That's a question worth mulling over. We know the safety net, though poorly understood, appears stable. Yet we know that even before the recession hits (or hit, as we might be there already) the net is threatened, and we know everyone, including the voters, are talking about the economy. But is there anything out there that helps us get a better feel for what's likely to happen?

We can guess that recessions trigger unemployment, which makes it hard to keep health insurance, but do we go back to the way it was afterwards? How long does it take? And what happens to the safety net in the meantime? In other words, is there any data or are we just guessing?

Perhaps not surprisingly, there's more data available on the effect of of recession on the industry of health care than on the effect on the consumer or on safety net itself. For example (and not the focus of this post), it's CW that if you invest in stocks, you should buy big pharma or hospital chain stocks because health care is 'recession proof'. And, as often seen in cases of CW, it's not so clear cut:

A macroeconomic forecasting model developed at the Temple University Center for Health Finance indicates that from 1960 to 1990 the health care industry, although growing faster than the economy as a whole, did show reductions in growth following each recession. Some of the effect is felt immediately as consumers cut back on discretionary primary care, over-the-counter medications, and dental work, but most of the spending reductions unfold over the subsequent four years, and the lag between recession (or recovery) and hospital construction can be as long as seven years.

That doesn't sound 'recession proof'. And for the consumer, we can see indirect results, in that when consumers cut back on OTC meds it might not matter to their health, but cutting back on primary care and dental care may well matter, depending on how long care is cut back. And one can only assume delayed hospital construction is not a boon to local communities or the local economy.

Of more import than which stocks you pick is the effect recessions have on health insurance. From Tulane:

In this [1998] paper, we estimate the influence of economic, demographic and health care cost variables on the likelihood of having insurance coverage during the 1990s. During the recent economic recovery, the economy has returned to pre-recession levels of employment, but the percentage of adults with employer-sponsered insurance (ESI) has not returned to pre-recession levels, and the percentage of adults without health insurance coverage continues to climb.

Losing health insurance through losing a job is one of the most important effects of recession, and recovery afterwards is prolonged and incomplete. When the uninsured grow, how will they pay for their health care? For those who are already uninsured, when food and fuel costs rise, out-of-pocket health care becomes all the more unaffordable. More data:

New research [April 2004] conducted byCornell University researchers John Cawley and Kosali Simon, funded by the Economic Research Initiative on the Uninsured (ERIU) at the University of Michigan, shows that the economy's effect on coverage is best measured by looking at unemployment rates, which continue to increase well after a recession ends. The most recent recession ended in November 2001, but unemployment continued to rise through June 2003. The economic downturn led to more than one million Americans losing coverage during the recession, and the economy has yet to make up for these losses more than two years into the recovery.

Here we are talking about 47 million people uncovered in this country as it is.

What about the safety net? One thing we don't have any data on is the effect of recession on (relatively new concept) private walk-in clinics (featured at Wal-Mart and elsewhere).

Walk-in clinics help to cure US healthcare ills

The explosion of walk-in clinics is one of several significant moves to reform US healthcare by business and other groups outside the traditional medical industry. They range from clinics in retail stores to internet social networking for doctors, retailers' rethinking pricing policies for prescription drugs, widening support for cost-effectiveness studies of medicines, and financial service industry help for hospitals.

These seemingly unrelated examples could change the system at some of its weakest points. They are tackling problems including inexpensive access to basic healthcare for everyone, transparency in medical information, and personal accountability for one's own health.

None of the 'cures' listed above are recession-proof and none have been vetted in an actual recession. For example, if people substitute walk-in clinics for traditional doctors as a medical home, it's tough to count on the for-profit sector for stability because their job isn't to function as a safety net (it's to turn a profit).

A CheckUps clinic inside a Tampa Wal-Mart is among the 23 CheckUPs clinics in four states that have closed.

CheckUps is conducting an evaluation of which of its operations in retail stores should remain open, according to William Armstrong Jr., a spokesman who said he was speaking on behalf of Jack Tawil, chief executive of New York-based CheckUps. The company is conducting a restructuring and working with investors to determine its future direction, Tawil said.

