Tuesday, March 23, 2010

ObamaCare and Wishful Thinking

Ideologies are complicated intellectual structures. They consist, among other things, in a more or less articulated ethical priorities and general theories about how political economies actually work. They usually have enough give in their intellectual joints to enable ideologues to maintain their general ethical and empirical convictions in the face of inconvenient facts without surrendering their intellectual integrity. That’s why ideological contests, like that between the American versions of liberalism and conservatism, can divide intellectually scrupulous people confronted by the same facts across generations. But they also nurture a lot of wishful thinking on the part of ideologues.

Consider Jon Chait’s words celebrating the passage of ObamaCare’s passage in the House:

“Historians will see this health care bill as a masterfully crafted piece of legislation. Obama and the Democrats managed to bring together most of the stakeholders and every single Senator in their party. The new law untangles the dysfunctionalities of the individual insurance market while fulfilling the political imperative of leaving the employer-provided system in place. Through determined advocacy, and against special interest opposition, they put into place numerous reforms to force efficiency into a wasteful system. They found hundreds of billions of dollars in payment offsets, a monumental task in itself. And they will bring economic and physical security to tens of millions of Americans who would otherwise risk seeing their lives torn apart. Health care experts for decades have bemoaned the impossibility of such reforms--the system is wasteful, but the very waste creates a powerful constituency for the status quo. Finally, the Democrats have begun to untangle the Gordian knot. It's a staggering political task and substantive achievement.”
It would be churlish to deny Chait his victory dance, especially when he's scrupulous enough to acknowlege that so sweeping a historical judgment is “ludicrously premature.” That he voices it anyway shows that, like nearly all liberals, he has a huge psychological investment in the success of ObamaCare. Under the circumstances, simple prudence dictates that liberals take the trouble to ask themselves whether having so much riding on ObamaCare inclines them to wishful thinking.

Chait’s on pretty solid ground when he observes that ObamaCare “will bring economic and physical security to tens of millions of Americans who would otherwise risk seeing their lives torn apart.” It’s hard to argue that lots of Americans who currently lack health insurance, or risk losing it when they lose their jobs and find themselves unable to secure new coverage for pre-existing conditions, won’t be much better off. If you ask me, that’s every bit the historic achievement that Chait thinks it is.

But take a look at the legislative process that generated ObamaCare, and will inevitably amend it over time. It hasn’t been pretty from anyone's perspective. How likely is it that such a legislative process could generate “a masterfully crafted piece of legislation” that operates over time not only to “untangle[] the dysfunctionalities of the individual insurance market” but to “force efficiency into a wasteful [healthcare delivery] system”?

That something you can believe only insofar as you’re prepared to say that our political system normally operates as an efficient and equitable allocative and distributive mechanism. But isn’t the process that gave us ObamaCare the one that liberals have been railing against for the last six months because it affords minority political parties special interests too much power? Isn’t that more or less the same process that, according to liberals, kept us from socializing the risks and costs associated with healthcare for the last fifty years? Does anyone really believe that the procedural innovations and the relaxed inhibitions about buying votes associated with the passage of ObamaCare have made it more likely to generate equitable and efficient results in the future?

Nothing should worry liberals more than the difficulty they’re having getting their story straight in this respect.

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