Tuesday, March 23, 2010

It's Hard to Stop a Moving Train

Ages ago, I attended high school with the son of a prominent Canadian political figure - and by prominent I mean, when the party was in power, not just to the extent of "getting invited to dinner at the Prime Minister's house," but having the Prime Minister come over to dinner at your house. (If you're wondering, it was a public high school.) He was a smart kid, opinionated (I have nothing against that), liked to debate, and was conversant about politics. Although we were well short of voting age, one day he asked me what political party I favored. I shared my opinion of the political parties, then asked the same of him. "What do you think? You know who my father is." Sort of an "Alex Keating" thing, or perhaps "Alex Keating, Jr." - locked into a political ideology at an early age and living it without reflection.

Although I make no claim of insight into the genesis of David Frum's conservatism, when I read David Frum's columns, he brings to mind my former classmate. The man is bright, capable of discussing the issues of the day, and usually attempts to provide a solid foundation for his arguments. He seems to have accepted that his brand of conservatism is not particularly welcome in the current incarnation of the Republican Party, and is making as strong an effort as he can to forge his own initiative to rescue the party from itself. I suspect I would find him personable and, given the opportunity, we would have some interesting political discussions. But at the same time I sense that he spends a lot of time examining and reexamining issues other than the conservative orthodoxy he has embraced.

I can say this: growing up in Canada, spending most of those years in the province that spawned the CCF (eventually the NDP) and the program of socialized medicine that eventually became Canada's Medicare system, it is really hard to scare me with stories of "socialized medicine" or with claims that U.S. politicians are "socialists". The Medicare system served me well in my childhood and teen years, and it has served my parents well during the decades since. I have no complaints about the care I've been able to receive in the U.S., save for the periods when I was uninsured and underinsured. But fables of rationing and waiting lists don't phase me. Every system has problems, most of which are related to funding. If anything is shocking, it's how many problems our own system has despite the incredible amount of funding it receives from both private and public sources.

I thus have to question when I read David Frum's commentary on healthcare reform if he has any actual concern about the substance of reform - if he has concern over access to or quality of medical care under even a single payer plan - or if he's more concerned about universal health insurance as a threat to his ideology. That is, I see little sign that he believes that universal coverage, however accomplished, is a bad thing of itself, but instead he seems to fear that once implemented it will hobble the implementation of his vision of conservatism.

Frum's Waterloo column suggests the latter - that the Republican Party should have cooperated with reform to somehow make it more "conservative" - not expanding Medicaid, finding other (unidentified) sources of funding... and maybe it would have been possible for such a bill to have been fashioned. But perhaps the difference is that Frum accepts that a significant healthcare overhaul would be possible without threatening the future of his version of conservatism, while the Republican Party views any expansion of health insurance as incompatible with its vision for the future. In both cases it can be argued that politics are being placed ahead of what's good for the country - it's difficult to credit to genuine differences of ideology conduct the following conduct as summarized by Frum:
Conservative talkers on Fox and talk radio had whipped the Republican voting base into such a frenzy that deal-making was rendered impossible. How do you negotiate with somebody who wants to murder your grandmother? Or – more exactly – with somebody whom your voters have been persuaded to believe wants to murder their grandmother?

I’ve been on a soapbox for months now about the harm that our overheated talk is doing to us. Yes it mobilizes supporters – but by mobilizing them with hysterical accusations and pseudo-information, overheated talk has made it impossible for representatives to represent and elected leaders to lead.
The most favorable interpretation is that the Republican Party expected their arguments to lose on their merits, and the alternative explanation is that the Republican Party didn't care about the merits, choosing under either interpretation to try to drown out the debate with lies and vitriol. Frum wants to believe that the Republican Party somehow lost its way, and could have been led back to an honest, reasoned debate of the bill on its merits. Maybe that would have been true twenty years ago, but I get no sense that the current Republican Party has any interest in taking a higher road, even though it remains theoretically capable of doing so.

I have read suggestions that, after healthcare reform, the Republican Party can't have "another Reagan". Absolute nonsense. During Reagan's era, if you recall, the British Conservative Party was led by his sister in arms, Prime Minister Margaret Thatcher. She broke unions, privatized industry, and went to war with Argentina. (Good times, good times....) No, what we're really talking about is that once an effective universal healthcare program is implemented, the country will not want to go back to the "free market" approach that preceded reform. We've seen that in Britain with the Conservative Party, in Canada with its version of the Conservative Party, and in every other industrialized nation. People may want the system to be fixed or improved, but propose an "American-style system" and (if you're not joking) you're not going to stay in office.

Seriously, for all their talk of how Medicare is not sustainable, the Republicans won't propose simple legislation that would make it more sustainable - such as implementing need-based copayments and deductibles to have people who can afford to do so pay more money out of pocket before their "free" benefits kick in. Instead you get "ideas" that range from "Medicare vouchers for private insurance coverage" to "eliminating Medicare"... and there's not much distance between those ideas. (But heavens no, don't cut subsidies for private insurers in the Medicare Advantage program.) If you listen only to Republicans you might think that the only choices we have are to maintain the status quo or scrap the entire Medicare system... interspersed with angry opposition to any Democratic Party proposals to cut Medicare benefits. That opposition panders to the elderly, while simultaneously helping to ensure that Medicare remains on an unsustainable path - what the Republican party might deem a "win-win". But it's wholly irresponsible

For all the Republican griping about how "the public doesn't support this bill", that's not what they're afraid of. It's easy, after all, to overturn an unpopular bill. Their fear, and this includes Frum's fear, is that calls to "spend enough" to support the system and fix its flaws will end the "Club for Growth"-type dreams of a nation in which the wealthy pay virtually no tax, and domestic spending is pared to the bone... more accurately, to the marrow. If the reform bill succeeds in its goals, the next time a G.W. comes along with a plan to slash taxes for the rich, he'll first have to explain why he's not using that money to fix or improve the national healthcare system. It's that brand of conservatism that is facing its Waterloo, and hence it is that brand of conservatism that remains desperate to kill reform.

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