Tens of millions of Americans lack health insurance. Extending coverage to them has been a core goal of health reform proposals since the 1960s. President Richard Nixon offered a universal health plan in his first administration, but since then Republicans have hesitated to commit the nation to so costly an undertaking. Is it time to rethink? Should Republicans accept universal coverage as a goal? We posed this question to NewMajority’s contributors.
The question before the House is whether or not the time has come for conservatives to endorse the goal of universal health insurance. The answer at the present time must be no, and it must be no for parochial reasons. Given the make-up of the Congress and the occupant of the White House any such program would, if passed, be far more statist , expensive, and hostile to innovation than any such program formed even two or four years from now. If a body of conservatives adopted universal health insurance as a goal right now it would split the opposition to Obamacare , which has none of the hallmarks of a conservative social insurance program, and allow for the co-option of the opposition just as they are registering success. Obamacare as it now stands is an issue that divides the Democrats and unites Republicans. No proposal that changes this formula ought to be suggested by the Right. The projection of $9 trillion in deficits also highlights the reality that no funds for such a program, however devised, are available. Such a project would divert, rather than aid conservative efforts to bring the deficit into a manageable range without further damaging the economy.
This is a tactical answer to a larger question however. If a time like the mid-60’s, the mid-80’s, the mid-90’s, or the mid-2000’s came again and economic growth was restored with deficits as a measure of GDP dropping, and Republicans had at least partial control of one branch, could a conservative program properly include universal health coverage? The answer, though closer, must still be no. It is a much closer question because of the permanent advantage Democrats and liberals have had on this question in politics, the huge advantages in placing the young, healthy people now uninsured into the insurance pool, and the fact that society writ large pays the healthcare costs of even the uninsured.
Any proposal that requires an individual to have health insurance has three negative consequences for conservatives. First, it violates the principle that the individual and not the government controls his own decisions in a vital area of personal behavior. Second, it vastly increases the costs of health insurance. Third, it raises the bar for the bidding war of what government spends on healthcare . The first principle is that if someone does not want health insurance he ought not have to purchase it. The rejoinder has always been that if he is catastrophically injured someone will. What this overlooks is that millions upon millions of uninsured are never so catastrophically injured. They either pay for their own check-ups and the like, or they forego them. In either case they cost the public zero. By absenting themselves from the insurance market they also lower the demand for the product and thus price.
This dovetails with the second point. Healthcare is expensive. The more we mandate requirements the more it will cost. Much of that cost will be on government which can ill afford it. Medicare and Medicaid are breaking the government. If all they covered was what they covered in 1965 that might not be the case. Inexorably they expanded. This leads to the last point. Once universal care is the goal the fastest and easiest way to do so is a government mandate. The Democrats will always outbid Republicans on the form of that mandate and what is included.
We have only to look at Europe, or North of the Border, or to Medicare and Medicaid, to see what the assumption that government will require and provide healthcare to all citizens does to conservative parties. They become unconservative . Republicans increase Medicaid spending and ask to be rewarded by the public for it. The Tories trip all over themselves stating how much they will increase funding for the National Health Service. A conservatism based on Bismarkian assumptions can propose universal coverage, one based on Burkean considerations cannot.
So what does this leave? It leaves conservatives with incremental improvements. There is no “health crisis.” As Obamacare has cratered we have seen that most Americans are satisfied with their healthcare. The population that is not can be whittled down by sensible conservative reforms, many of which have already been proposed but languish because Democrats do not want market solutions, or any solution that reduces the problem but either 1) does not eliminate it entirely or 2) does not increase state control of healthcare decisions. This allows conservatives an approach that has served us well in the past; point out that the Democrats are making the best the enemy of the good, and provide reasonable, cost effective improvements without upsetting the entire apple cart of a healthcare system that is, with all its faults, delivering high quality service to most of the people, most of the time.
To read other contributions to this symposium, click here.
7 responses so far
1 RLHotchkiss // Aug 23, 2009 at 10:29 pm
Mr. Vecchione could not possibly be more wrong in his analysis of the political effects of universal health care. Europe is more conservative than anytime since the 40’s. Much of this transformation can be directly attributed to universal health care.
