and in so doing, to redefine the intellectual terrain. This is why the book was attacked so vigorously (and incoherently) before it was published, by people like Brink Lindsay and Glenn Reynolds . If Hacker's framing of politics succeeds in taking hold, it will make it much more difficult to chisel away the foundations of the American welfare state than it has been in the past, and correspondingly make it easier to expand welfare state principles to new areas.
Hacker's account is twofold. First, he looks at the various ways in which risk has increased over the last few decades. Jobs: Hacker discusses how expectations of stable employment have nearly disappeared, how part time and temporary work have increased, and so on. He argues, as others have argued, that `flexible' jobs don't necessarily increase choice for employees, because these work arrangements are typically set up "for the convenience of employers, not workers." Part time work may in principle be a boon for mothers with young children - but not when the firm changes your schedule according to its week-to-week needs, and fires you if you can't make it in. Families: having a family increases your risk of going bankrupt, and involves massive, and increasingly risky investments in housing and education. Old age: as defined benefit pension plans become vanishingly rare, individuals take on more and more risk through defined contribution plans, which will do well if the stock market does well, and do badly if it doesn't. Health: health care has become ever more expensive, posing greater risk both to the uninsured and the insured (and people move back and forth between these groups far more often than most people realize).
At least some of this increase in risk is secular - it's hard to trace it back to specific decisions made by particular people or groups. But what isn't hard to trace back are the decisions made by policy makers to exacerbate these risks by aiding and abetting the transfer of risks to individuals rather than countering it. This is the second prong of Hacker's argument. We know that policy makers could have done differently - they have done differently in other countries. But in the US, thanks to Gingrich and others like him, government has sought to increase individuals' exposure to risk rather than to decrease it, typically under the mantra of increasing `choice' or `freedom.' Thus, for example, the abovementioned individual Health Savings Accounts. Thus too, the effort to tear down Social Security, and replace it with a system of `private' or `personalized' (depending on which buzzword works better with focus groups) accounts, regardless of the enormous switchover costs. Instead of trying to mitigate risk, government under conservatives has sought to pile ever more risk on individuals, even if the fiscal consequences are horrendous.
Hacker argues that not only are these policies ideologically loaded - they transfer risk from corporations to the middle and working classes - but they don't make any sense in their own terms. High degrees of personal risk are a hindrance rather than a spur to beneficial economic activity. If people perceive that their jobs are risky, they're likely to underinvest in specialized training (here, there is a well established literature in political economy which suggests that an extensive welfare state goes hand-in-hand with the development of specialized skills). Personal investments in education are less attractive if the rewards from education are highly uncertain. In the book's conclusion, Hacker briefly describes a variety of policies that might help mitigate personal risks, including his own proposal for Medicare Plus.
Despite this short discussion of policy options, The Great Risk Shift isn't really a book that is aimed at the professionals who write about health care, pensions etc, or at scholars, although it relies extensively on findings by both policy wonks and academics. It isn't intended to contribute to specific policy debates, but to transform very broad public arguments. To my eyes at least, it seems very clearly intended to claw back territory from what Hacker describes as the Personal Responsibility Crusade by making policy makers deal with the problems of risk, and by making ordinary people realize that the economic risks that they face haven't descended from the skies. In large part, those risks are the result of conscious, deliberate choices made by conservative policy makers (and sometimes by centrist Democrats) both indirectly to help pave the way for the transfer of risk to individuals, and not to intervene when government could play an important role in mitigating risk.
Which is all to say that this book is going to succeed or fail to the extent that it changes wider public debates. As an unreconstructed social democrat, I wholeheartedly hope that it succeeds; while there are bits of Hacker's argument (such as his explicit discounting of the issue of economic inequality) that I disagree with, on the whole, I think that this is a highly valuable, and indeed potentially explosive book. This is a good, smart, polemical book. It deserves a wide readership, so that next time a Newtoid starts talking about this or that appalling piece of legislation `increasing choice' or `personal responsibility,' he or she will be called on it. Even if George Lakoff and others' arguments about political framing are rather reductive, political debate is shaped profoundly by the language that it is conducted in and the concepts that it invokes. This is a fiercely and tightly argued effort to change those concepts. I hope it succeeds.
