The Death Of Conservatism As A Political Philosophy

Posted on May 12, 2011 by reflectionephemeral

Health care costs are different from costs of, say, toasters or Ford trucks.  Health care decisions are often made in emergency situations, require expert input and action, and are so expensive that they can only be paid for by using insurance.  In fact, experience has shown that even though Americans have as much or more “skin in the game” in out-of-pocket health care costs as others, our costs are uniquely high.

Plus, unique to the industrialized world, we have a whole bunch of uninsured people dying sooner and being less productive.  In order to prevent the ignominy of being the world’s greatest nation yet turning grievously ill people away from emergency rooms, President Reagan signed into law a bill requiring treatment.  Where do we go from here?

Well, conservatives (and many liberals) were reluctant to move to a system of government-provided health insurance, like they have in Canada, or government-provided health care, like they have in the UK.  So conservative economists came up with the idea of a health insurance mandate, on the theory that it leaves the current system of private health insurers intact, leads to better health care outcomes, and brings health care prices down by spreading risk more widely.  (It’s often the young and the healthy who don’t purchase insurance).  For about two decades, this was the mainstream Republican view, supported by noted not-communists like Bob Dole, Richard Lugar, Chuck Grassley, Orrin Hatch, Jesse Helms, and Trent Lott.

In August, 2009, Grassley called for health care reform “through an individual mandate,” on the grounds that ”Republicans believe in individual responsibility.”  In June of that year, he told Fox that even though some might view them “as an infringement upon individual freedom,” there wasn’t ”anything wrong” with a health insurance mandate.

[ADDED: Romney wrote in the summer of 2009 that “we established incentives for those who were uninsured to buy insurance. Using tax penalties, as we did, or tax credits, as others have proposed, encourages “free riders” to take responsibility for themselves rather than pass their medical costs on to others. This doesn’t cost the government a single dollar.” He said in June 2009 that Wyden-Bennett, which contained an individual mandate, was a plan “that a number of Republicans think is a very good health-care plan—one that we support.”]

Then, of course, the concept of health insurance mandates was embraced by Pres. Obama.  Grassley then said it violates the Constitution.

Into this morass steps Mitt Romney.

Romney, of course, signed into law a health care bill including mandates when he was governor of Massachusetts.  Now he’s on the verge of being excommunicated for his supposed sins against conservatism.

On the one hand, you kinda feel for the guy.  He was at the time adhering to a standard Republican view.  It’s not his fault that they all went insane.

But then, there he is, drawing weak distinctions between his accomplishments and the president’s plan, begging the Republican base to let him tell them the lies they crave.

Anyone who’s been a Republican politician for more than about a year and a half has taken positions that the Party now claims are not merely inadvisable, but tyrannical and unconstitutional.  Tactical imperatives, resentment of the president, and a few sentences worth of talking points, have undone decades of policy research and proposals.  Their only answers to the policy challenges of unemployment and lack of insurance are, “wait for things to get better.”

It’s hard to see how this irrational, tribal rage subsides anytime soon, or how a party without policy views can contribute anything constructive to governing.

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  • http://tarheelred.wordpress.com/ pino

    Health care costs are different from costs of, say, toasters or Ford trucks.

    In the same way that toaster costs are different than Ford truck costs; sure. However, I suspect you mean something else. In that case, health care costs are like food costs.

    Health care decisions are often made in emergency situations

    If “by often” you mean 2% of the time? Sure.

    require expert input and action

    I agree.

    are so expensive that they can only be paid for by using insurance.

    I don’t think this is true either. You can buy cars without insurance after all.

    And cars are way more expensive than the average ER visit.

    But then, there he is, drawing weak distinctions between his accomplishments and the president’s plan, begging the Republican base to let him tell them the lies they crave.

    Yes. Romney is being unfairly hammered for this. Like you said, it was the position for a long time; he was merely following the approved message. Further, states are more free to engage in the experimentation. Even if he DOES admit that Romneycare failed, I think he can do it without a blackeye. “Looks guys, I tried and it didn’t work; sorry.” But he won’t.

    I for one hope that Romney is able to mount a serious run, if only to up the quality of the front runners.

