Acting Like You Mean It: Show Your Work

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!”).

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46 thoughts on “Acting Like You Mean It: Show Your Work

  1. liberals and Democrats are left talking about how “public schools work!” (the equivalent of “the free market works!”),

    Something of a false equivalence, wouldn’t you say?

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  2. Yeah – school choice, or voucher programs even if effective in some instances still do little to address the overall problem with our education system, whereas when we talk health care reform we’re looking at fundamental changes to the system as it stands now. And whereas “free markets” are indeed a core ideological tenet, “public education” is just one small piece of a larger whole. Which isn’t to place judgment on the merits of either side of either debate, but I have to agree with Freddie that it’s definitely a false equivalence….

    Other than that, though, yes very good piece.

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  3. “No one denies that our current system is simply not working.”

    I don’t this is a clearly established fact among those on the political right, at least at the upper-echelons. If it is, then it’s a relatively new phenomenon.

    The willingness to acknowledge problems with health care is a big reason why Democrats and liberals own the issue. It seems like conservatives would just as soon never even discuss health care in the absence of Democratic proposals.

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  4. “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.”

    Seriously.

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      • By definition, if you’re saying that “public schools work,” you’re not acknowledging that there are problems with the public schools.

        Anyhow, is the analogy perfect? No – my point is just that the issue of education reform is one in which defenders of the public school system are in a position where they have to do exactly that – defend. School reform is an issue that is driven by conservatives and libertarians just as health care reform is an issue driven by liberals.

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        • No one is claiming that public schools work, at least not across the board. The claim is that public schools need to work if they are going to continue to be with us, which they are. To suggest there is any significant amount of denial of the problems among those who want to see better public education is totally divorced from the actual debate.

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        • You’re right that school-choicers have the communications advantage of helping concrete, visible people in ways they wish to be helped. Defenders of public schools must defend them by seeking to improve them (primarily through preserving and expanding funding), and currently face a difficult reality on the ground in some places, being at the whim of local voter attitudes and unable to provide the product they would like to be able to do, but that is as it always was and should be.

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  5. Whether or not liberals admit that public schools often fail doesn’t affect the point that conservatives and libertarians are the ones talking about the real-life issues faced by the DC parents in the above video, while liberals tend to fall back on abstract platitudes about utopian ideas to “fix” the public schools.

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  6. This is a fair summary. However there is a key difference. I don’t think i have ever heard any liberal say the government is always the solution. I am plenty critical of government. Conservatives can’t seem to admit that maybe free markets aren’t the be all and end all.

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    • Exactly, and liberals are very embracing of market solutions by anyone’s standard, especially those described by Mark as uncommitted to an ideology, other than the libertarian’s. Whereas libertarians and conservatives are by anyone’s (including their own) standards broadly and with very few exceptions hostile to all government solutions. It is their raison d’etre by their own admission.

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  7. Whether or not liberals admit that public schools often fail doesn’t affect the point that conservatives and libertarians are the ones talking about the real-life issues faced by the DC parents in the above video, while liberals tend to fall back on abstract platitudes about utopian ideas to “fix” the public schools.

    1. Define “often.” But then you can’t; because as I’ve said many times, proponents of vouchers make sweeping claims about both the effects of vouchers and the failures of public schools without any evidence at all.
    2. Nothing could be more utopian than voucher-proponent fantasies about what causes academic failure.
    3. Most importantly– you say that only conservatives and libertarians talk about ways to fix inner city schools. And yet there are no conservatives or libertarians in urban American school districts. Conservatism simply doesn’t have a real urban presence; electoral contests in inner city America are almost universally inter-liberal disputes. Conservatives and libertarians are often perceived as haranguing the system from the outside, in a position where they have no actual stake in the issue. So if conservatives want to really impact inner city education, they should build a real urban presence– but understand that doing so will have to involve jettisoning a lot of conservative dogma.

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  8. Most importantly– you say that only conservatives and libertarians talk about ways to fix inner city schools.

    No, that’s not what I said at all. You’re not disputing what I did say, which is that conservatives and libertarians who support vouchers are the only ones willing to think about and talk about personal stories like those shown in the above video.

    as I’ve said many times, proponents of vouchers make sweeping claims about both the effects of vouchers and the failures of public schools without any evidence at all.

    I thought the last time we disputed over this issue, you seemed to be willing (at long last) to read up on the scholarly evidence, which has gone completely ignored in any of the “many times” you’ve opined on the issue. Just to remind everyone, all of the top-notch scholarly evidence on vouchers can be found in links here: http://jaypgreene.com/2009/04/27/systemic-effects-of-vouchers-updated-42709/ and http://jaypgreene.com/2008/08/21/voucher-effects-on-participants/ Needless to say, voucher proponents aren’t the ones who opine in the utter absence of evidence; quite the opposite.

