Conservative Healthcare

CONSERVATIVE HEALTHCARE….Over at the Weekly Standard, Ross Douthat and Reihan Salam offer up a grand new vision of big government conservatism, and one of the planks in their platform is a new conservative approach to healthcare. They start off by noting that the commonly cited figure of 45 million uninsured in America actually understates the problem. If you look at any given 2-year period (instead of taking a single snapshot in time), there are 80 million people who are normally insured but lack insurance for at least a few months during that period. Then they get to their sales pitch:

Instead of approaching health care reform as the left does, as a problem for the uninsured ? a matter of charity for those less fortunate ? conservatives should cast the health care crisis as what it really is: a problem for the insured, for people whose insurance plans will lapse if they lose or shift jobs, whose plans don’t cover expensive crises, and who must pay extra, in the form of higher premiums, to cover the medical bills of the permanently uninsured.

….All these reforms would have salutary effects on family life. If your coverage were portable, you’d feel more secure in moving your family to a community with a lower cost of living, or where you’re more likely to find remunerative employment. At the same time, making health care more universal and affordable would reduce the costs of child rearing, encouraging family formation and offering a sense of security to parents debating whether to have a second (or third, or fourth) child.

This is 100% right. Unfortunately, because they’re conservatives, Ross and Reihan are unwilling to take the obvious next step and endorse some kind of sensible national healthcare plan, even though they provide a synopsis of the issues involved that would do justice to The Nation. In fact, I was unable to discern any real plan at all. They apparently feel that the answer is to somehow increase competition in the healthcare market, which will drive costs down so much that it will be feasible to simply mandate that everyone in America purchase their own private insurance. This is a fantasy.

Still, their PR idea is spot on. If liberals want to sell the idea of national healthcare, we should quit marketing it as a welfare plan for the uninsured. Instead, we should be focused on the healthcare complaints of those who already have insurance but are dissatisfied anyway: Lack of choice in physicians. HMOs that make it hard to see a specialist. High copayments. Fear of losing coverage if you lose your job. Long waits for non-urgent care. New (and usually worse) healthcare coverage every time your HR department is told to find a cheaper plan. Fear that preexisting conditions won’t be covered if you take a new job. The risk of financial ruin if someone in your family has a truly catastrophic illness.

That’s the way to sell universal healthcare. After all, the uninsured mostly vote for Democrats anyway, and the rest of the country views programs aimed at the uninsured as a mere welfare program to be actively avoided. Expand your marketing to the 80 million who are occasionally uninsured, however, and you’re starting to make real progress. Expand it even further to those who are insured but unhappy, and you’ve hit electoral gold.

So forget the uninsured for now. Liberals should concentrate instead on making sure that ordinary middle class workers understand just how bad and how expensive their current healthcare is, and how much better it could be under a decent national plan. I don’t think conservatives will ever follow Ross and Reihan’s marketing advice, but that doesn’t mean we can’t.