Slapping the Camel's Nose

By Megan McArdle

When I wrote the other week about why I am opposed to national health care, a number of people angrily demanded to know why I was writing about something that "no one is proposing".  Now, this is clearly a lunatic statement.  I was writing about something that many people were proposing.  I just wasn't writing about the nebulous bills currently wending their way through various committees.

I hadn't intended to.  I was writing about my deeper opposition to the entire project of providing, paying for, or otherwise guaranteeing health care.  Since for most people on the left, this is akin to declaring that I would like to take up killing orphans in my spare time, I outlined why I think that this is morally correct even if you take the liberal set of initial values, and don't place any moral weight on taxation or other coercive action by the state.  I have voiced my various practical objections to the particular options on the table at various moments.  But the main thing is that I don't want to give the government a greater role in health care markets.  Nay, not even if all the other countries . . . well, all the cool countries, anyway . . . are doing it.  To the liberals proclaiming that, unlike those of us in the conservative or libertarian camps, they are practical people just seeking the best way to make us all better off, I say:  I think your utilitarian calculus is badly wrong.

Now, I felt this was relevant, because in fact, no one I know who is interested in national health care views these bills as the final iteration of American Healthcare 3.0.  Everyone agrees that these bills are very bad, fix few-to-none of the underlying problems with the American healthcare system (cost inflation, the tax break for employer-provided insurance, etc.)  But we have to do this because we can't just do nothing, now.  So we'll do this now, add a whacking great new line-item to the budget, and then fix it later.  The implied fix is things like cost controls on pharmaceuticals, comparative effectiveness treatment to decide which treatments "work" (and by extension, which ones shouldn't be provided), and an ever-expanding role for government treatment mandates.  The goal of everyone, to a first approximation, on the "pro" side of these health care reforms is a European-style system where the government basically runs the whole show.  Maybe they contract out the billing services to insurance companies, which you may choose between (though you can't choose covered services, etc).  Maybe there's a safety valve in the form of a private system that the very affluent can buy into.  But for 95% of the population, the government dictates what treatments are covered, and usually, how much should be paid for them.

I mean, pardon me if I've been totally fooled by all the people saying yes, these bills suck, but they're better than nothing, and they'll open the way for all sorts of government awesomeness later.  But assuming that they aren't funning me, why on earth would I confine my discussion to what's on the table right now?

I think most of the people demanding that I discuss nothing but current legislation understand this very well.  That's because they feel exactly the same way about pro-lifers advocating for bans on partial-birth abortion, various sorts of counseling, waiting periods, and parental consent.

The fact is, leaving aside partial-birth/late-term abortion (I will not here dive into the debates over whether the health of the mother includes mental health, or whether late-term abortions are or are not performed upon women who simply decided they'd rather not have a baby), these restrictions do not strike very many people as unreasonable.  They recognize that outside of the pro-choice movement, most Americans think that having an abortion is a Really Big Deal, and gently discouraging it by asking women to think the thing through is not crazy. 

Nor is demanding that teenagers have an abortion for some reason other than, "I don't want my parents to know I was having sex."  I'm sure that had I gotten pregnant in high school, I would have had an abortion on my own rather than telling my parents--and not because my Upper West Side liberal parents would have horrifically abused me.  I also think that that would have been the wrong decision in many ways, but most basically, because abortion is not something you do because you'd rather not have a difficult discussion. Yet a lot of teenaged decisions are predicated on preserving as much privacy as possible from their parents, rather than, say, what will ultimately give them the happiest, most fulfilling future life.  The whole reason we don't let most teenagers live on their own is that we recognize that they're not ready to make a lot of major decisions.

Now, the pro-choice side generally does debate the provisions on their own terms, and comes up with horror stories about women who are horribly inconvenienced by waiting periods, teenagers whose parents beat them up because they're pregnant, etc.  But these are not arguments against reasonable laws; they're arguments for finding ways around them, like a judicial override for teenagers who really believe that telling their parents would put them in danger, funds to help women who cannot afford to travel back and forth while they wait, or teleconferencing.  That's why pro-choicers so often lose those debates.

And while some pro-choicers are hard-core libertarians who resent the slightest intrusion by the state, how many of them would really get excited about these provisions if they didn't perceive them as battles in a longer war?  They think that these are just the first step on a slippery slope--a way for the pro-lifers to get the camel's nose under the tent.  And since the pro-lifers seem to view it exactly the same way, I think they are absolutely right to believe this.

So it makes sense, in the context of a debate over waiting periods, to discuss your broader philosophical opposition to inserting the heavy hand of the state between the woman and her doctor.  Pro-lifers can say that it's not on the table, but that's just so much flim-flammery.  It's always on the table.  Likewise, in the health care debate, single payer.  So there's never a wrong time to bring it up.

At the heart of it, in most of these debates, both sides are saying "I don't want to go here because once I do, I'm afraid I'll end up there."  They don't trust the other side, and usually, they're right not to.  In this case, I think that the political logic of an expensive new health care plan will push us faster and further towards price controls on key inputs, and somewhat hamfisted "one-size-fits-all" standard-of-care recommendations.  I am reinforced in this belief by the fact that many of the people pushing health care reform are also enthusiastic proponents of . . . price controls on key inputs, and national standard-of-care recommendations.  I don't trust them when they ask me to focus on just this bill right here.

They shouldn't trust me either.  Except they should, because I'm being right out front about this.  I don't want this bill, and I don't want any other bill that increases the number of people for whom the government pays for care. I may point out why you shouldn't want this bill, and I will try to be intellectually honest about it--i.e. focus on things the bill actually is likely to do, rather than "death panels".  But I wouldn't like it any more if it was more like something you want.  In fact, I'd probably like it less.

This article available online at:

http://www.theatlantic.com/business/archive/2009/08/slapping-the-camels-nose/23094/