Politics is rarely about maximizing the good. The vast preponderance of the time, it’s about minimizing the bad. That’s why I decided in March, after months of vigorous opposition on ideological and philosophic grounds, to support the ideas behind the individual mandate to purchase health insurance.
Not for a second do I believe this policy is the best in terms of incentivizing economically sound behavior or controlling costs across the system. It isn’t, and it won’t. Putting everyone on insurance will most likely continue the creeping increases in cost (which grossly surpass inflation) that have plagued our healthcare system for decades. My world view believes that the best way to control cost is to put that cost directly in the hands of those most impacted by the ability to make choices about their care; consumers. I remain a believer in that idea.
The ultimate problem is that we are no longer discussing this problem in real terms. My political allies speak of things such as individualism and the local togetherness of communities. We love to wax on about soup suppers to fundraise for the sick and neighbors taking care of their own. As someone who grew up in such a community, I can attest to the reality of these stories. They can and do make a meaningful impact on people’s lives.
Unfortunately, as is so well documented in Charles Murray’s latest book, “Coming Apart: The State of White America, 1960-2010,” that America is vanishing before our eyes. With the exception of the upper class and surviving rural and lower class communities, which have resisted such collapse, the America we speak of is disappearing. That’s not a “woe me” statement. It’s empirical fact. The institution of marriage is disintegrating. Social capital is a thing of the past. The very communities we cherish are losing the cohesion and solidarity that makes them so valuable to American life.
If this were 1960, I would vigorously oppose the mandate and related government creep. Unfortunately, as I’ve had to remind my political friends so frequently over the past few years, it’s not. We must adjust our policy options to face that reality.
That means confronting the fact that Americans demand access to care. Our option is no longer to sit on our hands. We are then left with using the state to provide access to care or utilizing markets. That means single-payer (or some variant of it) or forcing markets to provide insurance to all. The latter is hardly ideal, but if you share my general world-view, it’s far better than universal care.
So there. I hate the fact that our society has degraded to the point where we must have this discussion, but we can’t pretend that it hasn’t. As much as I prefer Murray’s cardinal virtues that separate America from other industrialized democracies, those don’t mean what they once did.