Why can there be no compromise on health care?

Nancy Pelosi has stated in explicitly: any bill that does not include a government option cannot pass the House. Howard Dean says that true reform of health care requires a government option. The question is why a larger role by government is deemed essential by ideological liberals. the main reason is fear that the compromise might work, and that would upset their larger agenda for government control.

We have a good idea what Republicans want. Republicans uniformly favor tort reform, which is estimated to account for 10% of the direct costs of health care, and as much as 20% more in the form of unnecessary tests and procedures done to fend off potential future lawsuits. Republicans favor laws that would eliminate health insurance companies refusing to accept customers with pre-existing conditions and dropping coverage on customers who develop expensive illnesses. Republicans favor changing the laws that prohibit insurance companies from doing business across state lines, which results in some areas having health insurance unavailable.

There are certain legal obstacles to the sale of high-deductible health insurance which Republicans would like to remove. This would serve the presently-estimated 22 million who can afford insurance, but don’t get it because they choose to take their chances. Many might get a catastrophic health insurance policy as a compromise.

There are 47 million uninsured, but after subtracting illegal aliens, those who make over $75,000 but elect not to purchase health insurance, and those who qualify for Medicaid but haven’t applied because they are not sick, there are about 12 million who need support in obtaining health insurance. Senator DeMint has proposed legislation that would give a $5000 voucher for the purchase of health care to each of these individuals. The total cost would be about half of what Democrats claim their program would cost, and if tort reform could be accomplished overall health costs would still drop.

Incidentally, illegal aliens should be insured by their employers. The costs would then be passed along to consumers. So, for example, people who buy vegetables and rent hotel rooms would pay the true costs of labor in the agriculture and hospitality industries. This is fair. It ought to be a part of health care legislation.

It’s not clear how many Republicans would sign on to DeMint’s legislation, but it indicates an area where a compromise is possible. Other Republicans have advocated cooperatives as a mechanism for providing insurance, but here is a question as to whether cooperatives would end up as just a proxy for government. It’s nonetheless in the area of compromise.

Why are Pelosi, Dean, and their ilk unwilling to discuss legislative approaches that seem to have a good chance for success? I think there are at least three reasons.

First is that the more or less obvious improvements, like allowing competition across state lines and denying exclusion for pre-existing conditions, are held hostage to what they perceive as the greater goal of expanding government involvement and control. They claim that the obvious improvement can only be obtained as part of the larger package that presages government involvement. As opposition to government involvement grows, they have changed “health care reform” into “insurance reform” and played up the obvious improvements as the centerpiece of the legislation. In fact, since Republicans have already introduced the legislation, they could be swiftly enacted if the Democrats desired.

Second, tort reform is not in the Democrat’s package, even thought it would pay for the uninsured, because trial lawyers are the top group of contributors to the Party. Give credit to Howard Dean for acknowledging this fact. When you work the numbers, health insurance company profits are about 1% of health care costs, and they earn those profits by administering stiff fraud prevention programs and introducing genuine efficiencies. However, tort reform may represent 30% of costs, but it is untouchable due to Democratic special interests.

Third, radicals having the gnawing doubt that a compromise might work so well that their demands for revolutionary change would no longer have an audience. This is the larger agenda in holding obvious improvements hostage to grander schemes. The radicals fears are well-founded. Incremental improvements are likely to provide good results, and that might well lead to additional incremental improvements.

For leftists, security for the country as a whole comes from the power of a liberal elite to rule. Bureaucrats handle the details. For rightists, security comes from national wealth. Free markets handle the details. That makes seizing power the top item on the leftist agenda, for if the chosen elite rules then problems will be solved by the elite, and the rest of us need not be concerned with what they are going to do. For right-wingers, security is achieved by making the nation prosperous, and doing that is the top agenda item. We see these priorities played out in the health care debate.

Conservatism is the doctrine of evolutionary change. Small changes expose weaknesses before they are institutionalized, so the errors can be undone. Leftists do not like to compromise precisely because incremental change works, and it defeats their agenda.

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One Comment on “Why can there be no compromise on health care?”

  1. defendyourrightsamerica Says:

    I agree: On this issue, with this administration, and this Congress, at this time, there can be no compromise.

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