Hacker reports on a broad-based risk-shift from society to individuals - across healthcare, pensions, and job security. The shift has been obscured for many by its slow movement across several stages. For example, pensions have been trending from defined-benefit to defined-contribution to 401(k) - each leaving more risk and less benefit to employees. Similarly, in healthcare we are moving from employer-provided full coverage to higher deductibles, co-pays, and exclusions to employee-provided HSAs. As for job security, those starting new careers are less and less likely to finish with the same employer, or even in the same industry - thanks to intensifying foreign competition. Meanwhile, leaders of our federal government are trying to weaken government programs providing pension (Social Security), healthcare (Medicare, Medicaid), and job security (unemployment insurance).
Why is this happening? Hacker points to philosophical pressure in the political arena (take responsibility for yourself; reduce moral hazards; increased opportunity for private industry (eg. private pension accounts)--> greater political donations to legislators), and economic pressures (foreign competition; management incentives to build stock P/E ratios).
So what to do? Hacker suggests becoming much more aware of these trends (I'd also add trends in energy, the trade and budget deficits), much greater reliance on personal savings (eg. don't overstretch on a home, spending for an expensive private college), and supporting Universal Health Insurance. (Actually universal health insurance is cheaper - avoids the significant marketing, selective enrollment, and expenditure review costs associated with competitive private plans.)
However, Hacker misses two main issues: The first is the need to recognize that times have changed - "free trade" was great for the U.S. post WWII when we essentially were the only game in town; now it is a disaster when we are confronted with billions of educated workers willing to do the same things we do for 90% less, armed with the Internet and fast trans-oceanic transportation. Thus, we need to go back to some sort of trade barriers. Similarly, regarding the impact of illegal aliens within the U.S. - at first they really only took jobs Americans didn't want (stoop labor) - no longer! These steps will allow us to afford healthcare, pensions, and job security again.
2)We also need to reduce expenditures and improve quality in two of the biggest segments of our economy - healthcare and education. Clear credible evidence abounds that they both waste about half the money spent, and even without those excess funds could substantially improve outcomes.
Finally, "The Great Risk Shift" reminds me of the story about the frog slowly boiled to death in a pot over the stove - the heat goes up little by little, and he doesn't notice - until too late. The globalization heat on America has been steadily rising, but we have ignored it for decades, compensating with working added hours, adding one's spouse to the workforce, maxing out credit cards, spending one's home equity, and living without pension and/or healthcare coverage. Economists reading from old textbooks are a major reason America has been in a "state of denial" regarding globalization. However, we now have no more means of evading the problems. It is long past time to confront our problems with globalization!
on September 28, 2006
This book is an extraordinarily lucid, thoroughly researched, practical work that synthesizes the important elements of a longstanding and unprecedented campaign that has to one degree or another already buffeted the lives of almost every American.
As the title suggests, the author closely examines a profound and pervasive policy shift away from collectivist (and functional) notions of the value and need for a social insurance safety net (founded on a variety of institutions, concepts and programs including Social Security, Medicare/Medicaid, Unemployment Insurance, Defined Benefit Pensions, Employer Provided Health Care, Stable Long-Term Employment, and Responsible Enterprises) that the post-war American worker (and economy) thrived in, to the extremely individualist (and dysfunctional) "Personal Responsibility Crusade" that is bent on destroying any form of collective risk pooling, along with any form of individual (and therefore ultimately collective) economic security. He also does a fine job of pointing out the contradictions inherent in the Personal Responsibility Crusade's lip service to a fantasy of economic empowerment and individual choice that purports to support families, increase opportunity, and promote freedom. Sadly, the well documented results so far are increasing numbers of Americans of all demographic profiles being crushed in a vise of flat or declining real incomes, enormous income volatility, greatly expanded risks impacting all aspects of their existence (most specifically around the primary concerns of Employment, Families, Health Care and Retirement that he addresses), and inadequate personal resources to actually take advantage of a largely illusory, inadequate hodgepodge of new "choices".
Though tracing in detail an extremely destructive arc to the brave new world of an "ownership society" in which the average "personally responsible" American is now free to choose (and lose) everything, the author also develops well reasoned, practical solutions that provide an optimistic path for moving back to a reasonable framework of societal risk management. This vision addresses what's needed to improve outcomes for the broadest cross section of Americans, while also strengthening the foundations of the free enterprise system.
From the extensive footnotes and incisive use of data one would think the author has absorbed just about everything there is to consider on these topics. His analysis successfully pulls together theory and observations from a multiplicity of disciplines (including political science, sociology, economics, law, psychology, history, policy analysis and business theory) to provide a full, yet also readily accessible and easily digested, picture of what has happened, how it happened, and what can be done about it.
