No Country for Conservative Health Care Policy
~by Dan Miller
There’s something a bit frustrating about the health care debate that’s been going on here at the League. Health care has been THE liberal project for literally decades; entire careers (not to mention presidencies) have been built around it. There’s a vast policy apparatus on the progressive side of the aisle built around health care, with industrious wonks digging into every nook and cranny. Meanwhile, the right has…nothing. To the best of my knowledge, the right has never instituted any major policy shift in health care (with the exception of Medicare Part D, although even that came about substantially because of pressure from the left and with the help of liberal Senators). The right, speaking broadly, doesn’t see a problem with the current state of affairs in the health care system; it’s just not a subject that excites them. If there was a way they could continue the status quo while solving the problems of cost growth, I think most conservatives would gladly take it.
Into this gap steps E.D. Kain with a health care plan. And maybe it’s a workable one. I don’t actually know, I’m not a health care wonk; politics is my area of expertise. But E.D, and I mean no offense – I’ve got great respect for you – but you’re not even an A-list blogger. You have, as far as I know, no institutional backing; you certainly don’t have the ear of a Senator or 20. And yet you claim dissatisfaction because the plan that’s being debated in the House and Senate doesn’t match up to the lofty standards of the plan you offered in a blog post.
I’m a liberal. I’ve seen literally dozens of ideas on how to do health care and health insurance. It’s not like they’re a scarce commodity on this side of the aisle—every aspiring wonk has a few ideas. If having a plan was enough, this would have been done years ago. It’s not. You’ve got to put in the work—putting the ideological and institutional infrastructure in place, making clear that this is a priority, thrashing out the details of what you want. And all that work gets ruined and has to be redone the second you make contact with the political process. The current bill is not by any stretch a liberal dream bill. But it’s what we’ve determined is a) as best as possible, consistent with our priorities and b) politically feasible, after a 15-year-period where we planned this out.
Meanwhile, the right has basically abdicated its role in the conversation. It has not and as far as I can tell will not treat health care reform as any kind of priority—every major player on the right is sitting on the sidelines. If we’re lucky, we’ll get two GOP Senate votes. And this after not one but two elections in which the right was beaten by historic margins. So forgive me, E.D., but it’s hard to take your concerns with the weight they would deserve on another issue. On health care, you and yours simply haven’t put in the work.
I can understand being frustrated with conservatives on this, but why heap that all on E.D.? So he doesn’t like the plan, and your side has done the homework? Then use your homework to show him why he is wrong, politically infeasible, or both. Don’t just dismiss him out of hand. Sure, it is late in the real-life game to propose a reworking like this, but this is a blog. If a discussion with no real-life implications can’t happen here, where is it supposed to happen online? I learn from pointless blog arguments. That’s something useful E.D. is providing opportunity for, at least.Report
Yeah, it does seem that because E.D. is sticking his neck out with at least some ideas, he is getting his head bitten off for even trying. And i have come pretty close to doing some of the biting, though I have tried to be very judicious and explain fully why I think engaging with the debate as is, however imperfect the proposals, is crucial. (That approach, of course, is very much a function of the fact that I very much want to see the healthcare industry reformed in a major way.)
That said, I broadly agree with the sentiment in the post. I have avoided putting it in such stark terms because it just sounds so provocative, but in fact it is true. If we kept electing Republicans, the problem simply wouldn’t be addressed. That’s not to say people here are advocating electing Republicans. But at the moment (make that, in the foreseeable future) if this is going to get addressed, it’s going to be by either Republicans or Democrats.
I would love it if a libertarian or other alternative ideological approach to health reform that honestly acknowledges the problem and offers real solutions could be seriously debated at the national level. But in reality, for that to happen, such an approach would have to have a real constituency, and maybe even a viable political apparatus of some kind.
The Party of Ordinary Gentlemen(and women), perhaps?
Here’s a proposal: let the party with both the power and motivation to address the problem as they see fit right now do so and see if it works. Spend the next couple of decades developing your ideas on how to once again reform the system when todays reforms inevitably fall prey to problems foreseen and unforeseen, as you are convinced they will. At the same time, organize a political movement in support of those ideas. And then when you come of age, go in and kick some deregulatory (or whatever reforms you settle on) butt!
The pendulum will swing again, but when it swings as decisively as it did last year, the party on the winning end does need to be given a chance to show what it can do.Report
We’re conservatives. We purge heretics and burn witches. It’s just what we do.Report
Oh, I dunno, I think E.D.’s one of the better bloggers out there, A-list or Z-list.
Re: “Health Care,” You people (Soc/Dems) can screw up a one elephant parade! The problem with American “health care” is gummint and the Dem solution is to insert more gummint?
