Universal Health Care: Now or Never

I'll return to this in much more detail soon, but here's a short version: The Bush administration's "compassionate conservatism," as much as it was mocked by liberals and derided by the right, drew from an important insight about the future of American conservatism - one that the Milton Friedmanites haven't understood. The idea, in part, is that conservatives can no longer ignore issues like health care and public education. Instead, the compassiocons realized, they needed to transform those issues so as to move them onto conservative turf. And while compassionate conservatism, the brand, has been discredited, the concept lives on - and is likely to become even more important.

Thus the op-ed by Kimberly Strassel in today's Wall Street Journal. Strassel reports a sudden optimism among conservatives - on the health care debate, of all things. The effort to remake health care as a conservative issue got a big boost this week,

when Oklahoma Sen. Tom Coburn released a big-ideas blueprint for restructuring the entire health-care system--the tax code, Medicare, tort liability, insurance laws--along free-market lines. Dr. Coburn's plan builds on the White House's own bold proposal in January to revamp tax laws so as to put consumers back in control of their health-care decisions. Both plans are about fundamental, bottom-up health-care reforms, cast in the language of markets, consumers and individual control.

Describing the chintzy little tax breaks President Bush proposed in the last SOTU as "bold" may call Strassel's judgment into question, but there's no doubt that conservatives feel they're onto something here. Strassel frames it as a distinct alternative to Romney- and Arnold-style insurance mandates, as well as to the frightening specter of "government-run" health care as proposed by The Libs. Strassel even has the chuztpah to try and smear single-payer proposals with a reference to the Walter Reed scandal - once again demonstrating how conservatives mistakenly believe that everyone else is as incompetent as they themselves are when it comes to governing.

Whether the conservative plan for "health savings accounts" is serious or not is a matter for debate. What are conservatives trying to accomplish? Pardon my cynicism, but the least likely possibility seems to be that they are genuinely trying to find an affordable way for all Americans to have adequate health care. Oh, I'm sure a few of them are really after that goal, but not enough to matter.

Another possibility is that conservatives are hoping to use the health savings account concept to undermine any social insurance-based approach to health care. They see another social security about to be born, and they're looking to strangle it in its crib. Yet another possibility is that they simply want to look like they're doing something about health care, for short-term electoral reasons.

This is all pretty surface-level analysis - we'll get into in greater depth soon. The point for now is that the right is now talking about health care, for real. And with increasing enthusiasm:

Conservative health-care guru John Goodman remembers going to Washington in the early 1990s to get Republicans interested in individual health savings accounts, and "only about five guys would even meet with me," he recalls. Now, HSAs "are a religion" among the right, he notes, and Republicans used their last years in the majority to significantly expand access to these accounts. In the past 15 years, the GOP has also planted the roots of Medicare reform, looked at interstate trade in health insurance, and got behind competitive Medicare reforms in their states. [...]

The important thing is that debate equals education, which equals understanding, which equals precisely what the GOP needs right now. The Heritage Foundation's Mike Franc says Republicans are still too preoccupied with health-care small-ball--which procedures should be covered by Medicare, how much should generics cost--to get their heads around the broader subject. "This is still outside their intellectual comfort zone, and Republicans never do well in that situation," he says. "But to win this debate--the defining issue of the next 40 or 50 years--they're going to have to address it forcefully, head-on, and with every bit of their intellectual firepower."

Of course, "for real" is a relative term when discussing conservative policymaking. But at the same time, compared to liberals, the right has better understood the power of words. And they're putting their linguistic talents to work in a debate which we should have won years ago:

Those on the free-market side are starting to understand the need for a new language, especially if they are to coax more nervous elements of their party into embracing radical change. When President Bush unveiled his health-care tax overhaul in the State of the Union, he stressed that health-care decisions needed to be made by "patients and doctors," not government or insurance companies. Mr. Coburn's bill summary is littered with the words "choice," "empowerment," "competition," "flexibility," "control"--which is not only an honest assessment of what his proposal would provide, but one with which Americans can identify.

There are all kinds of reasons why conservative health care "reform" is a ridiculous idea. But even if it never goes beyond rhetoric, the right's health care plan could fatally cripple any attempt to achieve truly universal coverage. All the more reason for liberals to be bold and simple when talking about health care, rather than dinking around with what seem like safe little proposals. Mike Franc is right: it's time to stop playing small ball.

The health care debate is suddenly far, far more urgent than many Democrats realize. Because if we don't get the public's attention, the other side will.

Labels: conservatives, health care, Kimberly Strassel

  ¶ Posted by Paul Curtis 10:55 AM