A Government Takeover of Healthcare?

So, I often get myself in trouble for ascribing  unflattering motivations to people with whom I disagree. But I come upon that honestly, so to speak. I assumed that most people writing about public policy or international affairs are reasonable intelligent and well-informed, and thus when they make demonstrably false arguments or patently idiotic ones, I assume they must have some hidden agenda. In some ways that is the nicer assumption that the alternative, which is that they just don’t know what they are talking about.

Anyway, an example of this is the right-wing meme that the Affordable Care Act represents a “government takeover of health care” and that since health care will soon represent 20% of U.S. domestic GDP, that this represents a creeping form of socialism since the government will control such a large sector of the economy. This is, of course, an idiotic position. But are people making this argument ill-informed? Or just cynically playing political hardball? I really don’t know.

What’s interesting to me, though, is that even if we were to grant the premise, the reality is that killing ACA would do nothing to change the supposed problem.

First, regardless of whether ACA stays or goes, health care spending is certain to increase as a share of GDP. Whether you get to 20% of GDP in 2023 or 2025 or 2021, that is the trendline irrespective of ACA. Indeed, I often joke darkly that if current trends continue, our grandchildren will all be working in the health care field… well, except when they are getting treated. But treating and getting treated will be the sum-total of human activity in the United States come 2075ish.

Second, regardless of ACA, government expenditures on health care will continue to rise, remaining at the roughly 50% level of total health care spending. ACA increases the ratio slightly on one side — the increased subsidies — but decreases it (in theory) on the other by slowing the rate of growth of Medicare. But either way, roughly 50% of health care spending will be by the government under Medicare, Medicaid, the VA, and Tricare.

Third, despite the length of the bill, the footprint of ACA on health care is both smaller and lighter than existing programs. ACA is, in the final analysis, less socialist than Medicare or Medicaid or Tricare, and way less than the VA which is, in fact, the only real example of socialized medicine where you have not just a single payer, but a government provider. The case that ACA represents a government “takeover” of health care reflects, I guess, a notion that regulation is equivalent to ownership, or something. But of course, the reason a mandate and subsidy to private insurers first arose was an a direct alternative to a single payer plan. But note, even a single payer plan is not socialism. The modes of production remain in private hands, they just are paid by the government. Some may call this socialism. But by that logic, all government contracts are examples of socialism. Is the defense industry an example of socialism as well? But ACA isn’t even a single payer plan, it is a subsidy to individuals for them to buy private insurance which will then pay private health care providers. If that is socialism, then what is the VA?

See, the argument about government takeover is essentially one of control through regulation. But health care is already highly regulated. Indeed, the entire economy is subject to significant regulation. Call that socialism if you want, but then your problem isn’t with ACA, but with government regulation. And again, getting rid of ACA does nothing to get rid of that.

I get that some people see ACA as the straw that broke the camel’s back, but the reality is that getting rid of ACA does nothing to overturn the basic facts that (1) Health care expenditures will continue to rise, (2) the government share will remain at roughly 50% of those expenditures, and (3) that the entire health care sector is heavily regulated and impacted by government programs.

You want to fight socialized medicine? Well, go after the VA first, then Tricare, then Medicare and Medicaid. But going after the least socialized part of the system strikes me a weird place to focus one’s energies.

7 comments to A Government Takeover of Healthcare?

  • Well, in my view, we’ve covered this before: “The Republican Party has abandoned policy beliefs for resentment. … The GOP can support Keynesian stimulus, an uncheckable executive, cap and trade, the health insurance mandate, etc. when they’re in power, then literally weeks later decry their own policies as not merely unsound, but unconstitutional and indeed tyrannical.”

    Making points about the ACA vs. the VA and other programs completely misses the point of the exercise. It’s like saying, “wow, why are those Phillies fans so mad? That was clearly a strike.” Whether or not it was the right call doesn’t have anything to do with it. They’re mad because it didn’t help their side.

    Conservatism in the US today is an ever-shifting array of enemies onto whom conservatives project disdain. All that matters is the expression of scorn for outsiders– it’s the only way conservatives know who they are, given that they dropped any and all political convictions by the wayside sometime in the past 5-10 years.

    Hence the nonstop stream of “demonstrably false” and “patently idiotic” arguments. Chris Mooney pointed out that “better-educated Republicans were more skeptical of modern climate science than their less educated brethren. … For Democrats and Independents, the opposite was the case” on climate science and on nuclear power. Arguments like “government takeover” come neither from insincerity nor even exactly from ignorance– they come from the deep certainty that my team is awesome, so everything the other team does is bad and wrong. The ignorance follows from the tribalism.

    (This comes, I think, from the Southern Strategy. Pat Buchanan wrote in a memo to Pres. Nixon that a GOP effort to heighten whites’ resentment of blacks and of “the elitism and quasi-anti-Americanism of the National Democratic Party” would “cut the Democratic Party and country in half; my view is that we would have far the larger half.” In 1971, that was a tactical gambit. Today, it’s the alpha and the omega of Republican rhetoric, policy proposals, and legislative effort.)

    Bruce Bartlett argued about two years ago that the GOP is ”the greedy, sociopathic party” driven by an “ambition to retake power so that they can reward their lobbyist friends with more give-aways from the public purse.” I can’t see how he is in any way mistaken.