    • http://poisonyourmind.wordpress.com dedc79

      1) in some states (perhaps not North Carolina, but others) you are required to have car insurance.
      2) you need to be more specific when you refer to health care costs being like food costs. Health insurance is definitely not like a food cost. Food costs don’t change based on your age or your medical history, health insurance does. A 75 year old cannot buy health insurance for anywhere near the price that a 21 year old can. They can both by a tomato for the exact same price.

      • http://tarheelred.wordpress.com/ pino

        in some states (perhaps not North Carolina, but others) you are required to have car insurance.

        I don’t think that any state requires you to insure your car.

        Health insurance is definitely not like a food cost.

        You need medical care in the same way you hunger care.

        Food costs don’t change based on your age or your medical history, health insurance does.

        I do NOT advocate using insurance in the manner we do today. The idea that we insure ourselves for normal care [like a physical or a blood pressure check] is as silly as insuring ourselves that we need to care and tend to our house.

        They can both by a tomato for the exact same price.

        Those same two individuals can purchase a blood pressure check for the same price too. The fact that one needs to purchase MORE blood pressure checks only seems to give him leverage to purchase “in bulk” if you will.

  • http://reflectionephemeral.wordpress.com reflectionephemeral

    http://www.ahrq.gov/research/ria19/expendria.htm

    Five percent of the population accounts for almost half (49 percent) of total health care expenses.
    The 15 most expensive health conditions account for 44 percent of total health care expenses.
    Patients with multiple chronic conditions cost up to seven times as much as patients with only one chronic condition. …
    The elderly (age 65 and over) made up around 13 percent of the U.S. population in 2002, but they consumed 36 percent of total U.S. personal health care expenses.

    http://seekingalpha.com/article/146992-comparing-u-s-healthcare-spending-with-other-oecd-countries
    In 2007, the total spending for health care accounted for 16% of the country’s GDP, the highest share among the OECD and almost double the OECD average
    On a per capita basis also the U.S. spent the highest with a total of $7,290 which is two-and-half times the OECD average
    The public share of health care expenditure in the USA (45%) is less than any other OECD country
    Despite spending the most, the U.S. provides health care coverage for only the elderly, disabled and some of the poor people
    —
    Them’s the facts.

    The theoretical background for all this has been known for decades. See, e.g., Kenneth Arrow: http://www.aeaweb.org/aer/top20/53.5.941-973.pdf

    The most obvious distinguishing characteristics of an individual’s
    demand for medical services is that it is not steady in origin as, for
    example, for food or clothing, but irregular and unpredictable. Medi-
    cal services, apart from preventive services, afford satisfaction only in
    the event of illness, a departure from the normal state of affairs. It is
    hard, indeed, to think of another commodity of significance in the
    average budget of which this is true … There is
    some risk of death and a more considerable risk of impairment of full
    functioning. In particular, there is a major potential for loss or reduc-
    tion of earning ability. The risks are not by themselves unique; food is
    also a necessity, but avoidance of deprivation of food can be guaranteed
    with sufficient income, where the same cannot be said of avoidance of
    illness. Illness is, thus, not only risky but a costly risk in itself, apart
    from the cost of medical care …
    It is clear from everyday observation that the behavior expected of
    sellers of medical care is different from that of business men in gen-
    eral. These expectations are relevant because medical care belongs to
    the category of commodities for which the product and the activity of
    production are identical. In all such cases, the customer cannot test the
    product before consuming it, and there is an element of trust in the
    relation.’ But the ethically understood restrictions on the activities of
    a physician are much more severe than on those of, say, a barber. His
    behavior is supposed to be governed by a concern for the customer’s
    welfare which would not be expected of a salesman. In Talcott Par-
    sons’s terms, there is a “collectivity-orientation,” which distinguishes
    medicine and other professions from business, where self-interest on
    the part of participants is the accepted norm. …
    The physician is relied on as an expert in certifying to the existence of illnesses and injuries for various legal and other purposes. It is socially expected that his concern for the correct conveying of information will, when appropriate, outweigh his desire
    to please his customers
    –
    No one knows if/when they’re going to fall into the 20 percent that spends half of health care costs, or that 5 percent of people that accounts for half of spending. So, we pool risk. We insure.