A complementary work that focuses on the political shift from acknowledging "We're In This Together" to trumpeting the fact that "You're On Your Own" (and without adequate resources at that) is Jared Bernstein's "All Together Now: Common Sense for a Fair Economy".
Perhaps due to the time frame of the research and development of the book (or the fact that the threat is a little less pervasive), I do think the author missed another huge risk shift the American people have just been handed: Dealing with natural disasters. In this case it seems government has once again abandoned its responsibility, whether deliberately or through sheer incompetence, leaving the victims effectively on their own.
As the author and many others point out there are certain tasks (or risks) of a scale that unfettered (yet hardly unbiased) markets are fundametally not efficient (or sufficient) for dealing with. The inevitable question is why the 99% of Americans who lack virtually unlimited wealth have not yet woken up to why this Risk Shift is happening and started to insist that it stop.
on November 19, 2006
"The Great Risk Shift" has much to recommend it. Hacker cogently explains the way risk has been transferred since the New Deal and Great Society eras (when health care, pensions and the like were seen as collective or corporate responsibility) to individuals. Hacker is at his best in describing the issue -- indemnity medical plans replaced with HMOs or medical savings accounts; defined benefit pension plans replaced with defined contribution plans or 401(k)s; secure, full-time jobs replaced with several part-time jobs cobbled together to make a less-than-full-time salary; broken families who cannot be relied upon for support.
Where the book falters, however, is in its view that every risk should be socialized, at least to some extent. When it comes to catastrophic health risks, many would agree that society should assist. I tend to agree with Hacker that one's medical insurance should not depend on one's employer: some businesses cannot afford adequate insurance for their employees. Likewise, adequate health insurance cannot always be purchased in the market: insurance companies "cherry pick" the healthiest candidates. Thus, Hacker has convinced me that we need some sort of baseline national health insurance, at least for significant or catastrophic illnesses (after all, we have something like it today, as those with health insurance subsidize the emergency room visits of those without it). However, we need to beware of a system with Canada-style rigidity or one which leaves no room for innovations.
Fewer would want to subsidize pensions, however, and Hacker fails to provide a real solution. The problem with defined contribution plans is not that they cannot work, but that they must be adequately funded. They can work if employers contribute enough to them so that employees can have a real pension when they retire. Likewise, individuals should be allowed to put greater amounts of pre-tax income into 401(k)s, and companies should be able to match a greater amount dollar-for-dollar. (This is the type of free-market solution that Hacker does not favor, as he believes individuals are not always able to manage their own 401(k) money.) In any event, Hacker provides no advice for those who find themselves in a defined contribution plan, under the present rules, other than "save more and stop spending on luxuries." As for broken families, that is a trend that predates "the risk shift" and will not be solved by the government. Although Hacker wants more risks to be socialized, it is important to ask what this will cost, and whether we will have a Eurpoean-style economy at the end of it.
Hacker has correctly identified the trend to shift risk from government and corporations to individuals. The question is whether the solutions he suggests will be appropriate and cost-effective. The jury is still out.
on February 5, 2008
Now in a newly revised and expanded edition, The Great Risk Shift: The New Economic Insecurity and the American Dream is a no-nonsense deconstruction of how current American policy has been systematically shifting economic risk from government and businesses onto the backs of individual people. Health coverage has become increasingly expensive and difficult to obtain; social security is relentlessly under attack; job security is a thing of the past; and some of the greatest risks and investments - such as years of expensive college training to prepare for a specific career - can be thoroughly upended with a shift in the labor market. The overused mantra of 'personal responsibility' is all too easily twisted into 'tough cookies for you if your child gets sick and needs expensive hospitalization.' Personal anecdotes are sprinkled throughout, yet the core of The Great Risk Shift is a big-picture analysis supported by the latest statistical trends. From the need to return insurance to its original purpose - protecting the individuals who most need it against catastrophic loss - to the pitfalls of a so-called 'ownership society', The Great Risk Shift is both a cautious analysis of the present and a red flag warning of what needs to be done in the immediate future to fight back against specific policies that are demonstrably harmful to society as a whole. Highly recommended.
on May 10, 2007
This past fall I heard Jacob Hacker speak about his work in The Great Risk Shift, and I just finally got around to reading the book. What I like about Hacker is that he not only critically examines complex political and societal issues, but he beautifully transforms his conceptions into practical solutions. He doesn't just ask, "What can we do?" He shows us how it can be done.