    Incidentally, as was pointed out at Seeking Alpha, “In 2007, the total spending for health care accounted for 16% of the country’s GDP, the highest share among the OECD and almost double the OECD average; On a per capita basis also the U.S. spent the highest with a total of $7,290 which is two-and-half times the OECD average; The public share of health care expenditure in the USA (45%) is less than any other OECD country”. So, we already have the freest health care system in the world… and we spend way way more, for not-any-better results. That’s why the pre-insane right tried to figure out a private-sector friendly way of reforming our deeply flawed system. That effort culminated in the ACA– which passed without a single Republican vote.

  • Yes, I agree with everything you’ve written. And yet, I’m not sure where one goes from there. Once we’ve called them out as sociopaths and liars, then what? How does that get us where we want to go? I admit, I go back and forth on this — between a desire to at least try to reason things out and an instinct to just call out lunacy and leave it at that.

  • atheist

    So, I often get myself in trouble for ascribing unflattering motivations to people with whom I disagree. But I come upon that honestly, so to speak. I assumed that most people writing about public policy or international affairs are reasonable intelligent and well-informed, and thus when they make demonstrably false arguments or patently idiotic ones, I assume they must have some hidden agenda. In some ways that is the nicer assumption that the alternative, which is that they just don’t know what they are talking about.

    What I don’t understand: why do people so resent having unflattering motivations ascribed to them? Why not simply try to disprove them? Do I really care what some random person on the internet thinks of my motivations? Of course not. So why get angry about it?

  • I think there’s definitely a place for this kind of post, factual debunkings of whatever the GOP’s lie of the day or month happens to be. I was just responding above to your “liars or ignoramuses?” question.

    As to what to do about it, well, that’s a pretty broad sociological question. It seems to me that there needs to be a more widespread recognition of the GOP’s behavior.

    Brad Delong wrote a response to Mann & Ornstein’s incontrovertible conclusion that “The Republicans Are the Problem”:

    Look. You two are expecting normal politics to rein in a Republican Party gone bonkers extreme. But it will not work. The press corps will continue to say “he said, she said, yadda yadda yadda” either because they are gutless cowards or because they are bought. In a world of low-information voters, the bonkers extremism and sheer total meanness of the Republican Party will not get through. The only way it could get through would be if moderate Republican barons were to announce that they had had enough and were crossing the aisle, and if they did so in a way that they brought their affinities with them. But I don’t see Brent Scowcroft doing that, I don’t see Colin Powell doing that, I don’t see Greg Mankiw doing that, I don’t see Marty Feldstein doing that, I don’t see Gail Wilensky doing that, I don’t see Bob Dole doing that, I don’t see Jack Danforth doing that, I don’t see Richard Lugar doing that– and I don’t see you doing that, Mr. Ornstein. I don’t see you calling for the defeat of every single Republican candidate this fall and every fall until the party comes back to reality. And since all of you moderate Republicans are unwilling to take the only step that might fix the situation on your side, we have to take the only step open to us: We have to stop bringing a set of policy proposals and briefing papers to what the Republican Party has made a thermonuclear exchange. We have to oppose their noise, slime, and lie machine with a noise, disinfectant, and truth machine of our own– and at the same intensity.

    I can’t see how that is wrong.

    The reason we care about the government is because it implements policies that affect people’s lives. The Republican Party doesn’t care about policy; therefore, they don’t care about America. Supporting Republicans is unpatriotic.

  • Yeah, but I’m reminded of old line about why you shouldn’t wrestle with a pig: “You’ll get dirty and he, sort of, likes it.”

    The GOP has a structural advantage in this situation. If they just make politics nasty, stupid, and pointless enough people will buy into their view of government as nasty, stupid, and pointless. But, of course, it is also true that trying to rise above it is a losing strategy.

    There is a certain perverse brilliance to an approach that claims government can’t work when wielded by people who have the capacity to make it difficult for government to work. It is evil, and yet undeniably a strategically advantageous position for them.

  • dckinder

    Mr. Finel, your logic is impeccable. But as you, yourself have noted, that avails nothing against those who have no interest in the truth. The people with whom you debate believe that they have theirs, Jack, so what the hell should they care. But this is not true, because of the economic crisis, now focused in Europe but spreading elsewhere. To them, perhaps you might say: “The North Wind doth blow, / And we shall have snow. / So what shall cock robin do then? “

  • Very true as to the GOP’s structural advantage. Departing GOP staffer Mike Lofgren pointed that out:

    A couple of years ago, a Republican committee staff director told me candidly (and proudly) what the method was to all this obstruction and disruption. Should Republicans succeed in obstructing the Senate from doing its job, it would further lower Congress’s generic favorability rating among the American people. By sabotaging the reputation of an institution of government, the party that is programmatically against government would come out the relative winner. A deeply cynical tactic, to be sure, but a psychologically insightful one that plays on the weaknesses both of the voting public and the news media. …

    Your point about pigs & mud is true, but we are where we are. Aging, pro-America Republicans like Bob Dole, George Bush Sr., Dick Lugar, and Brent Scowcroft aren’t standing up and calling out their party’s decay. So I don’t know how Brad Delong is wrong about the next step for people who like America, want it to do well, and care about reality.

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