One of the more hopeful but intermittently expressed premises of this blog is that great divides are rarely insurmountable natural features. Most are imaginary lines that only become impassible chasms when we believe in their power.
The story of human progress is based on individuals, then groups, then societies looking across a void and deciding they can cross. At some peril, perhaps — especially in the beginning — but not of perdition. I understand why people want to stay where they are. I only have a problem with that when they want to make the rest of us hang back, too.
So I parked my cynicism at the door to attend the Center of the American Experiment's event, which asked, "What Should Conservatives Push for This Legislative Session?" Neither policy wonk nor political operative, I wanted to listen and consider my own question: Is there any hope we can learn to play together? [An overview post on the event is here, and there's a further expansion here of Kramer's points. I may yet do a third on what panelists said about education.]
At different times, David Strom of the Taxpayers League and Joel Kramer of Growth & Justice made a similar point. We have been operating in a period where politics has primacy over principles — where ideology, not results, determines policy. Some ideologially based thinking was in evidence, but there were also a few bi-partisan nods of agreement.
Few of those nods occurred during the health care part of the discussion, however — evidence that the market-based/single-payer divide is not going away soon.
CAE's Mitch Pearlstein, noting the apparently widespread agreement that health care is an issue voters want addressed, asked if it might offer a bipartisan meeting ground. The answers were all over the map.
Strom: We have a complicated third-party-payer health care system that is the legacy of choices made in the 1940s where the patient benefits, the insuror buys and business pays. As a result, costs skyrocket and patient behavior is not impacted by any direct incentives. Adding more information and layers to this system can mean only modest improvement. The answer is to make the patient the ultimate consumer and not make it any harder for them to own their health care decisions. For example, make it easier for individuals who buy their own insurance to lower costs by purchasing across state lines. [Insurance is regulated by state. Presumably, companies can offer lower rates in states with less mandated coverage.]
Sean Kershaw (Citizens League): We have a market-based approach without a true market. Portability of insurance could unleash entrepreneurialism, because one of the major barriers to people making job changes is fear of losing health care benefits. [As an entrepreneur, I'd argue that greatest barrier to being successful is fear itself. But Kershaw is right — more would take the leap.] We could agree to reimburse for quality, but we don't have the data. [At least, consumers don't have the data.] Universal mental health care screening and insurance for kids. Let the market, not the legislature, guide medical facility expansion. [Kershaw has a post up at his blog, with links to some of the League's work on this issue.]
Dr. Karen Effrem (EdWatch): Don't increase the federal intrusion into privacy and health care, which both evidence-based medicine and shared medical records would do. Universal health coverage and mental screening for kids is a bad idea. Families, not government, should take care of our kids. [Effrem is a licensed physician who appears not to have practiced as a pediatrician beyond her training. She is the panelist Kershaw refers to in his post about the discussion.]
Tom Prichard (Minnesota Family Council): Ditto. Mandates sound good but don't work. Just look at auto insurance. We mandate it in Minnesota and yet about 14% of motorists don't have the required level of coverage. That raises the cost for the rest of us. [Prichard of all the panelists was the most one-dimensional and ideologically consistent; it's also his job to be. He may be all right preaching to the choir, but changing hearts, minds and policies in favor of marriage as a solution to social ills? Sorry, even if he has a reasonable point about the value of intact families, he's going to need state mandates before progressives sign up to his rigid definition of what makes a family.]
Kramer: Let's start with a definition of the result we want. Is it to have everyone insured? Or is the underlying goal the healthy longevity of the population? The answer will lead to the next question. Will money be better spent in public health and prevention or in medical care? A reasonable policy decision might be not to spend government dollars to reimburse costly procedures. Fund what works, not what fits your ideology. The Veteran's Administration, with its salaried physicians and government facilities, actually has the best health care results. [Yet Strom clearly believes the private model of integrative care represented by Mayo Clinic is superior and maintains that health care costs are high in part because government is the largest purchaser. Is that ideology speaking?]
I give Pearlstein points for the concept and keeping things moving along, but his choices of Effrem and Prichard played to his base without shedding much additional light. What I'd pay money to see is a David Strom/Joel Kramer cage match... I mean, conversation about how to put principles above ideology to grow the economy, spread prosperity and address some of the issues that all of the panelists agreed were real.
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