There are points I agree with in his book and other points I still have some reservations about, but his explanations and reasoning is thoroughly engaging nonetheless. For instance, he proposes a health coverage plan that reemphasizes national concerns about health care security. His proposal places more obligations on employers, which in my opinion, is a plausible expectation if the United States is not willing to adopt a universal health coverage plan. Hacker points out that a large contributor to the rise in bankruptcies is a result of healthcare costs. It's clear that health care insecurity poses great risks to countless Americans from all different placements of the socioeconomic spectrum.
I did face some apprehension and concern regarding his "universal insurance" proposal. This insurance would be designed to protect families in the event of a threatening change in finances and security - for instance a drastic pay decrease. Although I can agree that current job market conditions are very unstable (I myself have faced a drastic pay decrease formerly working in the business sector), I also feel as though we generally have a highly exaggerated sense of materialism and pretentious consumption patterns in America. How will these factors be accounted for when claiming instability and who is entitled to what? Is this where federal money should go when much larger issues regarding our nation's schools, health and extreme poverty are being neglected?
In the Great Risk Shift, Hacker identifies significant points of concern for Americans and the anxieties and rising inequality pressing citizens. With higher and higher concerns, these are questions we will be continually readdressing for years to come. This book proves Hacker always has amazing ideas and great things to say. We can contiunally look forward to his new approaches at examining significant social and political issues.
on December 27, 2007
I give this book credit for advancing ideas that maybe a lot of people wouldn't have thought of before, and for tying together a lot of strands that people might have seen as elements of different problems. In a word, Hacker brings together much of post-1960 American life under the heading of "risk": increasingly, our economic fates are being thrown back on the cruelties of the market. Getting sick can cost us tens or hundreds of thousands of dollars; losing our jobs can mean economic devastation. The market thrives on Schumpeter's "creative destruction", and it is by common understanding the very hallmark of a dynamic capitalist economy. What it means, though, is that none of us can expect our jobs to be around in 10 years: they may be creatively destroyed just as easily as the next guy's.
Of course most middle- and upper-income readers will immediately try to defend their own sense of self, by supposing that their own level of education insulates them from the shocks of the new global economy: surely creative destruction is creatively destroying manual laborers' lives, not ours. Hacker says no, and submits a mountain of data to prove his point: over time, we're all becoming more subject to economic crises. The standard economic statistics don't point this out; they focus on economic growth or inequality, but not risk. If Hacker's book is valuable for nothing else, it is valuable for focusing attention on risk where previously few people did.
To deal with this risk, we need to return to an insurance society. Like a lot of people, Hacker advocates health insurance similar to Medicare. He advocates not only unemployment insurance, but unemployment insurance that helps people transition from a creatively-destroyed career to a new one. Hacker doesn't have time to build out the argument -- actual policy prescriptions are confined to the final 10% or 15% of the book -- but he says that the economic profession is broadly agreed on the necessity for this kind of insurance.
The broader social impact of American insecurity often goes unremarked. One of my coworkers made an excellent point about it recently: in Europe, he says, you'll find far more little shops run by sole proprietors than you will here. He believes this is because there's a social welfare net that lets you take some risks that you just couldn't take in this country. Most important among the strands of the safety net, of course, is health insurance: insurance for a small business is frightfully expensive, so presumably a lot of small businessmen go without. It would be interesting to test the connection between bad-sense risk (the chance of economic collapse) and good-sense (entrepreneurial) risk.
The move from pensions to 401(k)s is another big thread in The Great Risk Shift. A large body of research suggests that people are terrible at judging their own long-term prospects. We systematically undersave (for that matter, I systematically undersave), we systematically underestimate the likelihood of a major life catastrophe, and we invest too much money in the company we work for. Pensions used to protect against this, by shifting the burden of risk-estimation onto the employer. Workers didn't have to figure out where the money went, they had no choice about whether to invest, and their nest egg was more stable as a result. Even making 401(k)s opt-out rather than opt-in makes a huge difference in how much we use them. Forced savings are good for us. Here's where everyone is obliged to mention Ulysses tying himself to the mast to ward off the allure of the Sirens. He foresaw his own weakness and protected against it. So should we. Government can help.
