Strengthening Constitutional Self-Government

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Health Care

Repeal Won't Be Enough

Our brilliant commenter Carl Scott (who should be hired for some full time pundit gig at a major newspaper or magazine) rightly pointed out in one of the threads that if Obamacare passes, "Repeal It" will be the phrase of the day, month and maybe years on the right.  This sentiment might help drive turnout among right-leaning people who consume conservative media, and it might help win some close House and Senate seats.  But I think that "Repeal It" sentiment will prove to be a wasting asset if it is not supplemented with an-almost-as-great focus on alternative conservative policies.  People are risk averse on health care.  That is one of the great advantages that conservatives have enjoyed in the argument over Obamacare. 

The problem is that the moment Obamacare passes, that advantage begins to flip in favor of Obamacare.  Repealing guaranteed issue might seem like a net loss.  Some of the medicare cuts can be repealed.  Whats an extra couple of hundred billion between friends?  We'll take care of it with an... uh freeze...starting in a couple of years.  If premiums rise faster than expected, the blame can be shfted to the mean old insurace companies.  Not only are they raising your premiums, if we repeal Obamacare, they will take away your insurance.  There will be no alternative to patiently explaining the policy problems of Obamacare and pitching the message to the median (and even Democrat-leaning but persuadable) voter rather than commited and inflamed conservatives.  The problem is that it will be tough to sell them on the benefits pre-Obamacare status quo, not because Obamacare will be good, but because, in the short and medium term, the practical difference between Obamacare and pre-Obamacare will be so small.  One would give up security and get in return the pre-Obamacare rate of increase in premiums.  But that rate was already too high, so it might not seem like such a big benefit.  I can see Obamacare being replaced by a conservative policy alternative that promised lower cost and equal or better quality, but I can't see it simply repealed. 

Replacing Obamacare with a free market-oriented alternative will involve huge expenditures of time and energy in explaining the policies and benefits to the public and defending them from what are sure to be furious and well funded liberal attacks.  Conservatives are already years behind in the task of selling the public on free market-oriented alternatives to the status quo.  In the wake of Hillarycare's defeat, the dominant consevative message on health care was 1) greatest health cares system in the world 2) no socialized medicine 3) something about tort reform.  McCain had a health reform plan he could not bother to defend from Obama's attacks.  Perhaps he thought responding would take attention away from more important issues like earmarks and whether Obama had compared Sarah Palin to a pig.  Both of these approaches probably seemed like the easy way at the time.  Explaining how a combination of HSA's and catastrophic coverage (or moving to a system of individually bought insurance through tax code changes) will help bring down costs without hurting the availability of crucial services is tough.  Explaining the policies to help people with preexisting conditions during the transition to such a system will be painstaking because people will be scared, the ideas will be new to them, and the Democrats will be trying to terrify them.  If conservatives have a rhetoric for explaining these approaches to people who aren't CSPAN junkies, I haven't heard it. 

Focusing on "Repeal It" will likewise seem easy. Right-leaning America will have those words on their lips (and as Carl said, bumber stickers too).  It won't mean having to do the hard jobs of settling on alternative reform policies, developing ways of explaining them and having the sheer energy and persistence it will take to defend them in the face of what are sure to be relentless attacks.  But avoiding the hard jobs is one of the reasons why we are on the edge of state-run health care. 

 

Categories > Health Care

Discussions - 3 Comments

My thanks Pete. I'm not a health care policy-wonk. My mind boggles and flags at understanding our system, with or without Obamacare added to it. (My Manhattan Institute bud Paul Howard does know this stuff, though--he had a nice lil' column on NRO this last week.) So, again, you're probably right on the policy substance of this, and the importance of having more than just tort reform on offer. But I worry that certain Republicans, in order to have SOMETHING to offer as an alternative, wind up endorsing and pursuing policies that are minor-league versions of this Obamacare monstrosity. Romneycare, anyone? (I love Mitt, BTW) And in doing so they shore up the flawed idea that a solution to our health-care paradoxes must be out there somewhere, awaiting discovery by a just-more-dedicated super-wonk.

Did you read the Trevi Troy mini-history of health-care-reform politics at Commentary? I think I'm closer to his views of the politics of it all than yours. And even more simply, my fundamental take on this is that most of the health-care-reform talk prior to this year was fairly abstract. Most moderate and liberal Americans are for the reform in the abstract, and they nod their heads when pols left and right say, "We can do better."

Well, maybe, we can't. The devil is in the details, once again. The numbers simply do not add up. They haven't come close to adding up in any of the various versions of this bill. I assume they didn't with Hillarycare either, but I've somehow no desire to go read my political mags from 1993 on this. And that's just the numbers. Plenty of other complexities to this bill that do not make sense, or which are prove to be undesirable when they do.

So, Americans had to go through this process and grow up a little. Those not opposed to an expansion of central govt. power in principle, i.e., the moderates and liberals, had to go through the process of seeing that what would in fact be on offer was deeply problematic. Now, Obama's shameful games with the numbers is keeping many of them still in the dark, but enough have realized that this bill (and its process) isn't for them, and doesn't represent the sort of leadership they voted for.

Still, it may pass. Elections do have consequences.

Carl, you and Peter Lawler are two of the people whose opinions on politics I most value, but I can't understand your mutual liking for Romney. I know he was a good businessman, but his cynicism seems absolute, and his conservatism a series of market survey-derived clichés that were never spoken a moment before they became politically convenient. I think Romneycare was a series of ideas worth trying, but fatally flawed as a model for the country. I'll try to have more to say about Romneycare tomorrow. In all seriousness, would it be possible that you could write a longish (as in at least several thousand words) defense of Romney for one of the conservative mags? I don't see myself changing my mind on him, but I know I'm missing something too.

I read the Tevi Troy article and liked it, but I think he let conservatives off way too easy, understated how rising premiums are eroding living standards and hw unsustainable the current system is given demographic changes. People aren't wrong to think we can do better and we will have to or their will be some nasty consequences.

I totally agree with you that Obama's numbers and especially his promises don't add up. They weren't designed to. They were designed to gull just enough people to accept the slow motion government takeover of health care. The bottom line is that Obama believes that centralized direction of medical services will lead to better, cheaper, fairer outcomes. It will cover the uninsured, bend the cost curve down and tell you when to take a pill, shut up, and die. But once such a system is created and matures, it creates interests and destroys or co-opts alternative institutions so that it produces desperate loyalty from the public.

And I confess that I have underplayed the role of chance in the passage of Obamacare. If conservatives had done a better job of explaining free market-oriented health policy to the public, we might be almost as far from a state takeover of health care as we are from the imposition of across the board wage and price controls. But on the other hand, the Democratic supermajorities that are making the passage of Obamacare (barely) possible were not won on the health care issue. They were won primarily on public disgust over a mismanaged war, a badly timed recession, and a stunning financial crisis. So conservatives could have done better on health care the last fifteen years and would probably be in a better position if they had, but there are no guarantees, and I don't think any political strategy is going to master circumstance.

Pete, I just don't buy the Romney-is-insincere-cynically-changes-his-position theory. So I don't dismiss the guy.

Thus, since he's techno-business wonky in a good way, and a social conservative without making that into an overtly Christian or "Red-State of Mind" identity a la Huckabee, I preferred him to McCain and others in '08. But in the above comment, I was being a bit too polite (after insulting Romneycare) and "love" was too strong a word. Romney would be a fine vice-president. It would not be good for him to the Republican nominee for 2012, nor was it in 2008. Major image problem with the over-polished boy scout tick, for one. Then again, alas, he could again wind up being our best pick amid another bad-to-mediocre litter of candidates.

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