I don’t have time for a long discussion of President Obama’s speech on health care; I suspect many of you are grateful for that. But enough people have e-mailed me for a reaction that I thought I might as well respond briefly here.
First, because I like to acknowledge points of agreement, let me begin by saying that I thought the end of the speech (the part about the American character) was the best. President Obama is very good at summoning us to be better than we are without sounding like a scold. Reagan was a master at this as well. It’s a very important talent for a president to have. And leaving aside the President’s prowess as a messenger, the message itself was a good one. We can always use more civility and more magnanimity.
But all the magnanimity in the world is of little use if soft-heartedness become soft-headedness. And I’m afraid that intellectually, on policy, this speech left me with almost no hope that anything useful will come out of health care legislation during this presidency.
Of the three parts of the President’s “plan” (which as far as I can tell is still only a collection of bullet points at www.whitehouse.gov), I gather that the first part (letting you keep your current insurance and making it cover more) was supposed to be the spoonful of sugar to help the medicine (the “public option” and the “play or pay” mandate) go down. But as you’ll know if you slogged through my last three posts (here, here, and here), I believe the impulse to force employer-sponsored “insurance” plans to cover all kinds of routine services for all comers regardless of risk is exactly what we don’t need. This part of the program seems to me to focus on the worst thing about our present system and make it even worse than it is now.
As for the “public option,” I agree that an unsubsidized government plan presents no threat to private insurers, but I think it is naive to pretend that the political logic that favors such a plan does not also favor taxpayer subsidies when the program is in the red and we must either subsidize it, cut the benefits, or repeal it. So I assume it will eventually be subsidized, and furthermore I assume that unlike current government health programs like Medicare and the VA, it will not have a defined mission other than to provide care for “everyone else.” I think it far too likely that “everyone else” will become “everyone.” Some proponents of a public option probably know this and think of this as the camel’s nose under the tent. Others, perhaps, are simply naive rather than cunning. What are we to make of proposals like this that could go either way depending on some future political consensus?
During the Bush administration, this was the way many Republican-leaning voters thought about incursions on civil liberties. Sure, theoretically the administration could be spying on political adversaries without a warrant, and throwing you or someone you know in a military brig without charges the way they did to Jose Padilla, but they wouldn’t do that. They’re good, decent people who just want to keep us safe, right? But many of the same people who took this ho-hum view with a Republican in the White House were a great deal more alarmed by some of the reports that came out of the Department of Homeland Security early in the Obama administration. They trusted the Bush administration but not the Obama administration, and they let their trust for a temporary occupant of the White House influence their judgment about what government in general should be allowed to do.
I think it is foolhardy to give government any power that you wouldn’t be perfectly happy to see your most hated political opponent wield. So for me, I think it’s perfectly fair to evaluate the President’s current proposal for a rather modest program of government-sponsored insurance as if it is subsidized, and not only subsidized but administered by a Health Insurance Czar in the model of Margaret Sanger. That means you can put me down as a “no.”
It would be unfair, not to mention uncivil, to accuse the President of actually proposing Sangercare, and so I don’t accuse him of that. But since government programs never die, it really doesn’t matter very much how this president views the program. It’s a bad idea for reasons that are even bigger and more important than he is.