    And it isn’t like buying a car or broccoli. This is a cycle of life thing. Old people get sicker, worse, and need more care. So the smart way for a society to handle this is by pooling risk, with young and healthy people like me (I’ve probably consumed under $1000 in health care in the past ten years) paying into a system that will eventually help care for us when we need it more. That’s the way pretty much every other country with a per capita income over $20,000 handles it. No one tells older folks to just piss off and die.

    It’s fine if a libertarian wants to oppose this on ideological grounds, or if someone doesn’t like the ACA’s particular approach. But to pretend an insurance mandate is OMG TYRANNY@1!!1!, as we’ve gotten from the GOP in the past 20 months or so, ever since the president supported it, causing them to realize they hated it more than they hate Osama bin Laden, indicates that they don’t have policy preferences. They just have emotional impulses and tactical considerations.

    • http://tarheelred.wordpress.com/ pino

      Them’s the facts.

      I don’t dispute the facts. I stipulate to the fact that we spend more. You refuse to acknowledge that spending more and good things is a good thing. I love LOVE going to professional baseball games. You pointing out that I spend more than the average Polish guy on professional baseball tickets doesn’t make your point; it makes mine. Namely, that I live in a nation that is able to provide a thing I like AND offers me the chance of a lifestyle to afford it.

      In short, it’s a FEATURE that I spend $700 to have a wart removed, not a bug.

      It is clear from everyday observation that the behavior expected of
      sellers of medical care is different from that of business men in gen-
      eral.

      This is true only because we are not purchasing our own care. Our corporations purchase our care for us. Imagine if we were compensated for our jobs with food in the same manner we’re compensated with medical care. Companies would provide us “food plans” and we would have approved products and groceries that we could shop at. We couldn’t shop at others. Businesses would see groceries as an expense to be minimized, not a product that is meant to be maximized.

      So the smart way for a society to handle this is by pooling risk, with young and healthy people like me (I’ve probably consumed under $1000 in health care in the past ten years) paying into a system that will eventually help care for us when we need it more.

      No.

      I will maximize MY risk, you yours. It is a valid argument that you think we should legislate your charity of choice [medical care to old people]. But don’t be surprised when people object to that legislation. A government is not in business to provide charity, it is in business to provide Liberty. Giving a sick person medical care is not consistent with providing them Liberty. It may FEEL good, it may FEEL noble, but that’s not the job of government.

      They just have emotional impulses and tactical considerations.

      Here I’m willing to agree with you. The GOP has not been consistent in their policy.

      • http://reflectionephemeral.wordpress.com reflectionephemeral

        The role of government is to permit & encourage individual achievement. Freeing people from the threat of bankruptcy and the worry of going without care, freeing businesses from the expense of providing health insurance, permitting entrepreneurship by making health care affordable so that people aren’t left unable to start their own business, is consistent with the proper role of government. It’s not even charity, it’s just a rational response to the policy problem of spending more money that the rest of the world, by a longshot, for care that isn’t any better. It’s a drag on the economy. It’s a rational response to a policy problem.

        This is true only because we are not purchasing our own care.

        Our employers don’t purchase care, they purchase insurance, which purchases care. Consumers will never make the final decisions on most health care dollars; insurers will. This is a necessary consequence of the expense of care, as Arrow pointed out. And see the “skin in the game” point above. We pay more out of pocket already. It doesn’t drive down costs. Health care is not like cars or broccoli. The decisionmaking is different, the manner of payment is different, the price sensitivity is different, the ability to comparison shop is different.

        As to the Poles & baseball tickets, the problem here is that we’re spending more money on health care for identical or worse results. Your argument is like saying, “we Europeans spend way more for oil than Americans do! Suck it, America! WE’RE NO. 1!!!!”

        • http://tarheelred.wordpress.com/ pino

          The role of government is to permit & encourage individual achievement. Freeing people from the threat of bankruptcy and the worry of going without care, freeing businesses from the expense of providing health insurance, permitting entrepreneurship by making health care affordable so that people aren’t left unable to start their own business, is consistent with the proper role of government.

          No. No it’s not.

          for care that isn’t any better.

          You continue to ignore facts that demonstrate the care is most certainly better.

          Our employers don’t purchase care, they purchase insurance, which purchases care.

          The policies negotiated by corporations include care. How many well visits, which kind of medicines and what not. However, in order to same time, I accept your definition. The point is the same either way.

