Giuliani, McCain, Romney, Huckabee, and Thompson are all opposed to health care reform measures that incorporate universal coverage. Tax breaks, high deductible plans, consumerism – all are fine, but no GOP presidential candidates support universal coverage.
Why not?
A majority of registered Republicans favor universal coverage, and given the tightness of the race, one would think at least one of the candidates would jump on the chance to separate himself from the rest.
The failure to grasp the universal coverage plank looks to be a missed opportunity – if a majority of potential primary voters back an idea that is noticeably absent from any candidate’s platform, voter support for universal coverage may well increase if a candidate actually talks about it (and for that candidate as well). Again, why aren’t they?
I understand why social conservatives bristle at the idea, but economic and religious conservatives would likely favor reform measures that include universal coverage
Economic conservatives, firm believers in globalization and competitive markets, should see US companies as hamstrung by high health care costs, both legacy and ongoing. These employer-borne costs reduce the capital available for product development, infrastructure, and training. In a global market, US firms have much higher costs than their foreign competitors – costs that reduce their ability to compete. One of the core drivers of US health care costs, our demonstrated inability to effectively manage chronic conditions, not only drives up direct costs but reduces productivity – a child’s acute asthma attack means mom or dad (in two parent households) stays home from work; depression is a significant cause of absenteeism. Therefore it only makes sense that economic conservatives would want, and work for, health care reform that reduces US health care costs while improving productivity (effective management of chronic conditions would dramatically reduce total costs).
My sense is religious conservatives would want to help others, to aid the poor and the sick and the less fortunate. While I’m no student of the Bible, my recollection from years of Catholic school and Sunday school is the good book is replete with stories about healing the sick and making the lame walk, and requests, demands, and exhortations to ‘do unto others’. I’ll accept that this is not, strictly speaking, a call for an end to medical underwriting and beginning of universal coverage. It does strike me that these values and messages are a strong argument for universal coverage.
That leaves social conservatives (I realize there is a good bit of overlap here with religious conservatives). This group looks to be uninterested for good reason – they have other priorities. Abortion, school prayer, the Second Amendment, rights for homosexuals, illegal immigration, and American exceptionalism are all further up the list of concerns than health care reform. That, coupled with an instinctive distrust of government leaves little room for health care reform – and little trust in advocates thereof.
That still leaves two large and highly influential groups of conservatives that, I would argue, have reason to favor universal coverage models of reform. Why aren’t they more vocal?
Perhaps it is the traditional conservative opposition to any form of bureaucratic control or oversight. Bureaucracies, whether public (CMS) or private (health plans) are anathema to many conservatives who just want to be left alone. Applied to health care, this translates to a desire for individual control over, and responsibility for, decisions and outcomes. The CDHP movement requires individuals to take and maintain an active role in, and overall authority over, their health care. Conservatives believe it is the individual’s responsibility to decide whether or not they want to buy insurance, fund their HSA account, evaluate providers, discuss prices and determine the course of treatment. And to a large extent suffer the consequences of bad choices.
Sure, there are significant inherent issues with this individual focus, (low personal income means little or no money available to fund the deductible account; lack of usable data re provider performance; inherent problems with paper medical records; lack of access to insurance for those with pre-existing conditions), but these ‘problems’, while visible to and understood by conservatives, are more than outweighed by conservatives’ commitment to individual responsibility.
Conservatives also trust that the free market will develop solutions to these ‘problems’: they have a deep-seated belief that intelligent, motivated entrepreneurs will figure out how to fix the ‘system’ if they are given free rein (or perhaps ‘reign?’) to do so. Ending onerous regulations, opening markets and eliminating mandates allows business people to focus on fixing the core problem without the bother of complying with endless bureaucratic red tape and fear of lawsuits.
I do not get the impression that most conservatives are in favor of a completely unregulated market – few want to abandon the FDA, insurance licensing and capital requirements, physician certification processes, NASI, or Medicare. So they aren’t libertarians, but they do appear to favor less governmental intervention, specifically in the form of mandated universal coverage, than the general population.
But these realities don’t prevent any of the candidates developing a uniquely conservative approach to universal coverage – one that is more than a mishmash of tax breaks and paeans to the free market.
Or perhaps it is just the product of misunderstanding. As an example, conservative writer David Frum, speaking on yesterday’s Bob Edwards Show on XM’s Public Radio, said words to the effect that Democratic voters are generally in favor of a European or Canadian-style single payer system. I asked (via email) Mr. Frum for a citation, and to his credit he noted that he did not intend to say what I think I heard. But, and this is the ‘big but’, the disclaimer was in an email to me, while the interview was heard by lots of folks on XM.
Again, majority of registered Republicans favor universal coverage…in fact there is essentially no difference among Republicans and all Americans – both favor, by slim majorities, universal coverage.
The net is this – the GOP’s candidates are out of touch with the electorate.
It isn’t the voters who are not in favor of universal coverage, its the GOP candidates.
Outstanding analysis, and some interesting speculation on the rationales of the various conservative factions. I’m just as perplexed over conservative opposition to universal coverage.
For the business conservatives in particular I can’t understand the objection. Indeed, why aren’t they the greatest proponents of all?