There's no sense of 'but you can't close' here, the way communities react to hospital or public clinic closures. And let's put those findings in perspective with recent SCHIP discussions (again, from Tulane):

Our results indicate that the most important factor affecting changes in health insurance coverage was an increase in the percentage of families with income below 200 percent of the poverty line.

Just heard this today. I'm sure its not new here, but explains me.

We Can't Make It Here Anymore - by James Mcmurtry comes across just a bit more angry than I am, but not much.
Many have dedicated their lives and careers to maintaining a social safety net, an elevated platform for any who have worked hard but have still fallen through the cracks. So i don't consider myself special,but having personally found the gapping wholes in the "safety net" my perspective has been changed. More self indulgence below the fold.

"A credit card can be a great safety net if people know how to use it." Tracey Mills, American Bankers Association (Link)

"Payday lending technology may have lowered those fixed costs, thus increasing the supply of credit ... That suggests the payday innovation was welfare improving, not predatory." Defining and Detecting Predatory Lending, Donald P. Morgan and Samuel G. Hanson (Link)

"This [alleged bankruptcy abuse] has made credit less affordable and less accessible, especially for low-income workers who already face financial obstacles." George W. Bush, statement on enactment of the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005

For years, we've been fed on the poisoned propaganda that the price of a growing economy is a shredded safety net, growing inequality, and economic insecurity for millions of working families.

The problem with all that is that it just isn't true. In a recent essay in Scientific American, Columbia economist Jeffrey Sachs, author of The End of Poverty: Economic Possibilities of our Time, compares the economic performance of developed countries with low taxes and weak safety nets, which tend to be predominately Anglo-Saxon, with that of Nordic social democracies, including Denmark, Finland, Norway and Sweden.

He notes that the latter countries combine "a healthy respect for market forces with a strong commitment to antipoverty programs."

Progressives have to find a way to come together to sell Progressivism. Complaining about the Democratic Party, arguing about who is and who isn't a Progressive or who is and isn't "Progressive Enough" and other negative pursuits are not going to get the job done.

Possibly the only person in the Bush Administration who understands the economics of health care has just announced his resignation. Late word is that Mark McClellan will perch at the American Enterprise Institute rather than feather his nest with drug industry loot like his predecessor did.

The "deficit reduction" bill passed by Congress earlier this year is a perfect example of the twisted policies of the Bush administration and its rubber stamps in Congress.

Perhaps you remember the bill. It was the deficit reduction bill that increased the deficit. Specifically, it cut around $40 billion from programs that help middle class, working and low income families while giving $70 billion more in tax cuts aimed mostly at the very wealthy.

Interest rates on student loans were increased. Medicaid, which is a literal lifeline for over 50 million Americans--mostly children, but also low income adults, people with disabilities, and the elderly--just got a lot more punitive and confusing.

I read a diary this morning that reminded me of my own experience during the Reagan years.  This started me thinking about the difference between being broke then and now, and what we've lost; and why I come to this site.

I've kept a journal continuously since July of 1980. It lives in nine notebooks in a cupboard in my little office downstairs. I consulted the first book... and quickly discovered that there was a great deal that memory had lost or glossed over.  Supposedly it was morning in America, but I was in no position to enjoy the dawn.

I am the proud product of taxpayer investment. In exchange for my giving this country two years of military service, they gave me enough money to get through college. When I decided to go to law school, they chipped in again by subsidizing my student loans, giving me help with daycare expenses and letting me have some badly needed cash in the form of an earned income credit. I'm not rich by any stretch, but I'm comfortable. Without the "hand up" from the American taxpayer, I'd probably be worrying that my $10 an hour receptionist job was about to be offshored.

What's your story?

I was listening to C-SPAN and Senate Budget Committee Chair Judd Gregg (R-NH) was talking about how we need to sacrifice in order to help the victims of Katrina. But he wasn't talking about those who have the means to help "sacrificing," but of taking deep cuts in our social safety net programs such as Medicare/Medicaid, Food Stamps and subsidies for poor farmers.

Lovely. Take away from the sort of programs that would help the Katrina victims to give money to those corporations that will make a fortune "rebuilding" New Orleans as a paradise for the wealthy. That is so compassionate...for the wealthy!