What constitutes "good news"?

Friday, March 23, 2007

Over at RealClear Politics is an editorial that reports on the debate within the GOP on how to counter the Democrats' latest attempt to socialize medicine. Although it strikes an optimistic note -- and, I suppose that after observing the antics of Governors Romney and Schwartzenegger, we should be thankful that there is a debate at all on the GOP side -- what it really does is bring up the question, "What constitutes 'good news'?"

Three things stand out about the article.

First, author Kimberley Strassel notes that the initial skepticism among Republicans concerning health savings accounts when that idea was first introduced over a decade ago eventually gave way to broad acceptance.

Conservative health-care guru John Goodman remembers going to Washington in the early 1990s to get Republicans interested in individual health savings accounts, and "only about five guys would even meet with me," he recalls. Now, HSAs "are a religion" among the right, he notes, and Republicans used their last years in the majority to significantly expand access to these accounts. In the past 15 years, the GOP has also planted the roots of Medicare reform, looked at interstate trade in health insurance, and got behind competitive Medicare reforms in their states.
This sounds encouraging at first blush, and certainly, it is a sign that capitalism has gained somewhat broader public acceptance over the years, or politicians, who are notoriously timid about actually taking principled stands, wouldn't touch HSAs with a ten-foot pole. But is it not troubling that even this tiny first step towards a freeer medical sector has not gained more ground than it has, and that furthermore, GOP reform of the medical sector hasn't gone much further than half-hearted support for this measure?

Second, other reforms of the welfare state that most people regard as "free market" reforms have gained acceptance even among Democrats.
... When Republicans railed about welfare queens, they were viewed as the heartless party. When they turned the debate into one about the vicious cycle of dependency and poverty that welfare causes, they captured voters' imagination--they captured even Bill Clinton's imagination--and pushed through entitlement reform. Today, even the left agrees welfare-recipients should work.
The problem is, we still have welfare recipients, the government is "encouraging" them to work, and the moral premise behind welfare remains unchallenged. Indeed, the motivation for the reforms is not unequivocally the protection of property rights, but the moral improvement of the erstwhile recipients. In other words, even the welfare "reformers" take as a given that the government exists to take care of us. (And maybe the Democrats like the idea because they know it is not a threat to the welfare state.)

Third, in a move touted as a major advance (and which is Strassel's point of departure), a supposedly free-market alternative to "Hillarycare" is being proposed by Oklahoma Senator Tom Coburn. It is interesting to read both of Strassel's descriptions of this plan.
... Coburn released a big-ideas blueprint for restructuring the entire health-care system--the tax code, Medicare, tort liability, insurance laws--along free-market lines. Dr. Coburn's plan builds on the White House's own bold proposal in January to revamp tax laws so as to put consumers back in control of their health-care decisions. Both plans are about fundamental, bottom-up health-care reforms, cast in the language of markets, consumers and individual control.
This will sound good enough to many fiscal conservatives, although not to me. The only way to "reform" Medicare (or any other welfare program) is simple: to abolish it. There is nothing "free market" about the government forcibly redistributing income.

But the kicker is Strassel's own alternative phrasing later in the article, which comes after she cites Mike Franc of the Heritage Foundation urging the Republicans to get outside their "intellectual comfort zone" when thinking about medical reform.
Those on the free-market side are starting to understand the need for a new language, especially if they are to coax more nervous elements of their party into embracing radical change. When President Bush unveiled his health-care tax overhaul in the State of the Union, he stressed that health-care decisions needed to be made by "patients and doctors," not government or insurance companies. Mr. Coburn's bill summary is littered with the words "choice," "empowerment," "competition," "flexibility," "control"--which is not only an honest assessment of what his proposal would provide, but one with which Americans can identify. [bold added]
That bit about health savings accounts being "like a religion" from earlier in the article is starting to sound very profound, if unintentionally so, right about now. Why? Because it is clear that if the Republicans are feeling the need to "re-frame" (i.e., euphemize) their side of the debate, they do not really understand how capitalism works or, therefore, why freeing the medical sector entirely from government interference would be a good thing. But then, if the did, they would present any proposal for "reform" of our "health care system" as part of a broader campaign for a fully free economy. Instead, they accept on faith that the trappings of a free market will somehow make the welfare state "work" better, while simultaneously "selling" these "reforms" to voters who actually might support moving to a freer economy.

