COLUMBUS, Ohio — Imagine a young father stepping into the street. He is alert and conscientious. Then, a government truck speeds around the corner. The man lunges out of the way, but it’s too late: The truck runs him over, causing serious injury. Absent government misconduct, the man would have been just fine.
While the primary effect of the government’s conduct is an injured man, there are significant secondary consequences. His children will lose his emotional comfort and financial support. His neighborhood loses a valued contributor to its social fabric. His employer must find at least a temporary replacement for the man’s labor.
This scenario is a simplistic version of how many conservatives view the health care market. According to them, there was a time when the market worked reasonably well: Providers competed to offer quality services and consumers shopped around, curbing prices. Then the government, with its mandates and subsidies and regulations, wounded the market, driving up costs and decreasing quality. Everyone — the poor and elderly, the businesses — lost something significant.
I happen to be a conservative, but one need not accept the right’s theories wholesale to acknowledge the sometimes negative effects of government action on health care. The regulatory approach of the Food and Drug Administration and the Patent and Trademark Office has driven up the costs of generic drugs. The subsidy for employer-sponsored coverage has tethered health care to employment in a way that virtually no economist endorses.
Even the most committed progressive would have to admit that the government has injured American health care — just as the reckless government truck injured our young father.
That raises an obvious question: How do we fix health care? A patient bleeding on the pavement requires some plan for medical intervention.
The conservative policy world has offered a number of ideas, but elected Republicans have failed to coalesce around any particular strategy. And this is because they’re unable to accept that the government must play a role in paying to solve this problem. It’s tough to endorse a universal catastrophic coverage plan, for instance, when much of your caucus cares only about cutting government spending on health care.
This is where the Republican Party hits an ideological barrier that it simply must power through before meaningful reform can happen. Yes, solving problems can be expensive, and yes, that money always comes from taxpayers. But that’s true when a government truck plows into a pedestrian. You break it, you buy it, and the logic applies equally whether the broken thing is an individual or a complex marketplace.
This proposition didn’t use to be so controversial, at least among conservatism’s leading lights. In his illuminating analysis of Ronald Reagan’s legacy, The Working Class Republican: Ronald Reagan and the Return of Blue-Collar Conservatism, political scientist Henry Olsen uncovered some timely insights. “Any person in the United States,” Reagan said in 1961, “who requires medical attention and cannot provide it for himself should have it provided for him.”
These sentiments conflict with recent iterations of Republican health care reform. The “full repeal” bill is nothing of the sort — it preserves the regulatory structure of Obamacare but withdraws its supports for the poor. The House version of replacement would transfer many from Medicaid to the private market, but it doesn’t ensure that those transferred can meaningfully purchase care in that market. The Senate bill offers a bit more to the needy but still leaves many unable to pay for basic services.
In the rosiest projections of each version, millions will be unable to pay for basic health care. This wasn’t acceptable to Reagan in 1961, and it shouldn’t be acceptable to his political heirs.
It is true, as Republicans argue, that health care costs too much. And it is also true that Obamacare has failed to take care of this problem. But if Republicans fail to accept some baseline provision of care, we’ll find ourselves mired in internal contradictions — arguing, for instance, that a bill that cuts subsidies for the poor somehow makes care more accessible. We’ll rail against the way the government has destroyed our health care market in one breath and resist the support offered to the poor and middle class to navigate this brokenness with the other.
This is not conservative; it is incoherence masquerading as ideological purity.
Many problems — the monopolization of provider networks, a regulatory framework that forces Americans to overpay for generic drugs — require both a positive Republican vision and a more robust majority to carry it out.
But devising that vision is impossible when we refuse to accept that the government bears some financial responsibility in solving a problem it helped create.
J.D. Vance is the author of “Hillbilly Elegy.” Twitter: @JDVance1
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