Dah!Report
Do you have anything to back up your assertion that the problem with US healthcare is gummint? Because, sympathetic as I am to the idea that gummint can be unwieldy and inefficient, this line simply doesn’t jive with my experience, nor does it make intuitive sense.Report
Okay, I’m a bit confused. You are rightly upset that conservatives have not put out a comprehensive health care reform plan and then you pan a conservative that is concerned about health care reform who tries to put forth a plan.
I’m a fellow conservative and have been perplexed at the lack of concern on health care. That said, I am happy that ED and Mark Thompson have shared their own concerns and tried to put forth actual plans. The debate on the right has to start somewhere and at least these bloggers are doing it.
I think that ED and Mark have put in the time on this issue. It is a shame that you can’t acknowledge that.Report
This is an empty, condescending post — and it’s also dishonest, because I have heard many on the right say they are dissatisfied with the present system, and some have offered plans. You just don’t like the plans, obviously. You definitely wouldn’t like mine. This partisan hack-job is a poor excuse for a thoughtful contribution — it belongs in the comment section.Report
No question–I have much respect for E.D., which I apparently failed to enunciate clearly enough in the guest post. I do feel frustrated, however, that the debate is taking place on two entirely different planes–which, again, is a function of the larger conservative movement.Report
I’ve never stepped into a wrestling ring but I can explain why Kevin Nash sucks and why Christian is the bomb diggity. Moreover, I’m overweight.
Kevin Nash has written essays explaining that fanboys like me don’t understand what it’s like to travel 250 days a year and get punched in the face and fall on your back every night. Moreover, he points out, he gets much higher quality tail than me and mine are likely even to see in the gentlemen’s clubs in our little podunk parts of the country are likely to offer.
And yet… Kevin Nash continues to suck.
And Christian remains the bomb diggity.Report
le me be clear where I stand – I am for a public option and want to see the Democrats’ plan pass, warts and all, whatever they may be. That said, your critique of EDK is malicious. For one thing, here at LOG theres a determined effort to reject the obstructionist, ideologically-blinded approach of the GOp to conservatism and construct a new conservatism without the dead weight. So dumping the failures of the GOP on EDK’s lap is to ignore the reality of what this blog represents, and is kind of a middle finger in response to the gracious invitation to contribute.
yes, the GOP sucks eggs. now can we move forward and have a civil discussion about policy? Its what you say you want to see, well here it is.Report
in 2005, you could read Ezra Klein’s blog and find a conversation that E.D.’s idea would have fit into. Ezra was talking about the different permutations in use in various other OECD countries, discussing how and why the our system performs so poorly in comparison, and weighing the merits of various wildly different proposals. If you read Ezra’s blog now, you’ll find in-depth reporting of the Finance Committee’s mark-up. This isn’t because those big-picture discussions aren’t valuable, but because we’re going to have to weigh in on a specific bill soon, and we probably won’t see major health-care reform again for another decade if this fails. The different bills working through Congress now, plus the status quo, are the entire conversation. If conservatives don’t like what the HELP committee puts out, then fine. But they ought to be able to explain why HELP’s bill is worse than the status quo, not why it’s worse than some magical simplified concept that hasn’t encountered a special interest or the existing bureaucracy.Report
The timing thing. This puts it well. If you can’t get on board with what’s on the table, then I applaud developing ideas that’ll work better. But they’ll have to wait for next time around.Report
A very valid point is raised in this post, though. Where are the conservative wonk-rooms? Why do liberals have such a policy-idea-machine in place and conservatives don’t? This is an important critique of the conservative movement – and well worth heeding.Report
Buckley’s dead.
After that, all of the wonk and think tanks tend fiscal conservative, socially liberal if not outright libertarian and all of their plans are, effectively, somewhere on the continuum between “whenever you change something it all ends in tears” and “burn it down and it’ll organically turn out something better than the monstrosity we’ve got.”
Or, of course, “Let’s go back to the 10th Amendment and let each state figure it out and, eventually, there will be a workable, sustainable, helpful plan that comes out of *ONE* of them… and everybody can emulate that one if they choose. People who want that sort of thing can move there, people who don’t love it can leave it for another.”
They’re mostly meta-critiques attacking the fundamental assumptions rather than plans in their own right.Report
Oh and thanks to everyone for rushing to my defense, but Dan is more than welcome to critique me and point out the obvious drawbacks of constructing policy ideas on a little-known and rather new blog. And in all fairness, he submitted said post directly to me, and I don’t feel like it’s malicious so much as an expression of frustration. I hear that. And I hope Dan and other liberals who have wanted a good policy debate with conservatives that gets past the talking points can continue to find it here…Report
The spice of the comments is directly proportional to the spice of the post. That each is hard-hitting doesn’t mean that the participants aren’t having a “good fight”.Report
Oh totally. And I like a good fight.
“”I’m not gonna hit ya. I’m not gonna hit ya? LIKE HELL I’M NOT!” to quote some of my favorite fightin’ words…Report
Well, there are two kinds of disagreements.
