The Persistence of American Conservative Opposition to ObamaCare: Friday Focus for October 17, 2014
Jonathan Chait has an interesting piece on the thought on healthcare policy of the likely future senator from Iowa, Joni Ernst:
…have failed. And yet conservative opposition… has not diminished. If you want to know why this is, listen to… Joni Ernst….
We’re looking at Obamacare right now. Once we start with those benefits in January, how are we going to get people off of those? It’s exponentially harder to remove people once they’ve already been on those programs…. We rely on government for absolutely everything. And in the years since I was a small girl up until now into my adulthood with children of my own, we have lost a reliance on not only our own families, but so much of what our churches and private organizations used to do. They used to have wonderful food pantries. They used to provide clothing for those that really needed it. But we have gotten away from that. Now we’re at a point where the government will just give away anything.
That’s the fundamental belief…. Health care should be a privilege rather than a right. If you can’t afford health insurance on your own, that is not the government’s problem…. All of us non-socialists would agree that there ought to be some things rich people get to enjoy that poor people are deprived of. Access to health care is a strange choice of things to deprive the losers of–not least because one of the things you do to ‘earn’ the ability to afford it is not just the normal market value of earning or inheriting a good income, but the usually random value of avoiding serious illness or accident…. But that is the belief that sets [American conservatives apart from [other] major conservative parties across the world, and it is the belief that explains why they have opposed national health insurance…
But if there is one thing that all students of health care finance agree on, it is that health-insurance markets do not work: they are riddled with adverse selection and moral hazard to an extraordinary degree, and maintaining an equilibrium in which the market actually works–a “pooling” rather than a “separating” equilibrium–is very difficult and requires skillful and delicate regulation. The fact that the market can’t deliver derails the chain of contribution-purchase-consumption that (some) conservatives identify with desert and fairness. And if a market equilibrium is, as it is in health care, not just inequitable and unutilitarian but also unjust according to libertarian lights, why plump for it?
This is the reason that many of us non-communists go for single-payer: equity an utilitarian greatest-good-of-the-greatest-number are good things, and single payer can get us to them even though the health-insurance market cannot deliver on what it is supposed to do. And this is the reason that others of us work very hard to try to find a way to fix the health-insurance market so that it will work, somehow–with Obamacare being the latest attempt to make it work, for a while at least. Bluntly: the exchange marketplaces will not work without the mandate, and the mandate cannot work without the subsidy pool.
Doesn’t Joni Ernst have any friends on her side of the aisle to educate her about health-insurance markets? And how do the technocrats on her side of that aisle expect to make good policy if they fail to make the effort to educate those who may well be voting up or down on their proposals in a year? Wasn’t it British Liberal Minister Robert Lowe who, after the passage of the Second Reform Bill in 1867, famously said “we must educate our masters”?
Now more than ever.