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?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.
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]
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.