“Dude, you’re *TOTALLY* wrong” is one. I figure that you are a big boy and can handle arguments against your positions that say this sort of thing.
“Dude, you’re not even wrong, you obviously haven’t thought about it, and people who agree with you obviously haven’t thought about it EVEN MORE” falls into a category where I need to bust out the WWF.Report
Here’s the thing, jaybird–I’m not a health care wonk. I skim half the stuff on Ezra Klein’s blog. I basically outsource my position on actual health care to Ezra, CAP, etc. So I’m not well-placed to dive into the weeds of E.D.’s proposal.
But I do know about the political debate. And there’s no conservative Ezra Klein. Hell, there’s nobody doing for health care what Jim Manzi is doing for climate change.
What’s disappointing is that E.D. really is the best conservative voice I’ve read on health care. He’s thoughtful, he’s offering ideas, etc. But it’s years behind what’s present on the left. And this isn’t an insult to E.D.! Think of it this way–any country that had me on the Olympic sprinting team would be in dire straits, sprinting-wise. Similarly, somebody who’s relatively new to the issue and has an evolving view on foundational topics like the presence of a public plan probably shouldn’t be the best and most detailed exemplar of health care wonkery on the conservative side of things. The fact that this is true–that E.D. really is offering more detail than National Review on health care–says nothing about E.D. and everything about NR.Report
As I said, Buckley is dead.
Could we look at Cato?
http://www.cato.org/researcharea.php?display=6
Heritage?
http://www.heritage.org/leadershipforamerica/health-care.cfm
von Mises?
http://mises.org/freemarket_detail.aspx?control=279
(okay, that last one is a little bit out there.)
Sure, National Review sucks. You used to need a high-school reading level to get through it (and it helped to have a dictionary nearby when you read Buckley’s stuff). It has since regressed to the mean.
CATO is still around. Heritage is still around. von Mises, bless their hearts, are still around.Report
Here, here! When I read about vouchers in the previous post, I almost puked. Vouchers???
Shopping around for the best deal?? (Hell, I don’t know why people don’t do this already….especially in emergency situations. That ambulance the 911 operator sent to your house? Send them away if you get a better deal somewhere else!)
You’ve gotta be kidding me.
I think the solution to our healthcare dilemma is going to require an end to corporate profit-taking and that includes insurance companies.Report
I don’t think your ambulance example holds up to scrutiny.
And if you think a public option will mean the “end to corporate profit-taking” you have another thing coming.Report
Alright, stipulating that the ambulance example doesn’t hold up to scrutiny (if only because argument by anecdote is ineffective) and “end to corporate profit-taking” was hasty, let me just say that I’m not…repeat NOT…in support of a public option.
A public option will not reduce costs…it will increase them, not just for taxpayers but throughout the entire industry. Government dough tends to do that. So with a public option, we’re talking MORE corporate profit-taking, an egregious amount of it. Rather than END corporate profit-taking, perhaps we should just lessen it. That’s not what I said, but that’s what I meant.
As for shopping around for insurance now, the deal I get from my employer is the best deal around, so…what’s the point?Report
Uh, so what are you for?Report
Thanks, E.D., and to all the commenters I hope you’ll believe that my intent was not malicious in any way; I’m sorry if it came off as too intemperate.
What’s really frustrating to me is that this affliction seems unique to health care. Conservatives have plenty of ideas about, e.g., national defense. Or energy policy, or gun policy, or crime, and so on. Which isn’t to say I agree with those ideas–but they’re certainly out there, and conservatives are totally willing to make their case.
On health care, meanwhile, it’s crickets chirping. Conservatives will never bring health care onto the agenda unless liberals force it there, and when they do the debate rests entirely on abstracts and theoreticals because basically no conservative pays attention to health care unless political circumstance forces them to. I do find it frustrating, which leads to lack of temperance, which I apologize for, but I stand by the larger point.Report
Atta boy, Dan. Don’t suffer these fools gladly!Report
Let’s say that I did not see “health care” as a Federal issue but an issue reserved for The States or for The People.
Let’s say I wanted 50 cauldrons of democracy working on 50 different health care plans and allowed people to vote with their feet to live under the plan that suited them best.
What would your response be to that particular idea?
That it’s not an idea at all and I need to submit a workable plan?Report
Go to Google Maps and ask for directions from LA to NY. Google will give you turn by turn directions from your start to end. Or i can give you directions: Head east then ask along the way.
One is a plan. One is a hope and prayer.Report
And let’s say that Google Maps gives you bad directions and you end up in Mexico City.
If I look at the thing that the google spat out and say “that’ll take you to Mexico City”, will you respond with something like “at least I’m not in NYC!!!” or “Children are dying!” or “That’s not Mexico City, it’s LA”?
