Jens 'n' Frens
Idle thoughts of a relatively libertarian Republican in Cambridge, MA, and whomever he invites. Mostly political.

"A strong conviction that something must be done is the parent of many bad measures."
  -- Daniel Webster

Sunday, December 20, 2009 :::

This guy says the problem with taxpayer-paid-for health care is that it forces us to subsidize others' health-impairing decisions. I've more often pointed to the flip side of that coin — that, if we are to avoid subsidizing others' health-impairing decisions, we will have to prohibit people from smoking or skydiving or eating tasty food. A few years ago, the Supreme Court voted 6-3 that there was enough of a federal interest that the federal government could prohibit private marijuana use. But even the justices who contend that the Interstate Commerce clause doesn't apply to intrastate non-commerce might have gone along if it had been stipulated that taxpayers would fund the consequences. The Stupak debate is just a taste of the myriad arguments we can have once we are prevented from decoupling the permissibility of an action from its funding by the taxpayer.

Reihan Salam notes the convergence of complaints about the health care bills being passed from the left and those complaints from the right:
Kilgore offers the following:
To put it more bluntly, on a widening range of issues, Obama's critics to the right say he's engineering a government takeover of the private sector, while his critics to the left accuse him of promoting a corporate takeover of the public sector. They can't both be right, of course, and these critics would take the country in completely different directions if given a chance. But the tactical convergence is there if they choose to pursue it.

Actually, it is entirely possible for both sets of critics to be correct. The concern from the right isn't that the Obama approach will literally nationalize for-profit health insurers. Rather, it is that for-profit health insurers will continue evolving into heavily subsidized firms that function as public utilities, and that seek advantage by gaming the political process. Profits, including profits governed by medical loss ratios, can and will then be cycled into political action, which leads to the anxiety concerning a "corporate takeover of the public sector." Again, progressives don't literally believe that such a takeover is happening. Instead, they believe, rightly, that subsidies without effective cost containment represent a massive windfall for the private insurance sector, including non-profit insurers that generate salaries for large numbers of politically active middle and upper middle class professionals.

So yes, Obama does not intend to nationalize the private insurance industry and then turn around and auction off the new nationalized health agency to Rupert Murdoch or Monsanto. But the anxieties of critics on the left and right are, to italicize for a moment, perfectly compatible.
Jonah Goldberg adds a little to Salam.

Julan Sanchez notes:
I understand, and am sympathetic to, the argument for moving toward a more genuinely marketlike system. I understand the argument for single payer. I understand the arguments for different kinds of hybrids—baseline public provision with private coverage as a supplement. I don't understand this at all, and I don't understand who (but an insurance company) could be happy with it. Progressives and conservatives are both obviously unsatisfied, but you’d at least expect that the part progressives are pissed about would count as a victory for conservatives—a move that concedes some important value to them. Yet I can't see any way that it is: The plan sans public option is not one whit more "free-market," and arguably less so, to the extent one can make such judgments at such a distance from the genuine article. It just shifts some of the subsidy from the government to profit-seeking firms that can hire lobbyists.
Mind you, we already have a lot of the worst of both worlds of capitalism and socialism, but I don't think moving more power to Washington is an improvement. I think the public option would make the plan even less free-market, as it would lead toward a regulated monopoly as opposed to a regulated oligopoly. Note that a monopoly government-run payer would not necessarily deny fewer claims than private insurers; after all, what would people do if they deny a lot of claims? Choose a different payer?

For the record, I rather like the idea of a baseline public provision (or mandatory private purchase/guaranteed issue/community rating) with private coverage as a supplement, though I think it would inevitably lead to baseline creep; we'd eventually get something like that thing moving through Congress.

Jonah Goldberg provides the text of the pork that won over Ben Nelson. Finally, Megan McArdle notes that this quite bad and unpopular plan will almost certainly pass.

So, Merry Christmas.

By the way, I support the idea that's been bandied around that the Republicans should campaign nationally next year on the bill's repeal. I think this would work best if the national platform included not only a repeal but also an element or two to replace it with. But even if the Republicans won both houses, which is fanciful, they would have the system to campaign against again in 2012, as the Democrats have 43 Senators not up for re-election in 2010 and would need at least ten of them to override an Obama veto. The best the Republicans could actually deliver would be the closure of the barn door; there's no way to get back the horse.

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::: posted by Steven at 11:25 PM

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Idle thoughts of a relatively libertarian Republican in Cambridge, MA, and whomever he invites. Mostly political.

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