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The Central Front, The Right, And The Middle

James Capretta and Yuval Levin write that Republicans need to make major right-leaning health care reform the centerpiece of their campaign in 2012.  They estimate the stakes correctly when they write:

 

For Republicans committed to maintaining a vibrant and free society, there is no choice but to make genuine health care reform the centerpiece of their domestic agenda. If the health care debate is lost, then the fight for limited government is lost as well.

 

But the obstacles to Republicans enacting, or even running on a right-leaning health care reform agenda are enormous.  Part of the problem is with the right.  Aside from tort reform and vague calls to get the government out of health care, no particular set of right-leaning health care reform policies are a component of conservative identity.  Lower capital gains tax rates, expansion of oil drilling and opposition to socialized medicine are issues that have, for many conservatives, established narratives about growth, opportunity, freedom and justice.  Voucherizing Medicaid and giving a flat tax credit towards the purchase of catastrophic health insurance don't.  These kinds of connections can be made, but it takes time, effort, and repetition to create familiarity with the benefits of those policies, and the connections of those policies to principles of freedom, markets, and individual empowerment.  It could happen.  Most conservatives were in favor of greater oil exploration, but it took a combination of circumstances and political activism to make "drill baby drill" a big election issue (until the financial collapse.)  For a tangle of commercial and cultural reasons, it is not safe to expect the main outlets of the populist right-leaning media to take the lead in emphasizing particular right-leaning health care reform policies.  If those policies seem to be catching on, the populist right-leaning media will follow. 

One could hope for evangelical-minded conservative politicians and candidates to expand public understanding of right-leaning health care reform, but it would take a candidate of unusual character to make right-leaning health care reform the "the centerpiece of their domestic agenda."  That doesn't mean most conservative politicians won't have a good health care plan on their website (McCain did.)  That doesn't mean they won't have a one line or one paragraph nod to health care reform in their stump speech (McCain did.)  It means that focusing on right-leaning health care reform at current levels of public understanding and salience will endanger their campaigns.  In the Republican presidential primaries, it would make more purely political sense to talk about cuts to the corporate income tax, complain about this week's provocation from liberal-leaning figures, or find some new way (or yell some old way) to express contempt for Obama.  

Paul Ryan in one figure who takes right-leaning health care reform seriously.  He will get attention for his policy suggestions in the coming months (and not just on health care), but there are many segments of the population that a congressional committee chairman is not going to reach.  The politicians who can reach those other segments are Presidents and presidential candidates.  Ryan isn't running for President.  Newt Gingrich is (probably) running for President.  I heard him on the radio talking mostly about tax cuts and oil exploration and making fantasy promises about low unemployment rates and low gas prices.  Pawlenty is running for President.  His most recent CPAC speech included a vague little paragraph about giving people control of their own health care spending, but saved his energy for a phony and hyperbolic scream about how Obama should stop apologizing for the USA. Gingrich won't be Republican nominee and Pawlenty might, but their behavior closely tracks the political incentives and we probably can't expect better from most other politicians (that is a probabilistic rather than a normative statement.)

It doesn't get better when you get out of the Republican presidential primaries.  The issues involved in right-leaning health care reform are complicated.  Right-leaning health care reform policies would mean many people switching out of their employer-provided policies.  What about the currently uninsured and uninsurable?  There are answers (subsidized high risk pools or direct subsidies for those currently without insurance but with a cutoff date for new entrants), but they are complicated.  All the time the Democrats will be attacking you saying that you are going to kill grandma and throw people on the street if their kids get sick.  Public comprehension of right-leaning health care reform is low on the right, but virtually nonexistent among the potentially persuadable.  Health care security is an extremely personal and high salience issue.  John McCain was, in one sense, being quite rational in trying to get people outraged by pretending to believe that Obama called Palin a pig.  It sure beat having to explain his heath care plan.

But Capretta and Levin are right.  Public understanding and support for a patient-centered and market-oriented health care reform will have to be built somehow.  It could be a candidate of public relations genius, or a book that catches the imagination of the right-leaning populist media.  I hate waiting for one person to do something.  What if they get run over by a bus?  Also, 2012 might not be the year for Republicans to win (maybe it will, but conservatives should be ready for both eventualities.)  Republicans will have the opportunity to govern again, but will they be ready with the right reform program?  Even more important, will they have enough public understanding of, and support for their program so that Republicans politicians will be able to enact and sustain their policies in the face of Democratic counterattacks? 