If it’s that last one and you end up in Mexico City, is there a point at which you might be willing to say that you are not, in fact, in LA?
Or is the important thing that you are not, in fact, in NYC?
From where I sit, there are worse places to be… and, on top of that, you can’t get there from here. Yes, other folks got there… but not from here, they didn’t.
A follow-up: If it turns out that you do not end up in LA, will it be my (and everyone like me’s) fault for not helping enough and we totally would have gotten there if we just drove harder?Report
I understand and agree with the larger point, but I felt your frustration on it was mis-directed. To me, E.D. is not part of the problem here. He may by symptomatic of it, but only in a small way. But your article uses very dismissive language towards him, personally, without really engaging the idea. If you had taken more of the tack M.Z. did in a post below, and explained why the idea had been proposed and discarded, and then complained about not doing the work, it would have been a better post.Report
I was a conservative when I entered health care. I would still consider myself of the right, but I voted for Obama in the last election. For the time being I’m going to have trouble voting for Republicans. Okay, just a little more about me. I dropped out of debating health care almost two years ago, because it got frustrating debating with people that did not know health care, and more so didn’t really seem to have an interest in wanting to understand it. It would be like me debating Daniel Larison about the mix of religion and politics in Kazakhstan, only the roles would be reversed. And it isn’t so much that one couldn’t become educated on health care, it is just so many people feel confident theorizing over 12-18% of the economy without really understanding how it works presently. The theory isn’t necessarily bad, but there is not referencial framework behind it. So when E.D. Kain throws out the idea of vouchers for everyone in order to attempt to model a certain economic behavior, he doesn’t recognize that we have attempted to model that economic behavior through coinsurnace, then HRAs, and now HSAs. People will claim it should be just easy to refute him then, but it isn’t because there is a baseline involved. Think of the I believe apochryphal quote of George Bush, “Aren’t they all Muslims?”Report
This post seems to come straight the memories are short (or convenient) department.
I recall a serious effort led by Newt Gingrich and the then GOP majority in H.Rep to reform Medicare in advance of the meltdown that was widely predicted even 15 year ago, and then watched in dismay as President Clinton and congressional democrats (and liberals) demagogued the issue as “the nasty Republicans were going to take health care away from our seniors.”
My advice — don’t break your arm patting yourself on the back for having serious thoughts about healthcare reform.Report
Medicare is not synonymous with “the health care system.”Report
Yet.Report
It would be awesome if it were.Report
If I were the Pres. of Mexico I’d invite all the soon-to-be pissed off American Drs. down there to open clinics, hospitals and I’d subsidize their move ’cause that’s where all the Americans will be travelling when HIs HOliness takes over “health care.” Mexico would make billions!Report
Calling the healthcare salmagundi designed by the liberals an intelligent plan is like calling the Hindenburg the apex of airship design.Report
Well, if you say so…Report
Correction: “thrown together” not “designed”.Report
Here are some key points about healthcare in this country:
1. You cannot get a law passed that will allow emergency rooms to deny care based on inability to pay. This last line of defense will ALWAYS be on the taxpayer dime.
2. The working poor cannot afford even a bare-bones insurance policy. And even if they could, once policy limits are exceeded they’re off to the emergency room and the taxpayer dime.
3. As much as homeowners’ insurance doesn’t cover burning houses, private insurance will never cover pre-existing conditions. So once you’ve had one serious sickness, you’re either stuck in your job forever or pay for recurrences of that disease out of pocket.
4. The laws of averages says that the larger the pool, the lower the cost. Small employers will never get the same rates as those offered to larger ones.
5. People don’t want insurance; they want a cost pool — ie, pay a fixed price for life and get the care they need from the first dollar when they need it.
6. Simplistic references to the laws of supply and demand rarely work in this industry. Very few of us voluntarily consume more medical care than we “need”; we just do what we’re told.
So, what does this mean? What every other industrial country has found out — government must act as the clearinghouse.Report
The starting conditions do significantly tie would-be-reformers’ hands. The result is that the alternatives to all of us crashing and burning together are not numerous and not terribly attractive.Report
It’s also worthwhile to note that emergency room care is about the most expensive kind of care there is. If the uninsured people who use ERs as their primary care providers can be diverted into the much-cheaper GP-based system, a huge burden will be lifted, particularly from local public hospitals.Report
Your post reminds me of the biggest problem Republicans have at the moment. They don’t have any solutions to today’s problems. Instead they’re stuck in reruns of the Reagan Era where government was arguably too big and taxes were arguably too big.
Right now, as our country falls measurably behind in health care efficiency, public infrastructure, education, and other public goods and services we might need to consider that more government and more taxes is the answer for these problems at this moment time.
Most importantly we have the evidence that well designed public services, like health care, work in other countries. If they can do it, we can do it.Report