And if I sound too paranoid, compare this to the following passage from C. Bradley Thomposn's seminal essay on "The Decline and Fall of American Conservatism":
How does a conservative welfare state work? And how does it differ from a liberal welfare state?

The neocons advocate a strong central government that provides welfare services to all people who need them while, at the same time, giving people choice about how they want those services delivered. That is what makes it “conservative,” they argue. That is how the neocons reconcile Adam Smith and Karl Marx, Hayek and Trotsky.

In practice, this means that the coercive force of the state is used to provide for all of the people's needs—from universal social security to health and child care to education -- but the people choose their own "private" social security accounts; they choose their own "private" health and child-care providers; and parents receive vouchers and choose which schools their children will attend. The choices, of course, are not the wide-open choices of a free market; rather, the people are permitted to choose from among a handful of pre-authorized providers. The neocons call this scheme a free-market reform of the welfare state. [bold added]
Which beings us back to our underlying question: Is a "free-market" scheme for "health care reform" necessarily good news? In the sense that proposing such a scheme reflects broader public acceptance of capitalism, it does. But given that the GOP is more interested in taking over the welfare state than doing away with it, and that this understanding of capitalism is muddled to the point that many on the right regard such statist schemes as carbon credits as "free-market", it is bad news.

What I fear we will get instead of true free market reform is a new, Lakoffian "language" with which the GOP can dupe voters into believing it is in the business of freeing the medical sector from government control, while in practice, the Republicans merely perform a few minor cosmetic changes to a fundamentally immoral and impractical system. This will not only fail to end the "health care" crisis, it will set capitalism up as the scapegoat for the next round.

This is not to say that it is inconceivable that Coburn's proposal is better than I think it is (To be fair, this is the first I've heard of it.), or that some worthwhile ideas for reform will surface over the next few years, but advocates of capitalism must be very clear that the ultimate goal of any economic reform is not a "reformed" welfare state, but a welfare state consigned to the ash bin of history. Otherwise, we risk allowing proponents of the welfare state to speak for capitalism.

No matter what concrete measures (if any) one advocates during the ongoing debate about the role of the government in the medical sector, one must always be explicit about why one advocates it, one's actual principles and goals, and the qualifications, if any, of one's support.

-- CAV


Andy said...

Hey Gus...I agree. This is not good news. The political solution...don't support or vote for conservatives. As bad as the liberal sound, conservatives are not "better". They are the wrong solution to the liberal problem.

The fundamental solution...the proper metaphysics (primacy of existence) and the proper epistemology (reason vs. various forms of mysticism).



Gus Van Horn said...

A corollary question is, "When can one support a given measure?"

I would venture to say either (a) when it is of a sufficiently narrow scope that supporting it cannot be misconstrued or (b) when it is put forth in a fully free-market context. It will be a long time before the second obtains.

Jason G. said...

The problem with your argument is that it is unrealistic given the current political context, at least currently. If we don't offer conservative-framed ideas to temper the welfare state, but instead continue the hard line position of abolishing it, the Democrats will have free reign to take us down the path of socialism.

There is no way we can eliminate publicly-funded education at present, but we can put in place school vouchers. We can't to eliminate Medicare/Medicaid, but we can restructure it to offer competition, choice, and decentralization.

And who knows, maybe as these reforms succeed, people will begin to understand the individualist values of choice and freedom and there will be a greater opportunity to end the welfare state.

Gus Van Horn said...

There is nothing wrong with incremental reforms provided they are made with the object of more freedom down the road or occur while the overall cultural trend favors more freeom over the long haul. Sadly, neither condition obtains today.