I'll  try to have some thoughts a little later in the week.     

Categories > Politics

Discussions - 10 Comments

This is all fine and good, I suppose, and maybe I am missing something of great political significance or some other such, but my gut reaction is that such things should not conflict with what I think is the only spirit that is going to sustain a modern liberty-laden Republic--that the people can not and should not run to the government for every damn thing they need in their lives. And certainly not the national government, every time, without fail, with no hesitation.

There are a lot of people in this country not having health care paid for by the government. There should be a market there already. Which means the people should be able to shape the market themselves. Therefore, if so, and if able, do it yourself, people. On some things, take care of yourself, on your own. The settlers and Founders of this nation did not do heavy lifting over a period of centuries just so you could whine your way towards insuring your pursuit of happiness. You're free, and have power. Act like it.

Sorry to be cranky, but I am getting fed up with these exquisite policy proposals that ignore the fact that in many ways the people can do many things for themselves with resources already in their hands, without some law being bestowed, for their benefit, from on high, by some great political savior mounted on a public opinion poll.

The people may not necessarily be able to do it without organization and group effort, but some major changes in this country should still be able to get done without some kind of pontifical blessing in the form of a law that allows some politician to become your patron and benefactor. Are we free men or not? If we always have to wait for a law to be passed before major improvements are made in our lives, we're not. Or at least as not as free and independent as we could be--and perhaps should be.

When the people can't do it by themselves because a law prevents--but they should be able to based upon the numbers desiring it and economic principles of supply and demand--then start presenting the proposals. Otherwise, we are just figuring out how to bribe voters to gain office.

I leave it to others to figure out which is the case with these health-care reform proposals, as well as the Democrat desires. But as a general principal--just because something is sometimes easier for the government to do does not mean the people should have the government do it for them. Maintaining liberty and freedom depends on knowing where that line is.

This is because a good definition of liberty is "freedom from domination". But if no great change in the lives of the people can be made without a governmental input, then the government is the dominating factor in that nation. And then the question becomes how in control of that dominating factor are the people? And in that answer will also be the answer to the status of the liberty of the people as a whole. Though perhaps not the status of the liberty of the people in their particulars, which I leave for another time.

I have no final answer to whether or not this type of policy proposal should be pursued or not, but I am emphatic in my basic belief that one can win every election till Kingdom come and still lose the nation. And it is in that spirit--that there is more to politics than politics--that I should think such things as these health care reforms should be judged.

As with most of the problems we have, problems with health care are due to unConstitutional gov't activity. In the case of health care it is a combination of the FDA, the DEA, and any fed medical programs from Medicare on down. The camel's nose has long been under the tent. Everyone focusing on Obamacare are way late to recognition of the problem. 'It's unConstitutional!' they howl. How good of them to recognize that. Now how about SocSec, Medicare, and every other bit of the 95% of Fed gov't that's likewise?

Now it's true that the other gov't item that has directly caused medical costs to be high is state-level, not Fed: the medical practice acts. But I suspect that if we were actually a wise and just enough people to actually follow our own foundational law in this nation, we would be wise enough to start repealing those as well, freeing up the marketplace in medical care, reducing costs to the point that the average person could easily afford almost any medical care. Even high-level items, like open heart, would be within reach for most, probably paying for it in installments. The very very poor would be easily cared for by charities.

But we are a wicked people. We can't be bothered to follow our own Constitution. Efforts at health care 'reform' that don't actually address the actual reasons for the problem will either never pass, or will only trade one set of problems for another. This does not end well.

Unconstitutional activity is definitely part of the problem, but the second (and larger) part will be the practical and wise application of the Constitution to particular contexts. That is the problem stated in its most minimal form.

ID, I agree that people should not run to the government for every damn thing - though catastrophic medical expenses or even very large chronic medical expenses for certain large populations are far from every damn thing. A conservative health care politics based around "freedom of the liberty of settlers to stop whining" is the best way to ensure not merely that conservative political victories are few, but (and this is much more important) that they are barren.

