An Unexpected Engine for Innovation
Could universal health insurance be an engine for entrepreneurial innovation?
I don't mean innovation in the healthcare space in particular, although that's possible. I mean more generally, as an unanticipated benefit, an "economy of scope," if you will, of universal health coverage. It may well be that a shift to broad health coverage could trigger a period of surprising economic growth. This may actually be an argument that would win support for single-payer insurance among those not persuaded by the moral or social aspects.
I came at this thought in a somewhat roundabout way. It will come as no surprise to anyone who has done a rapid succession of talks and travel that, a couple of days after getting back from Zürich, my immune system went on strike and I was hammered by one of those colds that served as a reminder of just how much we take our health for granted. My current health insurance situation is a bit complicated, as it is for most freelancers, and although this situation wasn't enough to warrant going to a doctor, I began once again (in my waking, lucid moments) to think about whether I needed to find a "real" job that would come with benefits such as health coverage.
Today, it struck me: I can't be the only person facing this kind of choice.
How many people want to be out there, trying new professional experiments, working for themselves, but are held back by the thought that doing so would mean a lack of real health insurance?
It's not uncommon to see paeans to the entrepreneurial spirit of US citizens*, and read consultant-ese observations that the one success skill in a rapidly-changing economy and society is flexibility, a willingness to try new things. This latter argument makes sense, from the "economic resilience" perspective. In a period of turmoil, successful adaptation demands the ability to iterate, rapidly and in parallel, multiple different models. With product design, it may be sad but ultimately of little consequence to toss out the less-adaptive concepts; the same cannot be said for human lives.
This is the health care risk at the heart of entrepreneurialism: if you or someone in your family gets sick or injured, you could easily lose everything. And if you have a "pre-existing condition" (such as my palindromic rheumatism), you're really out of luck. If you're youthful and willing to take a chance, this may be an acceptable trade-off; but remember, this is an aging population, and innovation is not just a sport for the young. If you have a spouse with health benefits, you may be okay, but that puts enormous responsibility on the shoulders of one's partner to keep the job s/he's in, no matter how unhappy or unfulfilled it might be. COBRA works for awhile, if you can get it, but it has its own limitations. So too with the variety of packages for freelancers (if you can get them). The handful of remaining options -- including just going without -- can be amazingly expensive.
I don't think that there is necessarily a massive population of proto-entrepreneurs just waiting for universal health coverage in order to go out and change the world. I do think that there's a small number, however, which would then provide a model for people who might have long-ago discarded the idea of working for themselves. The lack of universal healthcare in the United States may well be a brake to the kinds of innovation and individual experimentation that will be necessary to adapt to a rapidly-changing economic -- and geophysical -- environment.
Just some thoughts on a Sunday afternoon, still in the midst of recovery.
(*The European experience provides neither strong support nor contradiction of this premise, given the substantial cultural and, often, legal differences regarding entrepreneurialism between the US and Europe.)