Having said that, I have no illusions about the possibilities of abolishing certain aspects of the welfare state any time soon. Nevertheless, if nobody makes such arguments, then the only real alternative to the welfare state, capitalism, will remain unheard of -- except insofar as some watered-down welfare state (with its many flaws and tendency to expand) is incorrectly known as such.

Until the public becomes better-educated about the principles of individual rights, the overall course of our society will be towards socialism. THIS is why you fear that making an honest stand will make the Democrats look good. Unfortunately, your alternative, to try to be sneaky about a few incremental reforms, can be subverted (as I argued), and, since, by necessity, no pro-capitalist arguments will have been made, all that is needed to lose to socialism will be for some Democrat to make his more statist measure sound like it will be "more effective".

Ceding the moral high ground to your opponents (by not openly advocating capitalism no matter what the short-term hardship) is a policy that is doomed to fail.

Laugh at "extremists" like me now, cry when we are proven right later. Or do what too many conservatives think is impossible, and start making a rational case for freedom.

Galileo Blogs said...

Jason G. says:
"If we don't offer conservative-framed ideas to temper the welfare state, but instead continue the hard line position of abolishing it, the Democrats will have free reign to take us down the path of socialism."

The opposite is true. We have had the conservative response to the welfare state for 70+ years now. What has it brought us? An ever increasing share of GDP consumed by welfare spending. Welfare today is far larger as a proportion of the economy than it was in FDR's day when the first public housing and other welfare programs were enacted. Now we have reached the dead-end of the conservative failure to oppose welfarism. It is called "compassionate conservatism" and is more than just a surrender to the welfarists. It is the me-tooing of them with expansionist *Republican* welfare programs such as Bush's prescription drug program.

By not challenging the root premises of the enemy, they get away with their ideas. By challenging those ideas, their confidence is eroded and the possibility of a different way is introduced to honest citizens. Do it long enough and we will have another American Revolution, whether that revolution happens all-at-once or piecemeal. But without clearly stating what we are for, we will never get there.

The bottom line is: being principled is eminently practical. Being "practical" -- i.e., pragmatic -- is incredibly impractical. It actually leads you away from your ostensive, hidden goal, the one you were too afraid to announce to the world.

Gus Van Horn said...

"The opposite is true. We have had the conservative response to the welfare state for 70+ years now."


Jim May said...

This will not only fail to end the "health care" crisis, it will set capitalism up as the scapegoat for the next round.

I have long told Americans that what they have now is already socialized medicine, privately administered.

Conservatism's moral paralysis in the face of the Left is shown more clearly here than anywhere else; unable to move *towards* any goal (hatred of socialized medicine is not a love for freedom), they fight not for change, but for whatever band-aid (like HSA's) buys them more time.

In the meantime, increment after increment of government interference is piled onto the system, driving costs up year by year, with the blame laid at the feet of the "free market". The Left knows that any alternative gets better and better looking than the status quo each year, and that if they fail to achieve socialized medicine today, it will get easier tomorrow.

With the Democrat victory in the last election bringing the issue back to front, and with even professed free-market supporters lke Megan McCardle folding up like cheap suitcases on the issue and Michael Moore about to release another agitprop hatchet flick, this time aimed at the health care industry, I'm simply not optimistic that they will be stopped this time around.

Gus Van Horn said...

Quoting from Megan McArdle:

"What I don't hear a lot of people addressing is what sort of system it is feasible for us to get, given the interest groups and institutions we already have. There are some serious constraints that I think would have to be considered by anyone trying to design a national health care package[.]"

This says it all. If she understood the nature of capitalism and what is wrong with a state-run economy, she would not even have to enterain that question.

This kind of policy-wonkish debate, with its not-picking over nonessentials and abject failure to cut through the conceptual fog drives me nuts in addition to making me wonder whether I overestimate the right.

And the woman calls herself "Jane Galt"!

With "capitalists" like these, Michael Moore is superfluous.