Posted by Brad @ 11:22 am on November 25th 2008

Does Health Care Reform Kill Republicans For Good?

So argues a few Republicans. Notably James Pethokoukis and Rammesh Ponnuru. The latter:

Obamaís health-care plan is designed to evolve into a national health-insurance program along the lines of Canadaís. The resulting government monopoly or near-monopoly on health insurance would stifle innovation, require bureaucratic rationing, and infringe on freedom. But it would also move American politics permanently leftward … the inevitable disappointments and failures of a nationalized system would just as inevitably be blamed on underfunding, creating a bidding war that liberals would usually win … the creation of a new system would make free-market alternatives look more radical to the public than they do now, because they would be more radical. The publicís aversion to risk, which now hurts advocates of liberal policies as much as it helps them, would only help them. So national health insurance could be a lasting political success for liberals even if it is a colossal policy failure; it could, indeed, succeed politically because of its failures.

I understand the argument, and think it’s probably right, but still find it a curious argument. On some level it reads “National health insurance would kill the Republican party because everybody would like it.” If you can’t win the argument before, during, and after the policy implementation…well then, you’ve lost the argument.

On another level, I certainly understand that as these things get implemented, they become nigh-on intractable. It becomes the status quo, and the psychological default, when the status quo isn’t satisfactory, is to layer on more action. That’s also, by the way, one of the big reasons why conservatism is in such dire straights. Because conservative solutions are backwards-looking more often than not (at least in some sense), they often don’t look like solutions at all, and instead come off as just poo-pooing the problem. Which works, precisely up to the point where most reasonable people do indeed perceive a real problem (as in health care), at which point voters go shopping for options. And that’s where conservatives lose. Frankly, by tying the argument up into a reverse Chicken Little position (“There is no problem! All is well! Our health care system is the best in the world! Change is not needed!”), conservatives often appear to have no solution. They do, of course, but they’re just as likely as anyone, it seems to me, to forget that, and instead bunker sounding a lot like Baghdad Bob, which, to voters, becomes synonymous with “no real ideas”. And again, that works for precisely as long as it takes for voters to get to the point where they’re actively looking for solutions and ideas.

Conservatism, then, needs to begin recasting itself as a philosophy of solutions, and begin to recast its conservative ideas of how to deal with things as being themselves proactive. I think this is actually something that should be at the heart of the New Conservative Principle project. This does not mean, by the way, that conservatives ought to embrace some kind of Big Government Republicanism. Far from it. But instead of just a “critique of all change”, conservatism itself needs to embrace change as a guiding principle (because voters sure do, when the status quo they don’t like). In the case of health care, some conservative plan to break the gridlock of insurance companies and big government getting between the doctor/patient relationship, and particularly the doctor/patient relationship where the patient, as the consumer, has all the power and all the options, would be a good start. That’s at least something Republicans can go to voters with and say “you want something done? You’re right, something ought to be done. Here is what needs to be done; elect us to do it.” This is America, after all; our national instinct is preternaturally geared away from “Well, we have tough problems, and sadly we can’t do anything about them, so let’s just suck it up and find our answers in Stoicism.”

Absent that realization, I find it hard to cry for Republicans when the American masses realize that our health care system is indeed screwed up, and I sympathize with them (the masses) when they have the impulse to try something new rather than just settle on the devil they know (and hate). If Republicans don’t want that process to be the death knell for their political future, they need to be there at that point of sale too, not just standing at the door protesting.


  1. This post and the next one about big business should be put together because they are related.

    The US does not have a free market when it comes to medical care. It is regulated to the hilt. Many of the regulations are for the benefit of big pharma and big medicine. Other are just stupid including mandating that nobody can be refused emergency care.

    It is a strange system indeed.

    So, the people are not choosing between free market and government run, but from one form of government run to another form.

    On a day-to-day basis, the government run health care proposed by the democrats will be superior than the one we currently when measured using dollars spent vs care received.

    This is proven daily in other countries that have a healthier and longer living populace while spending a third or less per person on health care.

    In the long term, such a system may hurt research, but that remains to be seen. Nonetheless, at this point people will be happier with a government regulated system. Most will end up living longer and being healthier then they are now, and they will also be a lot let stressed.

    And this opinion comes from someone who pays out of pocket most of the time and would prefer to do it all of the time if I could just get the same prices as the people in plans.

    Comment by daveg — 11/25/2008 @ 12:58 pm

  2. The next post was an afterthought to this one, and a common refrain of mine. Mostly, an excuse to link that CATO article.

    This post, specifically, is as you say it. The false “free market vs. managed care” choice Republicans advocate, and lose on.

    I have to say I find myself leaning to the Democratic model on this one, for much of the reasons you mentioned. If we’re going to have managed health care (which we do now), it makes some sense to at least try to manage it to the benefit of the consumer over the provider. At the very least, attempting to do so will probably amount to leveling the playing field more than the horribly corporatist-skewed system we have now.

    Comment by Brad — 11/25/2008 @ 1:23 pm

  3. I do think businesses would be happy to not be compelled to provide insurance for all of their full-time employees anymore. This would simultaneously help ill people get jobs (it is certainly the case that employers do all they can to avoid hiring anyone who is ill) and stop the subsidies being paid by those who are healthy (who generally have good life habits) to those who are unhealthy. It would also, sadly, cause me to lose my job…

    Comment by Redland Jack — 11/25/2008 @ 9:47 pm

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