Health Reform: GOP Must Offer More than "No"
So far the entire Republican position on healthcare has seemed to be reflexive opposition to whatever the Democrats are doing – and not just opposition, but opposition from the left! Basically, just scaring the seniors with the prospect of Medicare cuts (especially in the area of hugely expensive futile care in the last days of a person’s life) and spreading feminist propaganda (“women-focused cancers are seemingly receiving substandard attention” – yep, that’s Sarah Palin, not Gloria Steinem: ). But what does the GOP actually have to offer?
Normally, of course, conservatives defend the status quo. But the status quo is indefensible! And it’s only going to get worse. Medical costs are growing fast and will continue to grow (as people live longer while using more of the new wonderful – and expensive! – treatments), the number of people with chronic conditions is growing and their costs are skyrocketing, and in the meantime genetic tests, other medical tests, mathematical models (my professional subject) and other methods allow us to predict individual risks more and more accurately.
We keep hearing that we should maintain our conservative principles. But what exactly do our principles require us to do on healthcare? Let’s consider a hypothetical situation which is going to happen more and more often in coming years. Suppose, prenatal genetic tests show that while the child is likely to be born healthy, adulthood is going to be a different story – the individual is very likely to develop some incurable chronic condition at a relatively young age. Suppose further that the condition is quite debilitating if untreated, but can be easily managed (allowing the patient to lead a virtually normal life), albeit not cheaply – say, at the cost of $2,000 a month. Suppose finally that the same tests also show that the individual will probably have mediocre cognitive, artistic, athletic and other abilities and thus will be unlikely to earn more than, say, $3,000 a month. What exactly can we suggest without violating our principles? Obviously, abortion would be a grave violation of our pro-life principles, and I hope that even pro-choicers would be appalled by such a Spartan-style “solution”. If the parents have a modest income and other children, they are not going to be able to leave enough money to provide for that child lifetime’s healthcare. That individual will be able to save only very little before the onset of the disease, and afterwards pay as you go will be just unaffordable (while not getting treatment will be just as unaffordable since in that case the individual will not only suffer, but also will be unable to work and earn a living!). So what’s that individual to do? Meticulously maintain health insurance since the early age in order to circumvent restrictions on pre-existing conditions? But a disease triggering gene variant is in itself a pre-existing condition! In a truly free market insurance companies will, of course, be aware of known risks and will price them into the premiums. Denying health insurers access to medical records is akin to denying auto insurers access to driving records or denying lenders access to credit histories (yes, there’s a moral difference, since unlike genetic composition, driving record and credit history are based on behavior – but what matters in a free market is risk assessment, not blame assignment). Mandating some form of “community pricing” (i.e. ordering insurance companies to disregard individual risks) may be a solution (although young people with “healthy” genes will quickly figure out that their premiums are absolutely not commensurate with their risks and will then be hesitant to buy insurance), but it’s definitely not a free market solution – it’s the government clandestinely forcing some people to pay for other people. A more honest thing would be for the government to tax people openly and spend money on treatments for those who can’t afford them. But that would mean creating new government programs or expanding the existing ones (while probably raising taxes!), and conservatives can’t stand for that, right? (just ask the Club for Growth!)
So, what are we to do with that hypothetical individual? The only thing I can think of that does not violate any conservative principles articulated by various conservative spokesmen over the past couple of years is to do nothing (as far as the government is concerned) and hope that some private charity will pick up the tab. This approach might actually work (and in an ideal world I would in fact prefer it). But the inconvenient (for the purists) fact is that in the here and now we have to sell this (or any other) approach to the majority of voters. I’m afraid that as the number of people struggling with expensive chronic conditions grows, the “let them beg” answer is not only going to be unacceptable to a significant number of independents, but also even to significant segments of the Republican base, such as many evangelicals who are primarily motivated by social conservatism but are not very keen on free markets and are in fact quite sympathetic to “compassionate conservatism” (Exhibit A: Mike Huckabee). And, of course, if Republicans don’t offer convincing answers, the voters will turn to the Democrats.