Yesterday I argued that, when they’re disagreeing about health care policy, liberals and conservatives are usually arguing from a common premise: viz., that the health of one’s self and one’s loved ones is so important from everyone’s standpoint, that anyone is entitled as a matter of social justice, and should be entitled as a matter of law, to access minimally adequate health care. The meaning of the words I’ve italicized is sufficiently elastic to leave room for our seemingly unbridgeable ideological differences over health care policy.
Liberals spend most of their time talking about the redistributive implications of this premise; securing everyone’s access to adequate health care requires a significant redistribution of resources from richer and younger Americans to poorer and older Americans. That’s the rationale for the least popular features of ObamaCare like the individual mandate and the prospect that public cost control measures will deprive people of subsidies for treatments that might do them some good but aren’t cost-effective on a system-wide basis.
Conservatives spend most of their time worrying about the premise’s jurisdictional implications; if access to health care is so important from everyone’s standpoint, no one can reasonably delegate decisions with sufficiently serious implications for the health of himself and his loved ones to the sole discretion of government bureaucrats. That’s the worry behind conservative talk about “death panels.”
Neither side has been very forthright about the terms and conditions of the tradeoff it’s contemplating between security and autonomy within the health care system. Liberals usually don’t have anything to say about the jurisdictional implications of achieving universal health insurance coverage and aren’t above dispensing a little politically expedient disinformation (“you can keep your present policy if you like it”). Conservatives have virtually nothing to say about the redistributive implications of providing for the uninsured and pretend that a few market-based reforms (e.g., selling health insurance across state lines and tort reform) would automatically solve the problem.
Under the circumstances, the mere hint of intellectual honesty sounds positively incendiary. Here, for example, is Paul Krugman acknowledging that, from a liberal standpoint, “minimally adequate health care” does not mean that you won’t be denied subsidies for non-standard treatments that are life-prolonging and medically indicated in particular instances:
A comparably honest conservative might say something like this: you haven't been denied access to “minimally adequate health care” when unforeseen and uninsured medical expenses drive you out of the middle class and into Medicaid eligibility. That won’t happen very often, but it will happen sometimes and we can’t afford, and shouldn’t try, to guarantee that it won’t.
Don’t hold your breath waiting for lots of politicians and pundits to start saying such things. But it’s hard to imagine our reaching a political settlement about the health care system until they do.