Robert (Bob) Lampman’s work on the reduction of income poverty in the United States is well-known. Less well-known, however, are his contributions to the economics of health and health care. In some of Lampman’s early work from the mid-1960s, he pointed to the gap in utilization of medical care between the poor and those with higher incomes. He also wrote on employment in the health care sector and the positive role it played during recessions, although he presciently warned that excessive growth would likely result in spiraling health care expenditures. Today, this sector operates as an important economic engine; over 14 million people, or 11 percent of the nation’s workforce, are employed in health care, up from 9.5 percent at the start of the recent recession.
A large number of jobs in this growing industry go to lower-skill workers. In a 1969 paper, Lampman pointed out the rapid growth in health care costs, and the political and economic limits of privately provided health insurance. He also raised questions about how to secure better health for more people, such as through more insurance, more direct investments in medical personnel, or perhaps through direct income transfers. He recommended that any proposed health care plan be confronted with a question that came to be associated with Lampman’s name: “What does it do for the poor?” Lampman’s views in this area have as much salience today as they did then. Indeed, for the better part of the last four years, these very issues have been debated in the United States, with researchers and policymakers asking: How do we control health care costs while providing access to care and improving health among the poor? In this article, I extend Lampman’s concern with the health care sector with a focus on the 2010 Affordable Care Act (ACA). Among other questions, I pose Lampman’s big question. I believe that the creators of the health care reform bill would be graded positively by Bob Lampman, as the (often overlooked) pro-poor impacts of this legislation are perhaps its most important components. (author abstract)