MIT economist Jonathan Gruber has advised both major parties on health-care reform. In fact, he enjoys the unusual distinction of having helped shape both "Obamacare" and "Romneycare," the sometimes-derisive nicknames for 2010's Patient Protection and Affordable Care Act and its Massachusetts predecessor. He's also one of the sharpest people I've ever interviewed, which is why I pay attention when he speaks or writes.
Gruber has argued repeatedly that if universal access to health care is achieved in a smart way, it can be a long-run economic spur - for instance, by eliminating a source of friction that discourages people from taking entrepreneurial risks. So-called "job lock" is an undeniable side-effect of the accidental system we have now, in which health-insurance coverage is generally provided through employers. If you have a great idea and also have, say, a spouse with a pre-existing condition, you're at least a little more likely to stay put in your job and shy away from a risk.
In a new piece in the New Republic - Will the Affordable Care Act Kill Jobs? - Gruber says the economic literature shows that expanded coverage should provide several sources of economic boost, in part because the newly insured will demand more care.
"[W]hile it takes many years to train a family physician or nurse practitioner, it doesn’t take much time to train the assistants and technicians (and related support staff) who can fill much of this need," Gruber writes. "In many cases, these are precisely the sort of medium-skill jobs that our economy desperately needs—and that the health care sector has already been providing, even during the recession." He also suggests it will spur spending by consumers who would otherwise be paying or saving for uninsured care.
But what about the costs of expanded access - and all those new taxes? Gruber writes:
Gruber's new piece also addresses the job-lock issue - acknowledging that the Congressional Budget Office predicts a small dip, initially, in employment as a result of the law, but arguing that it's the explanation that matters:
As a columnist, I get an angry response every time I argue that the ACA's increased access to coverage will provide substantial benefits to society along with its costs. The truth is that policymaking is always a balancing act, and the ledger does include intangibles such as ensuring a more humane society (on my side of the argument) and limiting the role of government (on the opposite side).
Plenty of people are complaining about the costs of Obamacare, and about the potential for unintended consequences - such as a drop in the fraction of employers who provide health insurance, or, as an email I received this morning argued, the incentive for low-wage employers to avoid the new penalties by cutting workers to part-time.
But in the best tradition of his profession, Gruber has identified tangible economic benefits that should also be weighed as the country faces an election that may decide an important new law's fate.