I think The Great Risk Shift will be mostly valuable in two directions:
1. Helping to guide conversations with non-believers during the health-insurance debate: we're not just talking about poor people getting sick here. We're talking about a much broader economic problem that can only be solved by joining forces with our countrymen.
2. The deeper research in the ample footnotes. I've found a lot of good stuff in there.
It's not a very good piece of rhetoric, though. When Hacker talks to Real People, he sounds like an academic rather than a beat reporter. Indeed, if you read the footnotes, it turns out that most of the Real People conversations are from other people's books. I don't think Hacker has much power as a polemicist: he's not going to talk with real people, or appeal to them very much either.
What I'd like is something like Jon Cohn's Sick: scholarly and yet passionate. (For a taste of Cohn's style, see his essay "Creative Destruction"). Hacker's not quite there, but I'm willing to give his earlier Off Center a shot.
on December 15, 2006
Although Jacob Hacker exaggerates the level of risk shift in the "Great Risk Shift", he makes some public policy proposals that deserve at least debate if not adoption.
Much of the book is a critique of what he calls "The Personal Responsibility Crusade", which he views as the vehicle for the shift. He tends to overreach at times. Much of the talk I have heard regarding "personal responsibility" was directed about teenage pregnancy or fathers who abandon those they impregnate and/or their children. He is right that "personal responsibility" is sometimes invoked as an argument against certain government social programs but those programs also have very real budgetary concerns that feed most of the efforts to constrain them.
Some of his arguments also seem peculiar. On page 66 Hacker quotes some corporate statements to outline what he calls the "new contract" for workers. "The only job security is a successful business" and "if loyalty means that this company will ignore poor performance, the loyalty is off the table". It is strange he would cite these as somehow new, when were they not true? Even under the "old contract", an unsuccessful business could not offer job security, nor was poor performance ignored.
Hacker makes a compelling case that there is more volatility in incomes (although incomes are generally higher) than in the past. His argument that this was essentially by design is a little less compelling. The three decades after World War II is his (and that of many others) reference point for security. That era can't be recreated. Fortunately, he doesn't resort to the easy (but unwise) option of endorsing trade protectionism, rather he recognizes the globalized economy is a fact of life and suggests a series of measures to mitigate the greater risk born by workers.
For health care coverage, he proposes something called "Medicare Plus", which is a variation on "pay or play" coverage proposals, which require employers to cover their employees or pay into the government plan that covered their employees and everyone outside of the employer market. It isn't really clear why this proposal is better than a universal government run system, other than Hacker seems to think the latter can't be enacted.
He also wants to enhance unemployment insurance and introduce "wage insurance" (for those who are displaced and take a new job that pays less than their previous job).
He also makes a proposal that appears to be novel, what he calls "universal insurance" that would cover families from an array of potential vicissitudes. Both this idea and wage insurance do not have a track record (at least not in the United States) and may not work as well in practice as they might in theory, but they at least deserve discussion.
on August 16, 2008
This is not the easiest book to read, but the subject should hit home for a number of Americans and it's well-done.
Hacker shows how over time, government and corporate actions have led us to a point where just about every risk imaginable is being borne by individuals. Once upon a time, the government and corporations shared in the risk, but we're getting towards a point where that is not the case. With the stories he shares and the points he makes, one can see that it's no accident that stories abound of people who have lost just about everything - be it their retirement funds, their homes and any other savings they have. Oftentimes, something as simple as job loss due to a layoff or an injury/illness (not necessarily to the person, either, as a sick or injured child can do this as well) is what triggers it, and Hacker spends a good deal of time talking about health care since that's about as broken as anything in America.
None of this, of course, has been talked about as much as the "prosperity" of the past few years in the American economy, one that was a house of cards and is now in loads of trouble that anyone with common sense could have foreseen.
At the end, Hacker shares some ideas well worth considering. Cynic that I am, I don't expect our elected leaders to do that, especially as they've been bought by corporations left and right.
The book is not always easy to follow, as Hacker makes extensive use of statistics and at times puts several together, and it at times has the feel of an academic paper being presented at a conference of some sort. But that's a relatively small knock, and it's a book every politician needs to read and probably won't (or they will just dismiss it because they're out of touch and don't have to live the lives ordinary Americans do).
on December 22, 2015
I think this is one of the most important books written for people to be abler to understand many of the changes that have happened in the United states that affects every person and every family . I strongly recommend everyone read this book.