With universal health care Europeans have been able to depend on themselves instead of their unions. Britain has a higher percentage of its population self employed than the United States. Britain has moved fairly consistently to right sense the establishment of universal health care. British government is far more privatized than the United States. The Labour government recently tried a partial privatization scheme of the last major government run industry, the postal service. And it will almost certainly be privatized under the Tory government, something only dreamed of by Reagan.
The bus services are privatized and unsubsidized. Drivers tests are given by private companies. And, it goes on and on.
Health care is a middle class issue because a major health incident leads to financial ruin. Health insurance in the United States has ceased to provide its most basic function, to prevent health emergencies leading to financial ruin. Health care is the golden calling card of unions. Many would be republican families, entrepreneurs and small business owners are tied to the Democratic party because they must keep one family member in unionized job, such as teaching for health benefits.
2 ottovbvs // Aug 24, 2009 at 8:27 am
…….Vecchione bottom line…….we’re opposed to it on ideological grounds and btw it might help the other party…….Republican reality check……..well at least he’s honest which is more than can be said for most of the other conservatives who are in one way or another opposed to major reform and advance a stewpot of largely specious rationalisations to justify their position.
3 sinz54 // Aug 24, 2009 at 9:28 am
John Veccione: “If a body of conservatives adopted universal health insurance as a goal right now it would split the opposition to Obamacare….and allow for the co-option of the opposition just as they are registering success. Obamacare as it now stands is an issue that divides the Democrats and unites Republicans. No proposal that changes this formula ought to be suggested by the Right.”
EXACTLY RIGHT!!!
That’s what I’ve been saying for weeks now!
The GOP is on a roll, as the Dems continue to struggle and the public grows increasingly disenchanted with them. Let it ride, as they say in roulette.
The congressional Republicans should continue to play rope-a-dope: Keep saying nice things about working for a bipartisan bill, playing on Obama’s desperate hopes for some Republican cover; and then when pinned by the Dems on a specific proposal, dance away. Approach the Dems and then dance away. Again and again. Stall and stall and stall.
“Never interfere with the enemy when he is in the process of destroying himself.”
— Napoleon
4 balconesfault // Aug 24, 2009 at 10:23 am
The congressional Republicans should continue to play rope-a-dope: Keep saying nice things about working for a bipartisan bill, playing on Obama’s desperate hopes for some Republican cover; and then when pinned by the Dems on a specific proposal, dance away.
Country First!
Seriously, this tactic wins in boxing if you have a knockout punch in your back pocket to unleash after your opponent has gotten tired from chasing you around the ring. If at the end of the bout, it looks like your opponent has consistently been the aggressor, and you’ve constantly been the one stalling, you lose on points as judges award points for the aggressiveness.
That’s the danger of your tactic. The Dems are starting to get out there declaring that the Republicans are not interested in ANY meaningful reform. If Baucus does so, pronouncing his “gang of six” to be defunct in the face of active sabotage by the Republican members of the gang, it’s going to suddenly be game over for the Repubs. The only tactic will end up being a filibuster of whatever comes to the Senate floor, no matter what it looks like, for fear that reconciliation will end up sticking in a public option.
At that point, either Dems and Repubs both hold unity in a cloture vote, and a bill gets passed without any input from the Repubs … or some Repubs cross over, giving the Repubs legit call to have a voice in the reconciliation process, and a few of those Repubs end up voting for the final bill … or some Dems cross over on the cloture vote, blocking the legislation until 2011.
Scenario 1 – if the public option becomes as popular as the Republicans and insurance companies fear it will, then Dems get all the credit, and probably lock in major gains for a few cycles. Scenario 2 – some Repubs cross over … and we have Sinz’s fear of splitting the party turned to reality. Scenario 3 – some Dems cross over, bill dies in filibuster, and the message goes out that there will never be a Republican vote for healthcare reform, and the only way to accomplish it is to elect more Dems.
In other words, the strategy at this stage works only if the boxer Reid forgot everything he knew about boxing scoring … or if the Repubs have some counterpunch coming that makes them look like the aggressor, and knocks out any Dem proposal. Given that the latter is looking increasingly slim, given the rhetoric here, you’re down to depending on Harry Reid.
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6 The Progressive Republican // Aug 24, 2009 at 2:25 pm
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