It’s just a matter of time before government takes over health care — unless conservatives master the subject themselves.
This article appears in the July-August 2008 issue of The American Spectator. To subscribe to our monthly print edition, click here.
THERE’S A MODERN FABLE written by Maurice Sendak in which an apathetic child named Pierre answers every question with the phrase, “I don’t care.” Eventually, Pierre responds that way when a hungry lion warns that he is about to eat him, and the young boy is promptly swallowed whole.
The story of Pierre should serve as a cautionary tale for conservatives in the looming debate over the future of American health care. While the right has been effective at mobilizing support among its activist base on issues such as guns, taxes, and judges, when it comes to health care, conservatives who aren’t involved in public policy for a living tend to tune out.
“I think they find health care a sort of squishy, bleeding-heart kind of issue that doesn’t interest them very much,” laments Greg Scandlen, president of Consumers for Health Care Choices.
Liberal activists have had more than a decade to pore over the failure of HillaryCare in 1994, and should Democrats capture the White House this fall and make further gains in Congress, they will be armed and ready to fight for government solutions to the U.S. health-care mess.
“Conservatives are not comfortable talking about this issue, and they are trying to survive it,” grumbles David Gratzer, a senior fellow of the Manhattan Institute. “Democrats are trying to win it, and as a result [conservatives] are always negotiating the terms of surrender.”
Much like Pierre and the lion, the persistent indifference of conservatives will virtually guarantee that government will devour the private market for health care.
PUSHING FOR FREE MARKET SOLUTIONS to the health-care crisis should be of central importance to conservatives, no matter what branch of the coalition they consider themselves a part. Economic conservatives have spent the past several years fighting earmarks that, all told, cost $20 billion a year. But losing the health-care battle would mean allowing government to dominate a sector in which spending tops $2 trillion annually, representing about one-seventh of the U.S. economy. And forget cutting taxes — the only way to fund even the least ambitious liberal health-care proposals would be to increase taxes by a staggering amount.
Hawkish foreign policy conservatives may think that in the midst of fighting wars in Iraq and Afghanistan, as well as in the larger ideological struggle against Islamic terrorism, there are more important debates to have than a tedious one over health care. These same people have consistently advocated the necessity of augmenting the size of the U.S. military, noting the fact that, by historical standards, we are spending a relatively small amount of our gross domestic product on defense. But rarely do they see the connection between our limited flexibility to increase defense spending in the wake of the September 11 attacks and entitlements, which are soaring in cost largely as a result of health care. Should the U.S. move toward a government-run health-care system, it is inevitable that America will come to resemble European welfare states that are too burdened by domestic spending to allocate much of their budgets to defense.
If the government had to take on more of America’s health-care costs, it would lead to an encroachment of the state in areas that are not immediately obvious. For instance, many of the nanny-state laws that have annoyed small government advocates in recent years—such as smoking and trans fat bans—were justified because ultimately taxpayers have to bear the burden for increased health costs through Medicare and Medicaid. Should the government role in health care increase dramatically, the state will have even more reason to impose draconian rules on Americans in the name of public health. One of the hallmarks of a free society is the right of individuals to regulate their own behavior by assessing its risks and rewards. But when government controls the health-care system, it adds a societal dimension to individual risks, thus giving the state more control over our actions.
This should also be a concern for social conservatives. If government is the leading, or perhaps eventually the sole purchaser of health care, the state will be in the position of deciding who gets what kind of care—this is precisely how government-run systems control costs. The Terri Schiavo case was just a harbinger of the tragic scenarios that are likely to arise in the coming decades with the development of life-preserving technologies. It is quite easy to see how government control of the health-care system would put lawmakers in the awkward position of deciding who lives and dies in such situations by determining how long to pay the bills before pulling the plug.
SOME CONSERVATIVES THINK that they’ll be able to defeat any liberal health-care reform as they did in 1994, but the terrain is now much more favorable for liberals. A May Quinnipiac University poll found that 61 percent of Americans thought it was “the government’s responsibility to make sure that everyone in the United States has adequate health care.” In a Gallup poll taken last November, 81 percent of respondents said they were dissatisfied with the cost of health care and 73 percent thought U.S. health care was either in a “state of crisis” or had “major problems.” Furthermore, with the costs of health care skyrocketing, businesses are becoming increasingly sympathetic to the idea of government stepping in and taking the problem off their hands.
Scared by the political implications of such polling, some Republicans have decided to enact essentially liberal reforms, arguing that this is the only way to stave off more intrusive measures. Along these lines, President Bush signed the largest expansion of entitlements since the Great Society in the form of the Medicare prescription drug bill. As governor of Massachusetts, Mitt Romney imposed mandates requiring every citizen to purchase health insurance, creating a state-managed system that is wildly over budget just two years after being signed into law. And in spite of such compromises, the liberal charge for national universal health-care legislation is fiercer than ever.
But there’s no reason for conservatives to be torn between indifference and acquiescence on one of the most important domestic issues of our time. There is no shortage of good ideas among academics, physicians, policy-makers, and entrepreneurs who envision a future for health care in which consumers are put in control, costs are lower, and people can take their health-care policy with them from job to job, choosing plans that are right for their health-care needs.
For conservatives to win the debate, however, will require several things, the most important of which is that it will need to be reframed. Currently the public perception is that liberals are fighting to change the health-care system with which most Americans are dissatisfied, and conservatives want to preserve it. That is surely a losing argument. Conservatives need to acknowledge there are the deep flaws with the current system, and offer a competing rationale for what caused those problems in the first place. It is important for conservatives to point out that far from having a free market, America is a nation whose health-care system is suffering from ham-handed government intrusions into the free market. Conservatives have to master liberal arguments for increasing the role of government, and be prepared to offer intelligent criticisms that go beyond merely screaming “socialized medicine.” And finally, conservatives have to demonstrate how freeing up the market could reduce costs and improve health-care outcomes.
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