To a certain extent, I think Freddie’s being too harsh on Reihan in this post. But at the same time, his broader point is an important one that I think a lot of conservatives and libertarians utterly miss when we discuss the issue of health care. It is also a point that explains why conservative and libertarian perspectives on health care reform have virtually no traction with the general public and why the discussion of health care reform is almost completely driven by liberals. This is true whether or not conservatarian solutions to the health care problem would, in fact, be better solutions.
No one denies that our current system is simply not working. No one denies that it causes a lot of unnecessary suffering. To be sure, there are disagreements as to which aspects of the system are failing and which are causing unnecessary suffering.
But the way in which conservatives and libertarians approach the issue often comes across as if we’re just proposing solutions for the sake of proposing solutions. The impression left on the average person is that the interest in fixing the health care system is subservient to the interest in creating a freer market, even if what we actually believe is that the problems in the health care system are a result of lack of free markets.
For years, whenever you see a Dem or liberal discussing the health care issue, they almost always begin with an acknowledgement of the problem – the “57 million Americans are uninsured” refrain, or perhaps a story of someone who died as a result of lack of treatment or because they couldn’t get their insurance company to pay for treatment. These stories and statistics tug at the heart strings, but more importantly they make people care about the issue because they make the issue relatable to those people, making them think “that could be me,” or in many cases “that is me.” As importantly, they give the listener the impression that what follows is a good faith proposal to solve that problem, not some half-assed proposal that’s really intended to advance a broader ideological agenda.
When you hear a conservative or libertarian speaking about the issue, though, you rarely get an acknowledgement of the problem. Instead, you may get a set of objections to the Dem proposal (usually including a rant about “socialized medicine”) or a statement that the free market solution is the better solution or some discussion of the areas of our health care system that are not the problem and that must be preserved and defended.
While Freddie’s argument is making a generalization, and it’s problematic to draw generalizations from one example, I think this exchange from one of the debates last year between McCain and Obama helps explain what I (and I think Freddie) am talking about:
Q: Is health care in America a privilege, a right, or a responsibility?
McCAIN: I think it’s a responsibility, in this respect, in that we should have available and affordable health care to every American citizen, to every family member. And with the plan that I have, that will do that. But government mandates I’m always a little nervous about. But it is certainly my responsibility. It is certainly small-business people and others, and they understand that responsibility. American citizens understand that. Employers understand that.
OBAMA: Well, I think it should be a right for every American. In a country as wealthy as ours, for us to have people who are going bankrupt because they can’t pay their medical bills–for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies–there’s something fundamentally wrong about that.
Notice how McCain just assumes that everyone, including himself, “understands” their responsibility and, by extension, the problems in the health care system. Obama, however, actually shows he understands the problem. It’s thus not surprising that the average person, who has neither a strong commitment to free market economics nor a strong commitment to government centralization, would decide that Obama’s discussion of the issue is more credible. Again, this is true even if McCain’s proposal would better solve the problem.
And let’s be honest, the reason conservatives and libertarians rarely put the problem front and center is because our interest in improving health care is often a lower priority than our interest in defending free markets. It’s not that we don’t care about health care reform, it’s that our ideological commitments force us to defend the ideology first: liberals and Democrats first diagnosed the problem and we’ve been doing little but play defense ever since.
This isn’t to say that this is an inherent flaw in libertarianism and conservatism – after all, there’s no shame in believing that on a macro-level, freer markets solve more problems than they create, and there’s also no shame in defending your ideology against what you believe to be unfair and/or inaccurate criticisms. It’s just to say that most people are a lot less concerned about some ultimate vision for society than they are about individual issues that affect their day-to-day lives. If you don’t show that you understand how that individual issue affects their day-to-day lives, then you’re going to have a hard time convincing them that your solution is better.
For what it’s worth, I suspect that ultimately liberals and Democrats are going to face a similar problem on the issue of school choice. There, conservatives and libertarians have the advantage because we’re talking about parents with children stuck in failing schools, while liberals and Democrats are left talking about how “public schools work!” (the equivalent of “the free market works!”), and warning about separation of church and state and privatized education (the equivalent of “socialized medicine!”).