Universal Healthcare, Brought to you by the GOP?
April 14th, 2009 by Nick SaintRegina Herzlinger, a former adviser to John McCain, has a terrific* post up at the Atlantic urging Republicans to put together their own universal healthcare plan:
The time for universal health insurance coverage has come. Everybody seems to know that — except for the Republicans, all too many of whom cling to traditional denunciations of universal coverage as socialism. Senate Finance Committee Chairman Max Baucus has been holding talks with Republican lawmakers over the past week, and all signs point to opposition from the GOP.
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There’s a massive constituency behind the policy. Buffeted by the recession and the threat of losing their employer-provided health insurance, the American people want universal coverage. Much of the US business community wants it too. CEOs rarely say “Know what I love about my job? Buying health care.” The chore is so unrewarding — corporate buyers have failed to create effective cost or quality improvements — that many small business CEOs simply skip it. As a result, millions distort the efficient allocation of labor in our economy by opting for jobs in dying, big companies that offer health insurance, rather than productive ones in small companies that do not. Furthermore, our employer-based health insurance system forces American businesses to pack our massive health care costs — about 70 percent greater as a share of GDP than other countries’ — into the cost of their exports, a huge albatross in a globally competitive economy.
The Republicans can do a Nixon-goes-to-China by offering a better version of universal coverage. There is, after all, substantial concern about the Democrats’ reliance on universal coverage through a government-controlled system like Medicare.
Strategically speaking, this is exactly right. Refusing to participate seriously in the legislative process over the bailout and, especially, the budget has not done anything good for Republicans’ image. As Herzlinger says, the momentum for some sort of universal healthcare plan is unstoppable at this point. Democrats will go into the midterm elections able to say that they have taken concrete steps toward comprehensive healthcare reform, even if much remains to be done. Republicans will be much better off if they can plausibly claim to have had an impact on that reform. That won’t be easy to do if they sulk on the sidelines as a purely Democratic bill passes on another party-line vote.
But it also makes sense ideologically for conservatives to put together their own universal healthcare plan. There is a tendency on both the left and the right to pretend that something like a free market in healthcare is the status quo. This, obviously, is nonsense. Government is already deeply involved in the healthcare market, and whatever you think of the product, it is a fiscal disaster. While it is probably true that under any universal healthcare plan worthy of the name, the government would take on an even larger role, that simply cannot be the decisive criterion, given how involved they are already, no matter what your ideology. In evaluating two alternative public programs, even the most radical libertarian has to weigh not merely how much the government is doing, but also how much good or harm it is doing in the process. So conservatives shouldn’t be ruling out the possibility that a universal healthcare plan could be more in keeping with their own political philosophy than the system we have.
Of course, the fact that we don’t have a free market in healthcare doesn’t mean we couldn’t. One could argue, as Ramesh Ponnuru has, that while our system clearly needs reform, that reform should move us in the direction of a free market, rather than toward a universal system. This is all well and good as an intellectual exercise, and it may even be right, but it is more or less irrelevant at this point. Perhaps if George Bush and Congressional Republicans had made reform of this sort a priority eight years ago, it would have been possible. They didn’t. With Democrats in control of the White House and Congress, this simply isn’t going to happen. If this sort of plan is all that Republicans are willing to fight for, they will simply be spinning their wheels again. If, on the other hand, they acknowledge that universal healthcare is coming, they could have a major impact on what form it takes. There is no possibility of bringing about the system they would wish for, but there is an opportunity for them to support a plan they like better than what we have now. This is the sort of approach that a reformed GOP, one capable of being nationally competitive again, will have to take. Unfortunately, I suspect they aren’t ready to come out of time out just yet.
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* Terrific on the politics, anyway. I am nowhere near knowledgeable enough to assess her specific policy ideas. The Swiss model she advocates certainly sounds good, but that isn’t much of an endorsement. One thing I’d love to see Republicans push for is what some are now calling ‘lifestyle rationing’, though I don’t care for the name. Basically, the idea is that people who, for example, smoke shouldn’t receive government help when they get lung cancer. I’ve written about this before, but I don’t know whether it’s technically or politically feasible. It’s a very appealing idea, though, and it would play to the current Republican strength of screaming about how we’re all paying for the mistakes of jerks.
May 8th, 2009 at 9:46 pm
[...] Public spending on healthcare is also spiraling out of control, which is certainly very bad and needs to be addressed. But for the part of this gap that is made up by private spending, one needs to know a lot more to [...]