The Closing Of The Conservative Mind, Some Of Them

Fri, 26 Mar 2010 01:36:12 +0000

What distresses me most about Bruce's post is not that David Frum needs to find a new home -- he's talented and will land somewhere.  It is the juxtaposition of the AEI position on health care reform -- speak no non-evil -- with this bit from Patrick Ruffini, a rising star among Republican activists (h/t Andrew Sullivan):

When it comes to health care policy, conservatives have been seriously outgunned. And I say this in all fairness to the friends I have who work night and day on free market solutions to health care. On economics, you always know what the conservative answer is: tax cuts and generally hands-off regulatory policies to spur economic growth. No matter how good the Democrats' promises sound, we return to these simple, pro-growth touchtones that resonate with a majority of Americans who intuitively get that you can't micromanage your way to a better future. 

On health care, I have no idea what our basic guiding principle is. Seriously, I don't. 

We have tried ineffectively to stretch free market rhetoric to health care without appreciating that health care is already too far removed from a free market for the analogy to make sense. Real markets are sensitive to price. Health care isn't. The insurance companies hide the cost of actual care from the consumer. 

What we have lacked in this debate is a simple clarion call to address an aching need -- bringing free market principles to bear to improve tangible health outcomes.

First, it is crazy to say that he's got no idea on "our basic guiding principle." <!--break--> What AEI has been distributing on health care reform is the Cogan, Hubbard, and Kessler framework, most recently expressed in this WSJ op-ed from one month ago. He has to have seen that, and it would do in a pinch. Second, he could cast a wider net and realize the the key problem, for everyone who now needs or may ever need health insurance, is the problem of excluding pre-existing conditions by health insurance companies.  The Republicans were "outgunned" because they failed to recognize this fundamental issue and produce a constructive plan to address it.  As I proposed it eight months ago:

  1. Community rating
  2. Guaranteed issue
  3. Ex post risk adjustment
  4. An individual mandate, with Medicaid for a fee as the backup option

It turns out that in the intervening eight months, the Democrats figured out most of that and put it in the Senate bill.  It is more expensive and intrusive than I would have liked, but they got most of the right answer.  The only victory for the Republicans is that the public option -- literally, Medicare for a fee -- from the House bill did not become law.  If the Republicans decide to run on the repeal of the law, then that will compound their misery.