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A progressive win, but not a conservative loss

A couple wags wondered how I could simultaneously say health-care reform is a big win for progressives while suggesting it's anything less than an unmitigated disaster for conservatives. It's because I don't think this is zero-sum -- at least philosophically.

The big win for progressives is covering the uninsured. Whether that coverage is public or private is a secondary (which is not the same as saying unimportant) concern. The reverse goes for conservatives. Covering the uninsured is not a loss for them. But if the vehicle for covering the uninsured was the nationalization of the insurance sector, that would've been. That didn't happen. Instead, we entrench the private-insurance sector (conservative!) while imposing some new regulations to curb its worst abuses in the individual and small group markets (liberal!), and attempt to move toward a universal health-care system that retains a for-profit insurance industry. We are nearly alone among industrialized nations in attempting that trick.

I actually think that's a big win for conservatives, though partisan passions on both sides have obscured it. But nevertheless, it's not necessarily the case that progressive and conservative interests are always and everywhere diametrically opposed. It's somewhat more true that Democratic and Republican electoral interests are diametrically opposed, and I've been clear in my belief that electoral concerns are driving this division much more directly than philosophical concerns.

By Ezra Klein  |  March 9, 2010; 12:31 PM ET
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I'm sorry to come here to the Ezra Klein Institute and inject partisan politics, but at the end of the day we're talking about a nearly $1T commitment of the US government to healthcare benefits for people who cannot afford them today, and even more importantly a permanent entitlement that will lead to universal health care coverage.

Ronald Reagan, Barry Goldwater, William F Buckley and every other conservative that have fought this throughout the 20th century up until this day will have once and for all been beaten, and every time from this day forward some right-wing candidate says he's for "reducing the size of government" he'll face an avalanche of attacks for wanting to let people go back to dying in this country without health care.

Can you imagine a bigger defeat for the small government conservative movement??

Posted by: zeppelin003 | March 9, 2010 12:41 PM | Report abuse

I would imagine that both sides of the arguement are assuming that HCR won't remain in its current form in the long run which is why they can't agree that enacting what we currently have benefits them both. I don't think either side really wants it to remain as it is either. Progressives are hoping this is just the first step which will eventually lead to "Medicare for Everyone," which conservatives are fighting against.

Posted by: saratogian | March 9, 2010 12:46 PM | Report abuse

When the government is regulating every parameter of the private insurance's business model, they are simply subcontractors of a federally run healthcare, making the rates they collect (which are monitored by IRS) nothing but taxes.

What is conservative about that? This is single-payer, exactly as progressives wanted. Don't worry about the CEO salary or share-holder payouts. They won't last for long.

Posted by: FastEddieO007 | March 9, 2010 12:47 PM | Report abuse

The other comments here leave me puzzled, but I have to say that anyone who doesn't accept your latter point is seriously deluded.

Posted by: ctnickel | March 9, 2010 12:53 PM | Report abuse

Ezra's point here would only be rational if once this bill passed, no other health care legislation ever came before the Congress. If you believe that, I'll sell you the Pacific Coast Highway for $5.

This health care bill is like the Allied forces finally storming the beaches of Normandy in 1941. Once the federal government seizes regulatory control of the health insurance business, they will squeeze out of it any profit whatsoever to rein in costs, medicare reimbursements will be grossed up in this sort of "doc fix" kind of stuff, and these meager subsidies will be royally expanded as time goes on, probably in a future Republican Congress.

And you know what? I have no problem with that at all, this will crowd out the defense budget and so be it. I cant stand the defense budget!!!

Posted by: zeppelin003 | March 9, 2010 1:23 PM | Report abuse

The whole deal seems to me like a loss for conservatives.

- There is a new healthcare entitlement.
- There doesn't appear to be much chance that reform will control cost growth.
- Increased use of comprehensive coverage, which further insulates the end consumer from cost pressures.
- Massive increase in implicit marginal tax rates across broad swaths of the middle class, which will increase with health costs.
- Lots of government regulation and new taxes.
- Small government conservatives aren't going to be excited about having to buy a service or pay a tax penalty, however much sense the policy might make.
- Concerns that more liberal add-ons to this program will occur in the future, and once entrenched it will be impossible to take away.

On the plus side, conservatives get:

- According to CBO, this will reduce the deficit.
- No single payer.
- Excise tax , maybe.

On the first benefit, lots of conservatives simply just don't trust the CBO's projections. They look at the projections for Medicare spending, look at the relative lack of cost control and note increased cost insulation for those who want health care services and are skeptical. It is not as if there is a mechanism to limit subsidies to a certain level if the CBO was wrong - if it is wrong, there is another entitlement bomb to worry about.

I'm not sure conservatives are necessarily always against single payer, but rather they oppose comprehensive single payer. Milton Friedman was for universal catastrophic coverage, and if part of the deal was government administration of said coverage he might well have taken it.

As for the excise tax, unions (which conservatives don't much like) get a free pass from it, the implementation is delayed and the tax itself is getting watered down. Not encouraging from a conservative perspective.

Posted by: justin84 | March 9, 2010 1:31 PM | Report abuse

zeppelin003....Exactly. That is what Chavez, Khameni, and Putin are all betting on. Pretty safe bet.

Progressive Utopia!

Posted by: FastEddieO007 | March 9, 2010 1:31 PM | Report abuse

OK, so maybe I'm a wag. But my point wasn't so much that you were saying two things, I was responding yesterday to your complaint about the framing of this. I added that you had contributed to the framing of it as a conservative win, non-loss, whatever.

I think politically it is a win for conservatives. And to the extent that this is not a radical bill, in my view, it is a win on the substance as well. But let's face it: all in all, this is a loss for conservatives, at least those purists who believe we need less government intervention in health care. I don't subscribe to it, but they have an honest view that we need to be turning away from the status quo and towards the free market, rather than building on the status quo. (Again, let me EMPHASIZE, I don't agree with conservatives on it.) So, having said all of that, I think Ezra is trying to frame this as way more of a substantive plus for conservatives than it is. It is a substantive loss and a political win.

Posted by: gocowboys | March 9, 2010 1:34 PM | Report abuse

Wrong. It's a bad bill from a fiscal conservative perspective. On the other hand, it's a great bill from a Compassionate Conservative (spend, don't pay perspective)...deficit neutral is not good enough.

Posted by: staticvars | March 9, 2010 1:45 PM | Report abuse

Additionally, lets be clear that the "small government conservative movement" doesn't really exist, at least not as a political force. That battle over government provided health care was lost with Medicare/Medicaid. The most liberal parts of this bill just expand on those foundations, that the government does have a roll to play in funding the health care of its citizens.

Posted by: etdean1 | March 9, 2010 1:58 PM | Report abuse

"That didn't happen. Instead, we entrench the private-insurance sector (conservative!)..."

Never, ever, believe a moonbat like Klein defining what is a conservative or conservatism. What they'll say is a lie.

Posted by: steve_tsouloufis | March 9, 2010 5:38 PM | Report abuse

zeppelin003-- the $1T is fully paid for (and then some) within the health industry. That $1T will be passed mainly to the middle class. As it stands, costs for the uninsured are now maostly borne by progressive income taxes, with the individual, the provider, and the hospital all taking a hit. This bill is not progressive.

Posted by: bmull | March 9, 2010 6:44 PM | Report abuse

--"Instead, we entrench the private-insurance sector (conservative!)"--

What a joke, you propagandizing pansy. You were roundly thrashed in the blogosphere yesterday, and you come back with that nonsense. I bet even you are beginning to smell the rot of your own disgrace.

Posted by: msoja | March 10, 2010 12:45 AM | Report abuse

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