I find myself more and more coming to ObamaCare’s, as if there were such a thing at the moment, defense. While not what I would prefer to see it is at least a step in the right direction. I played with the idea that maybe the status quo’s unsustainability might be preferable as a way to hopefully make the ideal more likely in the future, but that would require a massive crisis which is one 1. capable of being stymied 2. blamed on a marginalized group and not the elites and 3. would, at best, require massive pain. So, the compromise it is.
Megan McArdle has a piece over at The Atlantic which is one of the better anti-reform pieces I have found. It is also exemplifies the most persuasive arguments against reform. Her main argument is the Government Theater, where the government tries to pay as little as possible and so it stymies research into more expensive and yet more effective treatments. An interesting argument with a few problems. First, this argument assumes the dissolution of a private health care system. The public option would not replace private options. The current incentives for research would still exist. The current treatments would still exist. Surely the public option might provide less quality than the private options but it would also retain the fidelity to the “personal responsibility” myth hailed by conservative thinking folks.
Even if the dissolution argument is correct, reform is still preferable: preventive care is more important than catastrophic care, it would bring more people into a system of preventive care, overseas options would still exist for the middle and upper classes, status quo treatments would remain available because people know about them (the Government Theater could only distort so much), there would only be a loss of some research (note that ‘some research’ is very different from ‘all future research’ as R&D incentives would still exist), and much research is funded by the NIH (those commitments would remain and would actually ramp up as the government would become a consumer of government funded science.)
McArdle then tries to answer the ‘people are without insurance now’ argument. First, she says that she was uninsured for two years dealing with illnesses and still believed what she does now. So what? She has a credible stake in the debate. So does everyone, that’s the issue. Everyone is affected by this decision. Her disclosure is also demonstrates false consciousness, a topic better explained by others that comment or linked to by this site. She then tries to flip the argument, “why don’t you tell some person who has a terminal condition that sorry, we can’t afford to find a cure for their disease?” That flip, at best, only cuts against the argument and does not overwhelm it. First, there are many more un(der)insured than there are treatable terminally ill people. Second, an un(der)insured person is terminal. Studies show that these people die significantly sooner than the insured and their quality of life during their life is also significantly reduced. McArdle’s argument is doing the very thing she claims ought to be avoided. Third, this argument assumes the dissolution of private options, which is not accurate. Fourth, see the argument above about how research may be advanced by the public option. Fifth, as if the status quo option does not currently have rationing. Only the agent of the rationing may change and I for one would rather have the government with a larger and more generous pocketbook making those decisions than a CEO at an insurance company who is beholden only to stockpayer dividends.
Her final argument is about the intervention of government into our lives. What McArdle fails to realize is that this argument is about the importance of preventive care and to make this argument is to concede what is most persuasive about a public option: its ability to increase preventive care to those currently without. Her fear is that the government will then crack down on poor nutrition and smoking and other such lifestyle choices in the name of cost reductions. This argument is naive because the government is already involved in these problems. A public option causing such a cost-cutting measure might then be forced to evaluate its support of dangerous agricultural subsidies, unhealthy school lunch programs, fossil fuel subsidies and other government interventions that have made the very free market, which is supposedly so grand, a myth. It is a suspect claim to think this means the government will then intervene to ban Doritos. Maybe an anti-Doritos ad campaign, possibly. But why would that be bad? Especially if it means the government stops pushing Doritos to school children, which is where the obesity pandemic begins. Obviously the use of Doritos is a metonymy as there are more problems, not just nutritional, than Doritos and school lunches.
McArdle’s piece is the typical trope where larger connections are not made and their is an undergirding of free-market faith. The debate about the value of the free-market, even if one assumes it actually exists, is a rich one worthy of being explored as well but is beyond my scope at the moment.