Size of Government, Health Care, and Small Business

In many senses I couldn’t agree more with commenter gregniak when he/she (no assumptions) says,

there is a point in this kind of conversation where the topic (big gov vs. small gov) is so general as to become useless. most people Con’s included want some big gov. big or small just doesn’t say much unless you know what is the purpose: are there C and B, how does it work, who has power, etc….you need to know at least some specifics. national health care is a very different kind of “big gov” then warentless wiretapping, or the drug war or high military spending. each may have there own justifications and problems. the big vs small debate is more about vague posturing and grand pronouncements without actual policy knowledge.

In my mind, the debate on size of government is essentially a convenient but dead horse for partisan rangling. A country the size of America with the kinds of expectations around quality of life of its citizens requires for its effective governance an inherently large government. As has been noted a great deal lately in the wake of the Obama stimulus bill, conservatives of a variety of stripes have tried to shrink the size of government, to little effect. At some point you bump up against the reality of what people expect government to do if they are to remain invested in it and the limitations around how small you can actually make government without undermining that investment.

It seems to me that the much more useful debate is around the scope of government, as I heard articulated by Mickey Edwards in this Bill Moyers interview with Ross Douthat (ostensibly Edwards argues the same thing in his book, but I haven’t read it). My sense of at least interim finality around the size debate does not relfect a corresponding lack of concern around the issues of government intrusion into peoples’ lives and a need for checks and balances, as commenters Bob and Cascadian have been back and forthing about in the comments of the same post. Government may be a large beast, but that doesn’t mean that we shouldn’t look for ways to latch its feet to stakes in the ground in order to impose limitations to its ability to roam freely.

I say all of this with the issue of health care in mind. Today there is a summit happening at the behest of the Obama administration on how to get the costs of health care under control. Coming from a Canadian perspective, I don’t entirely buy the conservatives being adamant about not expanding government’s role in health care so that every citizen has basic coverage. There is no doubt that the Canadian health care system is fraught with problems of its own and those problems, in many cases, require the dynamic thinking of the private world to overcome. But the whole argument that expanding government’s role means an unacceptable intrusion into people’s lives simply doesn’t do justice in my mind to actually asking the question of what elements of peoples’ lives government ought to have some kind of role and what element it ought not to. It just seems too knee-jerk: expansion is bad, always (in the same way that some have pilloried liberals for assuming that regulation in economic affairs is good, always)!

Part of my belief around that being a knee-jerk reaction is that the burden of providing health care coverage in the US seems to be falling predominantly on businesses and if it seems foreign that government should have a role in peoples’ health care, then the idea that said healthcare is the responsibility of business seems like a martian concept to me. There are many ways in which businesses have obligations to their employees due to both the contractual and non-contractual relationship that exists between the two, but providing for something like health care when the primary goal of businesses is to generate revenue and wealth for itself and, ideally, its employees, seems tertiary, if not down right antithetical. That argument goes double-time for me when the burden of providing health care coverage is fundamentally hampering the ability for those businesses to maintain even revenue streams, particularly small businesses.

Given that the conservative/Republican line I’ve heard a lot of lately is that they are the movement/Party committed to small businesses as the driver of success in the country, it strikes me as one of the glaring examples of dogmatic rigidness inherent in the kind of ideological empire building to which I am so averse when this dilemma gets such short shrift in policy formulation.

Now, I’m no health care policy wonk and I know this is a hyper-charged issue in American politics, so I’m sure there are nuances I’ve overlooked. But this is an issue that has vexed me lately, especially given my own perception that the Canadian system, while not perfect, isn’t the armpit of all proposals. I look forward to getting some constructive feedback and having a useful discussion in the comments.

Tagged as: costs, dogmatism, government intrusion, scope of government. Mickey Edwards, size of government, small business