Obama vs The Ideologues


Gallup checks out how Americans feel about the government's role in healthcare:

An important principle behind the current push for healthcare reform is that healthcare is a basic right that the government ought to guarantee for all Americans. Not only are the details of achieving universal coverage proving to be highly controversial, but it is unclear how strongly Americans support the premise. Americans tend to agree with the government's taking responsibility for guaranteeing healthcare coverage when asked in "yes or no" terms. However, they are more libertarian on the issue when asked whether the government or individual citizens should be primarily responsible for ensuring that coverage.

I dispute the premise. I don't believe an attempt to help more Americans to get their own health insurance implies that it is some kind of basic right that can be demanded of government. Some may believe that. I don't.

But I do see the pragmatic benefit of removing chronic insecurity that impedes labor mobility. I do see the pragmatic benefit of ending expensive emergency room care in favor of more preventive insurance and avoiding the free rider problem. I see the advantages of including everyone in an insurance scheme to spread risks more widely. I see the waste of resources when sick people become destitute for lack of insurance, when they could otherwise be healthy, productive members of society. And I do see the moral case that it is part of the American character to care for those rendered helpless by illness, and the moral cost of seeing them suffer for lack of adequate preparation.

Moreover, what we're talking about here is insurance against the lottery of health - not provision of care as such. Obama is not proposing the British NHS. He's proposing an extension of private insurance through public subsidies because healthcare is now an utterly different thing than it was in days gone by, and enormously expensive to boot. Hayek - not exactly a socialist - expressed his view on the matter here:

"Nor is there any reason why the state should not assist the individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision. Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance - where, in short, we deal with genuinely insurable risks - the case for the state's helping to organize a comprehensive system of social insurance is very strong... Wherever communal action can mitigate disasters against which the individual can neither attempt to guard himself nor make the provision for the consequences, such communal action should undoubtedly be taken," - The Road To Serfdom (Chapter 9).

The current Democratic plans are not, it seems to me, driven by ideological templates, but are attempts to address obvious distortions and unnecessary inequalities in a healthcare system whose enormous costs have become insufficiently balanced by commensurate benefits. The problem with our current politics is that it has become too ideological, too framed around abstract questions of the role of government, rather than around the duty of government to adjust existing institutions and policies to newly understood needs and newly emergent problems.

In this sense, Obama is the Tory. It's the Republicans who are the philosophes.

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