Moving 47 million uninsured Americans into full coverage represents the biggest business growth opportunity the healthcare industry has ever seen. It’s bigger, even, than original Medicare, which brought in 20 million seniors in 1965. Though this was not private insurance, it certainly boosted the paydays of doctors and hospitals around the country.
It’s bigger than Part D, which brought new dollars to insurers, pharmacies, drug makers, doctors and hospitals, and was offered to 42 million seniors (though only 38 million took it up, since it was voluntary).
47 million new customers, whom the government guarantees will be paying customers. And the GOP says, in effect, “your money’s no good here.”
I don’t get it. I just don’t get it.
Joe,
Well as you can guess from past comments I’m a conservative and I’d like to take a stab at your argument here. First off, I doubt seriously that the study you cite was accurate. Conservatives have learned the hard way over the years to doubt polls in general because they can be skewed so easily (ie. how was the question asked)?
In general it is not, as Rick suggests, that the GOP is telling folks that their money is no good. The fact is more that universal healthcare, like any government mandated program, is contrary to the belief of Conservatives, and truthfully contrary to the intent of the founding fathers. What has been totally removed is the concept of personal responsibility, and liberty to choose.
Perhaps it would aid your understanding to go back and read some of the political writings of deTocqueville and his concepts of the state that provides for all the needs of it citizenry. He does a good job of pointing out the error that this path takes. Perhaps also a basic understanding of the founding fathers of the United States (I suggest the Federalist Papers) to see how the concepts of Liberty, Choice, and Rights were ingrained in the process.
Our opposition is philisophical, and our answer is this; let the market come up with an answer, incentivize the market to present the solution. Address the abuses (i.e. tort reform) and even pass laws like Massachusetts did that says everyone must have coverage (I can live with that) but let the market find the right mix – not government.
“Address the abuses (i.e. tort reform)”
You wrote a well-reasoned, polite post, so I’ll be nice in kind. But I think you were looking for “e.g.”, not “i.e.” One place where progressives and conservatives seem to disagree is what constitutes abuse of the current system. To the conservative, it seems to begin and end with torts and medical malpractice.
To the progressive, there is abuse at every single stop along the delivery chain. DME suppliers, doctors, hospitals, insurers, and the government are all gouging each other and the result is that all of us are paying for it. Either in higher premiums, higher taxes, or with our lives.
To progressives, this is unacceptable. To conservatives, it’s just good business. To me, that’s where the biggest problem lies. I’m not sure if the free-market is going to fix it, either. It feels like the Wild West as it is. Maybe some government oversight with some teeth will do us some good.
A great eye-opener regarding universal health care is a video called Dead Meat. You can see it here: http://onthefencefilms.com/video/deadmeat/
Actually ‘dead meat’ refers to a socialized system, not a universal mandate.
And many of the claims in that ‘film’ have been debunked here, by Matt Holt, and others.
The ‘film’ is not factual nor is it accurate.
Excellent commentary, as usual, Joe.
Thanks for the “tri-furcation” of conservatism into the 3 camps, which is an
important distinction that more people, including all conservatives and the Rep
candidates, need to understand. –Otherwise, the Dem candidates could pick up
economic & religious voters who rate universal coverage high on their lists with
skillful communication of the right plan.
Any thoughtful person on the issue of health insurance knows that you need universal coverage. Also, every thoughful person knows that it is impossible to get there without very heavy government subsidies or penalties. You can’t provide the necessary subsidies without a big new revenue source. Conservatives are not for that.
You can’t put in the necessary penalties because the liberals would never permit it. For example, putting a substantial tax penalty on the individual who does not obey the mandate (not the weak mandate that Massachusetts put in). Something that taxes the individual at close to the cost of the coverage.
Unless you have one of these mechanisms in place it does not make sense to call for universal coverage for the simple fact you will never achieve your goal.
I think most conservatives view things in practical terms. Liberals view things in theoretical terms. Practical people don’t propose things that won’t work even if they are theoretically correct.
“You can’t provide the necessary subsidies without a big new revenue source. Conservatives are not for that.”
It’s not about a new revenue source: conservatives (as most Americans) are not for the increased tax burden. But many fail to realize there is already a financial weight in the form of healthcare costs paid out-of-pocket or through employers.
It’s funny that people freak out with the concept of universal healthcare or coverage, and call it “socialism”, “imposing taxation”. Yet we all already do it with the school system for example.
This is fascinating, and demonstrates our findings from our market survey research in Iowa and Washington. We have statistically valid data now from these two very different states. They clearly show that the majority of Americans want universal coverage.
In WA 64% of the Republicans, 81% of the Democrats and 70% of the independents said we must assure everyone is covered. In Iowa, 54% of the Republicans agreed we needed to cover everyone, and 86% of the Democrats, and 73% of the independents.
We have not yet posted this data, but we have the Iowa report on line and Washington data, the comparative data and the party data will go online next week.
Clearly the candidates are out of touch with what the people want.
We will also post next week what the people want from our findings and what the candidates are proposing. It is not a pretty picture.
Cheers and more later. Kathleen
conservatives sure belief in tax evasion…and stealing from the american people in silly non winable wars…all to line their pockets…and of course bail-outs for the top 1% after conservative behinds messed up anything they ever lay a hand on…so conservatives want free market no constrains and after they stole and speculated..and ruined the country they want socialism and hand outs from the people ie.. bail outs…thats sooooo republican lol