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  9. Can I call a time out and remind everyone that this post was primarily about the way conservatives and libertarians address the health care issue? I was not looking to start an argument about vouchers, just to point out – as an aside – that the problem of resorting to abstract principles over personal stories is not a Left/Right issue but a function of political initiative.

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    • Brilliant post Mark.

      I think you’re really on point here. From my experience with loads more conversations about school reform, public education, and the achievement gap than healthcare, I’m struck by how similar the personal sense of frustration and rhetoric of moral responsibility are between the two subjects.

      Presuming that’s the analogue you meant, it’s very apt.

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  10. I’m but one lone, libertarian voice, who, by the way, doesn’t feel any affinity with conservative healthcare plans, so I’m not sure about the constant association in your post — however, if it’s stories you think that will clinch the argument, I have 17 years worth of stories which come from my work as a therapist in specialty hospitals dealing with alcoholism, drug addiction and mental illness. But before I spin a heart-tugging yarn, I’d suggest reading Tibor Machan who writes about the moral aspect of libertarianism and the deeper understanding present-day libertarians have regarding freedom and the voluntary contributions to help resolve serious social problems.

    I worked in private facilities but dealt with patients coming out of the state run facilities, because we had so many beds set aside to help those without the money to pay. Some of these people had been revolving door patients in the state run facilities — when they reached us they expected the same level of care they had gotten with over-stressed, burnt-out state employees. The stories they told me about treatment in the state facilities infuriated me, but I always kept my cool and told them to concentrate on the present and realize their responsibility in their recovery — but privately it sickened me. They had been verbally abused, neglected and herded around like cattle. They bought dope from interns, had sex with therapists, but were generally neglected and treated as if they were the scum of the earth, or didn’t really exist, according to their reports. This was in Atlanta, near Raleigh, and several other places I worked where I heard these reports. But I had also witnessed state run facilities up close, earlier in my life, when I watched a loved-one slowly die from alcoholism, in and out of the kill-or-cures the state called treatment, the long line of patients in DTs strapped to the beds, with the staff as arrogantly non-responsive as someone can be without being purely evil. The conditions were horrible, and if it had been during a period of my life when I could’ve afford to do so, I would’ve picked this man up and carried him on my back to a private facility where at least someone cared.

    The point is that government is not suited to run healthcare, and any system they devise will devolve to apathy and incompetence — I’ve just seen it too many times. Private charity hospitals would be run by local people without centrally controlled regulations to kill the spirit and numb the conscience, or chains which have to compete against others so that quality is forced to be maintained. You can say the same thing could happen with private facilities, but you probably wouldn’t believe it.

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    • But does the government need to run health care? I think they’d be fine leaving the running part to private enterprise as much as possible so long as they helped pay for people to go to said facilities/doctors/etc.

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        • Big difference is that education has been in the public sphere since this nation’s birth – with Thomas Jefferson himself a big proponent of public education. Medical care has a different tradition. There is no reason to go that length. There may be some room for government run primary care facilities, but not hospitals. Not at any major scale.

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          • If you ask “But does the government need to run health care?”, I’d ask if there is anything (seriously, anything) where they haven’t started calling the tune once they started paying the piper.

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            • Actually I’d say the reverse is becoming more and more true, as government contracts out more and more – in defense; in prisons; and so forth. So no, I don’t think that argument has a leg to stand on in this current political climate.

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              • Yeah, but what genuine advocate of the free market supports contracting out government services? Most free market advocates I know think such solutions are an even bigger problem than government getting involved in the first place.

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                  • There strikes me as *HUGE* differences between health care and, in the examples given, defense/prison work.

                    Health Care, so it seems to me, relies on people two standard deviations to the right of the mean, if not three, if not four. It is exceptionally important that you have smarter-than-average people providing health care… and, on top of that, the goal of health care will always, always, *ALWAYS* be thwarted by the fact that People Die. They get cancer. They have heart attacks. They have strokes. They get hit by buses. They get hit by lightning. They get hit by spouses. They will die, 100% of them, without exception. The best that quality health care can do is make sure that they die of catastrophic stuff rather than from infections.

                    Defense/Prisons, on the other hand, seem to not require folks two or three standard deviations to the right. The middle of the bell curve is good enough. You get a big guy, give him training, give him more training, and then give him more training… and you’ve got someone who can do the job asked. Sure, the higher ups are probably one or two standard deviations to the right… but the ratio of “solid and average” to “really, really smart” is huge compared to the ratio of health care (and certainly to the desired ratio to be found in health care). On top of that, what are the tasks in the military or in a prison? Compare to the tasks of health care.

                    I can see why defense/prisons are outsourcable. They are relatively simple compared to the effort required to keep people alive.