          It doesn’t drive down costs.

          Yes it does

          the problem here is that we’re spending more money on health care for identical or worse results.

          You continue to repeat your party line. That somehow results are worse. I’ve explained time and time again that spending money on having babies where otherwise it’s impossible is a feature. On top of that, our infant mortality rates are better than the rest of the world, our life expectancy rates are better than the rest of the world and the world’s most cutting edge technology is developed here.

          Using your continued analogy to the to the rest of the world, it’s like saying that we spend more on transportation than the people in Papua New Guinea. Failing to mention, of course, that we are driving blue tooth enable vehicles with GPS voice directed navigation systems. In car audio pulling from a 100 gig music library complete with the most advanced safety systems in the world. And that THEY are driving mules.

          We spend more on health care because we have more money ad more access to things like braces and lasic and liposuction and hair loss treatments and viagra.

  • http://reflectionephemeral.wordpress.com reflectionephemeral

    No. No it’s not.

    Yes it is. Because I say so, for the most part. Plus, countries like the UK, with state-run health care, and Canada, with state insurance, are not unfree countries. Hell, Heritage ranks Canada (and New Zealand, and Australia) as freer than the US. Health insurance policy is not tyranny.

    our infant mortality rates are better than the rest of the world

    No. We’re tied for 29th, with Slovakia and Poland.

    our life expectancy rates are better than the rest of the world

    No. We’re in 42nd place.

    “Something’s wrong here when one of the richest countries in the world, the one that spends the most on health care, is not able to keep up with other countries,” said Dr. Christopher Murray, head of the Institute for Health Metrics and Evaluation at the University of Washington.

    You can always find a reason to quibble with any given ranking, but the US does poorly, especially when you consider that we are a wealthy nation, and that we spend over twice the OECD average. This one puts us in 37th (this criticism says it should put us at 15). This one gave us a failing grade, noting that of the couple dozen countries surveyed, we were worst in infant mortality and worst in life expectancy once people reached age 60. On this one, we ranked 7th, 4 straight years. Woot! Now the bad news: there were only 7 countries in the study. Here’s a bunch of extra stray numbers.

    In the WSJ article I linked above, (at “this criticism”), they quote one expert who argued that “Nor can everything be ranked — especially health-care systems. ‘I think it’s a fool’s errand,’ says Dr. Musgrove.”

    Elsewhere, Dr. Musgrove said, “The United States mostly manages to provide emergency care, but there’s no uniform system to guarantee that it happens, let alone to ensure that everyone is covered for nonemergency medical needs. In any comparison of health systems, the United States stands out at the extreme end of the spectrum, and not in a good way.”

    You can criticize a given ranking for whatever, but at the end of the day, we pay over twice the OECD average, for worse results. That is an unequivocal fact. Presumably there are some areas in which we outperform. There oughtta be! But overall, we pay way more, for a worse product.

    • http://tarheelred.wordpress.com/ pino

      Yes it is. Because I say so, for the most part.

      Fair enough ;-)

      No. We’re tied for 29th, with Slovakia and Poland.

      However, if you are using mortality rates as a proxy for health care you have to normalize out other factors- Single mother, incarceration of father, race of mother and reporting of births. After you do that, we are…

      Wait for it….. ;-)

      #1.

      No. We’re in 42nd place.

      Same song different verse.

      That is an unequivocal fact.

      It IS not unequivacal. You continue to fail to acknowledge that we pay for services that simply aren’t available in other nations. The world’s leading cancer treatments aren’t available in Slovakia and Poland. It is here. AND we have the ability to pay for it. That sounds like a win to me.

      Further, you continue to fail to account for the fact that dying on a motorcycle is a different death than a man dying while he waits for medical treatment. Or, for the fact that a Japanese-American has the same infant mortality and life expectancy numbers that a natural born Japanese person has living their entire life in Japan.

      There is no better truth to this than the fact that the world’s sick stream to America for everything BUT standard commodity care. They come here and consider themselves lucky to pay more in exactly the same way that people are happy to pay more for a Corvette than a Corvair.

      Anyway.

      We’ve been ’round and around on this one. I’m over here at your place; make you case, I’ll read it but you can have the last word. I suspect neither of us will change much from our position.

      Have a great weekend!

