Universal health care and the medium chill
Reaction to the “medium chill” has been surprising and delightful. I’ve heard back about it from all sorts of people outside my typical blogger/wonk/green circles, too, like friends and family in the real world. Nice to reach the real world occasionally! I want to use this post to respond to one particular strand of the discussion. In a follow-up post, I’ll round up a bunch of other medium-chillish links.
Here’s the question: Is U.S. economic policy currently biased against medium chillers? Or is it biased against big chillers (i.e., “killers”)? Or both?
The term “killers” comes via Reihan Salam, who has this to say:
My own view is that a fairly large number of people are believers in “medium chill” and that a relatively small group of people — I call them “killers” — constitute a neurotic, ultraproductive minority that drives our economy forward, and sometimes backward. Roberts might see these people as deeply mistaken about the sources of the good life. I think of them as differently wired, like the sleepless elite, and their tireless efforts account for many of the things the rest of us enjoy. Killers are the people who found high-growth business enterprises and who work crazy hours staring at spreadsheets or running regressions. Sometimes they do it in the often false belief that it will improve their status, thus winning the affection of members of the opposite sex, etc. There are also killers who just like the thrill of competition. Killers can be found in non-profits and the public sector, though not quite as often as they are found in lucrative slices of the for-profit economy. I’d like to see more killers in the public sector, which is why I favor more autonomy for public sector workers and more dispersion in public sector compensation. I tend to think that our policy environment is not sufficiently pro-killer, but of course others will disagree.
Interesting. We’ll return to this in a minute, but first let’s hear from Will Wilkinson, who cops to being a medium chiller and chafes at America’s inflexible employer/employee model:
… I am convinced that autonomy is profoundly important to most of us, and that the sort of self-rental involved in the employment relation is regularly experienced as a lamentable loss of autonomy, if not humiliating subjection. I think a lot of us would rather not work for somebody else. It’s not necessarily that we’re burgeoning entrepreneurs eager to start small businesses. It just sucks to have a boss.
… I’d also like to see a shift away from economic policy that pushes us so insistently into the “employee” role. What does the government call you if you are working but not on somebody’s payroll with social security and Medicare taxes automatically deducted from your wages? Self-employed! You must work for somebody, even if it’s yourself. But I don’t want to be a tiny business that hires me. I don’t want to be my own boss. I don’t want to be a boss at all, or to have one. I just want to work and get paid for it, on terms agreeable to the parties involved.
Taking these two posts together allows me to make a point I wanted to make in the original post (before it got too damn long), namely: legacy institutions and arrangements in the U.S. work against both medium chillers and killers. And the way to support them both better — though I suspect Salam and Wilkinson will disagree — is more robust public provision of basic services, i.e., a better safety net.
Take the case of employer-based health insurance. Right now, just about the only way to get affordable, stable health insurance is by being a 40-hour-a-week employee. If you want to work part time or start a business or “just work” (as Wilkinson puts it), you have to buy insurance on your own, without all the employer subsidies. Premiums can rise without notice, you can be dropped based on arbitrary health conditions, and it’s just incredibly expensive. That kind of economic instability has deleterious and long-lasting psychological effects.
I suspect there are many, many medium chillers who would be happy working 30-hour weeks and trading the extra income for leisure time. Or perhaps they’d like to share a job. Or maybe they’d like to work more when they need money and less when they don’t — just “work and get paid for it” when they need to. Those options aren’t workable for most people today because of the specter of health insurance. To deviate from the 40-hour employee model is to take on risk beyond what all but a few brave souls are willing to bear.
Similarly, there are all sorts of people who might like to be “killers” and start their own business or invent something new but are inhibited from taking the leap by the fear of losing or not being able to afford health insurance. Plenty of people take that chance, of course, but how many more would there be if that risk were taken out of the equation?
In short, America’s stupid health-care system prevents people from shifting their work-life balance to less-work-and-more-life, but it also prevents people from doing the inverse! It locks people into a rigid system that serves almost no one (except insurance companies) very well.
To me this looks like an argument for universal, single-payer healthcare. Not only would it achieve better health outcomes for less money than the employer-based system, but it would free people to pursue much more diverse working arrangements. It’s a step toward “de-formalising and de-bureaucratising labour,” as Wilkinson seeks. Work-sharing along the lines of what Germany does would be another nice step. Or if you wanted to get really socialist-freaky, you could go for a guaranteed minimum income.
More and more labor is shifting into informal/voluntary non-market contexts, a trend that’s both inevitable and desirable. Clay Shirky once said of Wikipedia that it is “best understood not as a product with an organisation behind it, but as an activity that happens to leave an encyclopedia in its wake.” More voluntary activities will leave useful social resources in their wake in coming years, especially when the first large cohort of computer-literate retirees arrives. (Non-market labor will also interact fruitfully with nascent sharing economies in ways I don’t have space to puzzle out here.)
Greater public provision of essential services would acknowledge and support a diversity of work arrangements, with different balances of market and non-market, labor and leisure, risk and stability. We’d get better medium chillers, better killers, and fewer 40-hour drones.
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