JONATHAN CHAIT MAY 13, 2011
I once wrote an article arguing that contemporary economic liberalism and economic conservatism are not mirror-image ideologies. Economic conservatism is philosophically committed to smaller government, regardless of practical effect, whereas liberalism supports more or less government on the basis of its measurable effect on human welfare. This dynamic is on full display in the right's rejection of Mitt Romney's health care plan in Massachusetts. Conservatives argue that Romney's plan has failed on its own terms, of course, but they also argue that the mere fact of his trying to design a health care system on pragmatic grounds -- that which provides the most benefit and the least cost -- is a betrayal of their ideals.
Consider the Wall Street Journal's widely-cited editorial attacking Romneycare. It brims with disdain for the very notion of data-driven decision making:
Mr. Romney applied the approach that succeeded when he was a Bain & Company business consultant: He convened an expert task force. His health-care commission immersed itself in data, crunched the numbers and came up with a technocratic solution...
The raucous national debate over health care isn't about this or that technocratic detail, but about basic differences over the role of government. ...
For a potential President whose core argument is that he knows how to revive free market economic growth, this amounts to a fatal flaw. Presidents lead by offering a vision for the country rooted in certain principles, not by promising a technocracy that runs on "data."
Conservative blogger Jennifer Rubin approvingly summarizes the accusation against Romney as him "being a technocrat and not a conservative." It's a revealing use of language. She correctly deems technocracy and conservatism -- at least the sort of conservatism acceptable to the conservative movement and the current Republican Party -- mutually exclusive. This is an important reason conservatives have responded so fiercely to Romney's health care program -- it suggests a willingness to follow empirical results over free market dogma. That he views the market as merely a powerful welfare-enhancing tool, rather than as an a priori philosophical commitment, proves his ideological unfitness.
David Frum, the apostate Republican who has turned against his party's economic dogma, has an incisive item scrutinizing the ideological assumptions undergirding the Journal's editorial:
Let’s try to reverse-engineer the editorial to see what the editors believe Romney should have done instead.
When Mr. Romney took office in 2003, the state was already enforcing public utility-style regulation of insurers for premiums and multiple benefit mandates. The resulting distortions were increasing rates fast, along with the natural increases from good but expensive Massachusetts medicine.
In other words: rate regulation of insurers is bad. Using regulation to hold rates down causes rates to go up instead.
The conceit was that a universal reform would cover everyone and all but pay for itself by reorganizing the state’s health-care finances
Universal coverage: bad. Universal coverage will force costs up.
In the name of personal responsibility, Mr. Romney also introduced the individual mandate, first in the nation, requiring everyone to buy coverage or else pay a penalty. Free riders, he said, transferred their own costs to others, either through higher premiums or taxes. This is the same argument the Obama Administration is now using to justify the coercion of the individual mandate in the federal courts.
Individual mandates: bad. The “free rider” argument only conceals state coercion.
The people who don’t buy coverage though they can afford it aren’t really a major fiscal problem …. People who are priced out of coverage require subsidies—so in practice the logic of the individual mandate is that it is a government mandate too.
Subsidies to cover private health insurance for those who cannot afford it: bad. They cause government to grow.
Entitlements automatically grow and grow, and then the political class begins to make decisions that used to be left to markets and individuals.
Political decisions about health coverage: bad. Instead the decision about who should not be covered should be left to markets: if the market does not assign you enough money for coverage, you should not have coverage.
The only good news we can find is that the uninsured rate has dropped to 2% today from 6% in 2006. Yet four out of five of the newly insured receive low- or no-cost coverage from the government.
A decline in the number of the uninsured is good if and only if they receive no public aid. Then it becomes bad.
The assumptions encoded in the Journal editorial make nonsense of the Journal’s conclusions.
The Journal's philosophical opposition to government create an unshakable bias against Romney's plan. No real-world outcome could possibly vindicate it.
Frum has another item, asking pointedly:
A question for Tim Pawlenty at the next Republican debate.
“When you became governor in 2003, Minnesota had under 395,000 citizens without health insurance. In 2008, the last year before the recession struck, Minnesota had 446,000 citizens without health insurance. Do you regard that as an important failure of your administration? If not, why not?”
The obvious point is that a failure to impose government regulations and subsidies onto the health care system can never be viewed as a liability by conservatives -- and certainly not a liability remotely on par with Romney's -- regardless of real-world consequences. In the conservative movement, a more free market system is ipso facto superior.