      • http://reflectionephemeral.wordpress.com reflectionephemeral

        Sorry to be slow to get back to you– been up to other stuff, all these posts were pre-scheduled.

        I’m not sure I understand what it means to “normalize” for people who are born into circumstances that make it less likely that they get adequate care. If people who are most likely to be left behind are, in fact, left behind, that strikes me as an attack on, not a defense of, our current system.

        I don’t believe, or argue, that medical care in the US = medical care in Slovakia or Poland; but we do have the same infant mortality rate as those former Soviet Bloc countries. That’s why I didn’t just respond to the metrics you brought up– I included those other, more comprehensive rankings (and criticism for the sake of intellectual honesty), because “life expectancy” isn’t “health system at large.” All those studies indicate that in “health system at large,” we’re not doing that well.

        Hope your weekend is going well.

        • http://tarheelred.wordpress.com/ pino

          Hope your weekend is going well.

          5 year old camp out weekend with the Masons; hard to beat!

          I’m not sure I understand what it means to “normalize” for people who are born into circumstances that make it less likely that they get adequate care.

          Without debating, I just wanna clarify.

          A baby born on time at normal birth weight has a better chance of living than a baby born on time below “optimal” birth weight. Likewise, a baby born early, very early, below “optimal” birth weight has an even less chance of life.

          A nation that has more early births than another nation AND a nation having more babies born at low birth weights than another nation is going to have a worse infant mortality rate than that other nation. EVEN THOUGH they save more of each type of baby. They simply birth more at risk babies.

          Is it a concern that we have more and more single mothers having babies? Yes

          It is a concern that we have more and more father in prison? Yes.

          Is it a concern that our mothers are more and more overweight? Yes.

          Is it a concern that our mothers are at greater risk of hyper-tension? Yes.

          Is that an implication of out medical system of providing care to infants? No.

          Rather, it’s an implication of other systems not working.

          You are right, single black mothers giving birth to babies where the father is in prison while suffering from obesity and other ailments is a problem. It’s not a problem a pediatrician or birth doctor can solve.

          THAT’S what I mean by normalize. It’s a statistical method whereby things are measured equally.

          • http://reflectionephemeral.wordpress.com reflectionephemeral

            Nice, camping is a great time. I unfortunately haven’t gotten around to it for a few years…

            I still don’t get this normalizing you’re describing. It sounds to me like, “if you ignore the people for whom our health system isn’t any good, it’s actually awesome!” How do you normalize Slovakia’s results?

            And according to this chart, obesity only contributes a few percentage points to our health care costs: https://poisonyourmind.wordpress.com/2011/05/11/a-really-big-chart-about-health-care-costs/

            It’s true that the very wealthiest Americans get great care, and that the very wealthiest foreigners often come here to get high-end care. But that doesn’t mean the system as a whole is working for Americans. It’s not; all the studies say it’s not; all the numbers say it’s not.

            As to Sean Patrick Hazlett’s point below, yep, a larger pool of people eliminates adverse selection. It’s a cost for liberty, I suppose, but so are traffic laws and the rules of grammar. Life in a society involves these tradeoffs. The experience of the world in the past 50 years indicates that universal insurance provides better, cheaper care for more people. I’m open to the argument that it would entail some risks for R&D, but given that pharmaceutical companies in Europe still come up with good drugs, and that companies spend more on marketing than R&D, I’m not convinced straight away that that’s a big risk.

  • http://reflectionsofarationalrepublican.wordpress.com Sean Patrick Hazlett

    To be honest, I have not read even ten percent of the comments that are here, but I wanted to weigh in on the mandatory coverage debate.

    To be frank, this is the part of the health care bill that I actually like and I think the whole thing will fall apart if it goes away. There are plenty of terrible things in the bill that Republicans can attack, but this is not one of them.

    Mandating health insurance will actually lower costs for everyone as it eliminates the problem of adverse selection and makes the system work.

    It sucks for individual liberty, but on this point, I come down on pragmatism over ideology.

    Just my two cents…

    • http://tarheelred.wordpress.com/ pino

      It sucks for individual liberty, but on this point, I come down on pragmatism over ideology.

      Argh……

      If I have to lose the policy implementation debate, at least I feel better that people acknowledge I’m right!
      ;-)

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