                    I mean, if the baseline for “decent health care” was a strong-willed person saying “don’t drink so much, eat better, exercise once in a while, and for god’s sake, quit smoking”, we could have decent health care for the masses right now.

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    • “The point is that government is not suited to run healthcare, and any system they devise will devolve to apathy and incompetence — I’ve just seen it too many times. Private charity hospitals would be run by local people without centrally controlled regulations to kill the spirit and numb the conscience, or chains which have to compete against others so that quality is forced to be maintained.”

      Serious question: why does this not happen (at any meaningful scale, anyway) now? What are the barriers?

      Because if private charity hospitals could plug the (massive, yawning) gap, gosh that would be great. Nobody likes bureacratic care (one of the reasons so many don’t like their current, corporate bureacratic health insurance).

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    • The association is more one of convenience than an attempt to make any substantive point – I’ve made my share of arguments about the differences between libertarians and conservatives (and argued for libertarians to distance themselves from conservatism to boot) but for purposes of my point here, the differences weren’t really relevant.

      Anywho, to respond to your point, the issue is just that the problem for most people in the US isn’t one of inadequate care, it’s one of lack of access to adequate care. So while there are plenty of stories that can be used in defense against Dem plans, those stories aren’t going to really speak to the problems that people are looking to solve – they’re more stories about problems that they might face if Dem plans were implemented rather than stories about problems that they already can or do face.

      Again, though, I don’t think this is an inherent problem with free market solutions. It’s more that it’s an issue that liberals have been concerned about for a very long time – much longer than libertarians and conservatives – and thus they are able to control the terms of the debate and leave conservatives and libertarians looking like they’re defending the status quo rather than actually recognizing the severity of the problem.

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    • That is powerful stuff. But as they say the plural of anecdote is not data. I’ve worked in mental health, social services and drug treatments. I have seen terrible care in private and public institutions. There is a private mental health hospital here that is well known for discharging people the day after there coverage runs out. Many ex-staff there have stories about the uncaring staff and clueless management. My own experience in a private mental health unit in a private hospital was the same. They paid staff as little as possible, understaffed the unit and took inappropriate patients to the point the unit was unsafe.

      The most chaotic, screwed up org I ever worked for was a small non-profit. It was a mental health center that for months didn’t even have a list of all the clients we served. If I run into my ex-coworkers we all talk about surviving our time there, since it was so dysfunctional.

      The charity I worked in was the best job I ever had. Unfortunately for a year we spent spinning our wheels to a degree because another charity duplicated our services by opening up a drop in center, like the one I ran, a block away. That was a complete waste of badly needed resources, but without a central body to organize resources, they were wasted.

      I have known various workers in state services who bust their asses for their clients. I work for the state court and my co-workers and I have been pushing to expand our services and increase our work load.

      We can duel with anecdotes and we all have our political beliefs, but saying the gov can’t provide healthcare is just not factual. Many gov’s around the world do so. The VA in this country does so ( people i knew loved the big VA hospital where i used to live). Many states and towns run clinics. Many state universities run excellent hospitals. Etc, etc.

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  11. But, don’t worry — you’re going to get national healthcare, so we’ll see how it unfolds — I’m sure there will be plenty of stories to tell in a few years.

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  12. I respect your story Mike. I just think we all need to be very careful to avoid seeing events entirely through our ideological lens. We are all too fallible and none of our beliefs are close to perfect.

    If all you have is a hammer, you see all problems as a nail.

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  13. “If all you have is a hammer, you see all problems as a nail.”

    Wow, I think my life just changed. I’ll be more careful from now on.

    Seriously, dude, I don’t think I’ve said, or implied, that my beliefs are perfect. All this talk about libertarian ideology is becoming pretty comical. Plus, the irony is thick. The proposition that a society left to the voluntary benevolence of all when considering helping the unfortunate is a valid avenue to consider is nothing like my way or the highway. I find it interesting that it meets such ideolo…, I mean, such resistance.

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  14. uhhh i wasn’t trying to change your life. That quote applies to all, regardless of beliefs. My statement applies to all of us, it wasn’t meant as a criticism of you nor was i suggesting you thought your beliefs were perfect. We all tend to bloviate at bit on the intertoobz.

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  17. 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.

    HUH? What planet do you live on? Conservative and some libertarian hacks constantly assure us that the US health care system (including insurance) is the best in the world, that it doesn’t need fixing, and so on! Those people have already derailed the HCR fast track, and maybe the whole thing.

    Good lord man, look around. Maybe the sort of people (some prominent) who say it’s fine deserve to be “nobodies”, but unfortunately they sure have a lot of influence on gullible and excitable members of the public.

    This sort of posturing pretense, by certain intellectuals, that people really get it and we can somehow ignore the liars and truly ignorant who follow them – knock it off!

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