Doc, when we get past the "repent oh wicked people for your Social Security checks" posturing you are actually right that a healthy health care market would make procedure like open heart surgery affordable (depending on complications) out of pocket for much of the middle-class. David Goldhill wrote something to that effect over at the Atlantic. I fear you would find him a wicked man since a large part of his more market-oriented health care program involves forced savings. Government had, even prior to 1965 been a provider of health care services to many populations though at a local level - as well as a (federal) tax subsidy for private health insurance. For a variety of reasons (greater mobility, increased life expectancy, the expansion of medicines ability to offer desirable services) the ability of localities to fund and administer the full range of such medical services across all of the relevant populations is limited. Those same reasons have exposed and rendered unsustainable the once much less damaging features of mid- 20th Century health care policy. There is a very strong case for a block granting of Medicaid to the states with a funding formula based on some combination of population and inflation. The problem for the elderly would be more difficult and would require direct subsidy and/or forced saving on a large scale. Between them, Medicare and Medicaid cost more than 800 billion dollars (though states pay somewhere less than half of Medicaid's 300 billion+). The old especially have little ability to assume new costs at the moment. Even if a health care reform plan held medical inflation right at zero immediately (and it would take time for provider reorganization to occur), the idea that private charity (total of a little more than 300 billion for all purposes in 2009 though no doubt some giving is not counted) would fill the breach is insane.

You could not be more right that a policy program that leaves you unsatisfied "will only trade one set of problems for another." So will any other set of policies. So it has ever been and ever will be (though some sets of problems are preferable to others) until extinction or the Second Coming - where our wickedness will find a more qualified judge.

Y'know, Pete, even if any/all of the various proposals you mention would 'work' (define 'work'), they're still unConstitutional. Never mind the immorality of our citizens and legislators ignoring/denying the foundational Law of this nation; it's also a practical matter:

I'm given to understand that in cities there's some kind of doctrine called the 'broken window' concept. It goes something like this: police the graffiti, repair the broken windows, pay attention to what used to be considered 'petty' law-breaking, and all law-breaking tends to decrease. When we tolerate illegality, it spreads the idea that the law doesn't matter.

As a citizen of this nation I am one of the sovereigns of it. I have a responsibility to speak out against the breaking of our Constitution. Will enough people turn back to it? We are a nation in which, on average, every day a baby is pulled halfway out of his mother's womb, stabbed in the back of the skull, and pulled the rest of the way out, dead. Need any more proof that we are a wicked people?

I think debt/size of government should be the centerpiece of the next election. Of course, there is room for health policies (some combination of catastrophic insurance and purchasing reform), but what makes people hate Obamacare is not so much its actual medical policies as its gargantuan and Byzantine nature (and, of course, all those special 'perks' in the law for special interests). Americans in general don't trust government complexity -- simplification has to be our message.

Keep the message simple. Reduce government and make what we have more affordable. We should hammer away at the impotence of most government programs, the parasitic nature of Federal (and State) employment, and the return of real jobs that don't have to be subsidized by the state.

Pete,

You've seen my position, I've seen yours. Seems to me you have no need for my support nor blessing for your preferences, and I have no desire to give them. Therefore, god luck and good hunting in your quest to gain those conservative victories, hopefully of a fruitful nature.

But it seems to me that a people who are not conservative in their hearts will not long reward conservative policies. If the people be already against us, there be no hope. But if the people be for us, or not immediately against us, if the people actually be conservative in their hearts, or of such a state as to be amenable to being convinced to be such, we throw away hope if we cause them to lose those hearts, to embrace government paternalism by dint of continuing series of minor programs that only spark a hunger for larger ones--or at least remove the natural inclinations to resist such.

I thus say what I always say--fight. Prove not that we *could be* defeated, but that we *have been* defeated. Then warmly will I embrace becoming one of the propounders of the philosophies of progressivism-lite. But not until then.

You fight, or so it seems to me, for electoral victories. I am more desiring to change minds. Both have their places. I think mine will yield the greater results in the long run, and that your kind of conservatism--if it be close to the one called "compassionate"--has already proved all too barren. I question its long term stability. But perhaps I have overgeneralized your position, and that it is far more subtle. Perhaps even needed, as a matter of statecraft.

