10 Principles for a republican Approach to Health Care, part 1
Politically-speaking, the health care policy alternatives before us at the moment are limited: a strong or weaker version of the President’s plan (any of which would either include or prepare the way for the provisions and approach to health care objected to in my “10 Reasons to Oppose Obamacare” columns) or something not very far removed from nothing. With a different congress, different options would emerge. With a different president and a different congress, a whole range of new possibilities would come into being. For now, then, it is most important that we have clarity on the key question that will be before the congress when it returns from recess: is the status quo preferable to the President’s alternative?
There is no guarantee that “reform,” however good may be the intentions of those who advocate it, will make things better. The history of public policy has many, many chapters that can be summarized: good intentions, bad results. Unless we currently have the worst possible health care system, there are ways to make it worse. I believe that there are very good reasons, detailed in numerous previous posts, to believe that the President’s plan will reduce access to health care, increase costs until strict rationing is imposed, create a culture of Darwinian competition for medical resources and pressure on the weak to “get out of the way,” compromise liberty, and vastly expand the reach of the emerging corporatist, bureaucratic state. Given the choice between the President’s plan and doing nothing, we would be better off doing nothing. Given a different set of political possibilities, however, a republican approach to health care might look something like this:
1. Maintaining a fundamental respect for human dignity – One of the great dangers of nationalized health care is its tendency to compromise human dignity in a whole variety of ways. From the paternalistic assumption that government boards can better manage my health than I can to the creeping expansion of the number of our fellow men who are defined out of the human family (to justify abortion or the denial of treatment to those whose “quality of life” is substandard), a government-controlled health care system assaults our republican principles at their foundation.
2. Keeping the private private – The more health care is conceived of as a service provided by the government rather than a service contracted for between private parties, the more of one’s life is drawn within the public sphere. There is no national health care “bill,” as the President has put it, as if all Americans, in this regard, comprised one large family – and there won’t be so long as there remains a strong private market for health care services. It is no small reason to fight for the continued existence and growth of that market that we may forestall the onerous lifestyle taxes and regulations that must surely grow with the government’s role in providing and regulating health care.
3. Recognizing the tradeoffs that public spending forces – If I could wish two pieces of wisdom upon every policymaker in the nation, they would be: first, a proper understanding of human nature (consistent with the Biblical account of fallen humanity); second, an appreciation of the economic concept of opportunity cost. Over and over again, those who craft legislation and regulation fail to appreciate the policy implications of the obvious fact that a dollar spent on item x is consequently unavailable for the purchase of item y. $1 trillion spent on public health insurance is almost $10,000 that every household in America will not be able to spend on their heating and cooling bill, a healthier diet, more adequate clothing, improved housing, an exercise machine or gym membership, an extra trip to the doctor or dentist, or a safer car. Any or all of these items might be at least as likely to improve the health or life expectancy of Americans as government-centered health reform, but may be quietly foregone when the money is appropriated for public use. Spending on a government health care plan, to be justified, must at least be able to show that: a. it will bring about a net improvement in health after factoring in all the opportunities foregone in the collecting of the taxes to pay for it; b. that that net improvement is greater than the improvements available through non-public options, tax credits for health insurance, etc. To advocate a program that cannot meet these tests is an ideological, rather than a policy, judgment.
4. Promoting cost transparency – The more that payment for health care is removed from the relationship between patient and provider, the less the health care consumer is able to make his own important judgments about relative spending priorities. Greater transparency may not lead to less spending – and there is no intrinsic reason to believe that Americans should spend less on their health rather than more – but it will lead to a more informed choice.
5. Less “policy,” more responsibility – What portion of our health care system is it necessary for government to control? Must the government make it its business to reduce health care spending to a certain arbitrary level? Must the government provide health insurance companies with a list of items they must cover? Must the government ensure that there will be no personal benefit for healthy living in the form of reduced insurance premiums? Must the government decide what profits pharmaceutical companies may make, what rates doctors may charge, what services hospitals must offer? There is no necessity that any one group or individual make such decisions. In these and many similar areas, it is quite possible to have no “policy” at all, but to leave such matters in the hands of the millions of responsible citizens who sensibly go about their own business each day and the thousands of health care providers who respond to their desires and needs.
For those seeking a laundry list of “conservative” health care policies and programs to enact, the five points in today’s post must fall rather short of the mark. There will be time to consider legislative changes (items 6-10) that could mitigate some of the commonly-cited problems of the American health care “system.” But we will not allow ourselves to be forced into a debate on ground occupied by our opponents, where legislative activity is the measure of a legislator’s excellence, where public policy is expected to solve every private problem, and where individual citizens are collectivized and homogenized into an amorphous mass of government clients and dependents.
No related posts.
Great insights Matt. Add not enough docs to the list (if its not there, I just skimmed it). In other words, if we add more people to the system, who will care for them? Will the government start subsidizing medical school to get the types of docs they want where they want them (oh wait, we already do that in MA). Unfortunately, if this passes, there won’t be much of an incentive to become a doc, so, these numbers will continue to decrease. My suggestion: go to your doc now and ask if he sees anything going wrong during the next 1-40 years.