Tuesday 23 March 2010

The dangers of demagoguery

David Frum writes thoughtfully on Obama's health care bill:
At the beginning of this process we made a strategic decision: unlike, say, Democrats in 2001 when President Bush proposed his first tax cut, we would make no deal with the administration. No negotiations, no compromise, nothing. We were going for all the marbles. This would be Obama’s Waterloo – just as healthcare was Clinton’s in 1994.

Only, the hardliners overlooked a few key facts: Obama was elected with 53% of the vote, not Clinton’s 42%. The liberal block within the Democratic congressional caucus is bigger and stronger than it was in 1993-94. And of course the Democrats also remember their history, and also remember the consequences of their 1994 failure.

This time, when we went for all the marbles, we ended with none.

Could a deal have been reached? Who knows? But we do know that the gap between this plan and traditional Republican ideas is not very big. The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan. It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994.


We followed the most radical voices in the party and the movement, and they led us to abject and irreversible defeat.

There were leaders who knew better, who would have liked to deal. But they were trapped. Conservative talkers on Fox and talk radio had whipped the Republican voting base into such a frenzy that deal-making was rendered impossible. How do you negotiate with somebody who wants to murder your grandmother? Or – more exactly – with somebody whom your voters have been persuaded to believe wants to murder their grandmother?

I’ve been on a soapbox for months now about the harm that our overheated talk is doing to us. Yes it mobilizes supporters – but by mobilizing them with hysterical accusations and pseudo-information, overheated talk has made it impossible for representatives to represent and elected leaders to lead. The real leaders are on TV and radio, and they have very different imperatives from people in government. Talk radio thrives on confrontation and recrimination. When Rush Limbaugh said that he wanted President Obama to fail, he was intelligently explaining his own interests. What he omitted to say – but what is equally true – is that he also wants Republicans to fail. If Republicans succeed – if they govern successfully in office and negotiate attractive compromises out of office – Rush’s listeners get less angry. And if they are less angry, they listen to the radio less, and hear fewer ads for Sleepnumber beds.

So today’s defeat for free-market economics and Republican values is a huge win for the conservative entertainment industry. Their listeners and viewers will now be even more enraged, even more frustrated, even more disappointed in everybody except the responsibility-free talkers on television and radio. For them, it’s mission accomplished. For the cause they purport to represent, it’s Waterloo all right: ours.
(emphasis added)

If the analysis I've seen on the bill is right, it's a bit depressing. The best coverage combination - pay for things yourself by negotiating prices while carrying coverage for catastrophic care - is now illegal in the United States. Although, of course, we could just have achieved that via a sneakier route: the $2000/year fine for having no insurance coverage effectively being the premium for catastrophic coverage. Then, buy the insurance once you've discovered that you need something costly.

It's also interesting that the Stupak Amendment, which I'd thought might well kill the deal, was artfully negotiated around by Obama promising that money from the bill wouldn't be used for abortions.

It's a lot easier to stay calm about the Americans doing harm to their health care system when you're a thirteen hour flight away.

The government health care system here provides quality of service probably only slightly worse than Medicaid in the States (my estimate: better than Medicaid on the small stuff, worse on cancer treatment); high deductible catastrophic care insurance is cheap ($100/month for the three of us); paying privately for regularly scheduled maintenance is relatively cheap and simple.

The real downside in New Zealand is that we benefit greatly by free-riding on American medical innovations. As costs balloon under the new US system and eventual cost-control mechanisms knock innovation back a few pegs, we'll have a harder time doing that.

But Frum's right. It's a shame that the monster-shouters formed the negotiating bottom line rather than the opening position.


  1. Frum's post is shallow.

    The GOP took the right position, albeit for the wrong reasons. Had they "compromised" they would have simply have been willing accomplices in the takeover of what's left of our private health care system. It doesn't matter that this bill resembles one that two Senators Chafee proposed, or the one in Massachusetts that Mitt Romney still deludes himself into believing is "conservative." There is nothing moral about forcing people to purchase health insurance using the tax code as a gun. Where the GOP failed, if at all, is by not being forceful enough. They should have proposed real reductions in Medicare spending, rather than hypocritically decrying government health care while opposing Medicare cuts. They shouldn't have ceded the moral argument that it is somehow necessary to guarantee coverage.

  2. @Mo: if they'd had the numbers to stop it, I'd be with you. But they didn't.

    Guess that makes me more a consequentialist. Faced with the trolley car problem, I'd pull the lever even if it's immoral to kill the one guy.

    Totally agree that they should have proposed a more sensible alternative with real spending controls. But that would have been tough for them. Best Krugman post of the last year asked the GOP to put up or shut up on that question: he was right.