It doesn't matter. You of course, will win, in the short term. I will written off as unyielding, naive, and unrealistic; of not understanding that politics is the art of the possible, of going after the perfect that will never be achieved instead of taking the good that can be done today. You will be embraced, I derided. Nevertheless, I am not in favor of these things in my heart. They rub me wrong.

And it may be, just may be, that they rub me wrong because I think that there may be more possible in this art of politics than perhaps you would think is wise--that I think that there is more in this people than we give them credit for. If they are only challenged to achieve it. But you will not challenge them (or so it seems), and I, of course, have no platform to do so. Therefore, once again, good luck, and good hunting. May electoral victories come your way, and may they lead only to positive outcomes, and not second-order negative ones.

But as for myself, I am done with attempts to bribe the population. If what you wish to do does not fall into this category, my apologies. If it does, know that we will eventually be opposed.

Doc, there is always the possibility that the originalist members of the Supreme Court do not seek to strike down the federal welfare state because it is supported by a historically plausible interpretation of congressional powers in Article I. While hardly the unanimous position and originally intended to be applied to infrastructure, business and education, this interpretation of the general welfare clause was affirmed explicitly by Hamilton and implicitly by Washington (it was his administration after all), and later supported by Henry Clay, the younger John Calhoun and Abraham Lincoln. We are, as a constitutional matter, not talking about returning to 1928, but revisiting the Jeffersonian rather than the Hamiltonian and Washingtonian interpretation of the Constitution. It seems the wickedness goes way back and is found in unlooked for places.

While I do not share, I respect your views as I suspect most everyone else does too. Our nation seems not so wicked as to try to silence you. I salute your 200 proof, no compromise with the electorate, no compromise with prudence, no compromise with competing originalist constitutional interpretations Jeffersonian constitutionalism. I even respect your "I'll only accept full repeal of the federal welfare state lest block granted Medicaid become a constitutional broken window leading us into a gulag where we STILL are forced to purchase health insurance" approach to health care policy. But your prudence-free Jeffersonian constitutionalism will lack a certain credibility until you mange to talk the American public into undoing the (as Jefferson thought unconstitutional) Louisiana Purchase. It turns out that as long as our country exists, you will find infinite and invincible targets for gratifying your indignation. Still, opinions such as yours are not the cause of our present policy problems even if they are no way out of the thicket.

Our nation once held millions in slavery. Were we a wicked people then? Are the Food and Drug Administration and the interstate highway system (repent oh people of these unconstitutional things) scourging for slavery and Jim Crow? I would say that we are a people, and that every polity has had its moral outrages (some worse than others), and while this is no cause for laxity, some perspective and humility might help in ameliorating a society's deformities at any given moment.

Redwald, considering the scale of the cuts needed, we would also need to explain how the less expensive, more sustainable, reformed programs would affect people's lives (whose Social Security will be cut and how? among other questions). It would also be nice for the Republican to have a record of cutting spending while maintaining public key services.

ID, several points

1. I would say I am for the best policy I think possible within present conditions (which are not reduced merely to the conditions of public opinion, but also economic and social conditions.)

2. If I were interested primarily in political victories (in merely seeing some politician or organization of politicians win an election) I would offer very different advice and I would suggest different candidates. I would also personally find the likely consequences of that advice deeply wrong so I do not share it.

3. I am not at all convinced or even all that confident that the policy preferences I have outlined will prevail in the short, middle or long-term. I think disaster is at least as likely (though I think that a center-right that adopted your preferred program would make disaster - forfeiting indefinite policymaking power to the opposition and the least responsible elements of the center-right- even more likely.) I hope you are right about the short-term at least.

4. I do not consider a minimum and sustainable welfare state that offers the fewest perverse incentives to be "bribing" the population. Neither did pre-1928 Americans though they located those programs at the local level (which might still be a good idea in some cases.)

5. I'll mark you down as undecided

I used to be wondering what's up with that bizarre gravatar??? I know 5am is early and I am not looking my best at that hour, however I hope I don't appear to be this! I'd nonetheless make that face if I am asked to do 100 pushups. lol Anyway, in my language, there will not be a lot good supply like this.

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