The Corner

Means and Ends in Health Care

One more thought on the new Burr-Hatch-Upton proposal, sparked by some of the liberal responses to it today. 

At the core of this proposal, as of most other conservative health-care proposals, is the idea that what American health care needs is not consolidation and centralized control but decentralization and real competition. At the core of Obamacare is a fairly strict and national definition of the health-insurance product, and the use of public power to then compel insurers to sell only that product and compel consumers to buy it. (As if to insult us all, liberals sometimes then proceed to call the result a market, since after all it has buyers and sellers.) Conservatives tend to think that a more plausible way to solve the problems bedeviling American health care would be to let insurers and providers try a very broad range of different ways of offering consumers what they want and to empower consumers to choose among them—allowing experimentation, evaluation, and evolution to drive incremental improvements in quality and price. 

In this sense, the health-care debate is a pretty stark left-right economic argument: Do we achieve greater efficiency through greater consolidation and centralized management or through decentralization and bottom-up experimentation? Or in other words, do we already have all the answers and need to implement them or do we need a system that continuously seeks them out? 

Some liberals take their own answers to these questions for granted so thoroughly that they no longer see the questions, and so when they look at conservative health-care proposals they notice only the means and don’t think about the ends. They therefore end up noting that liberals and conservatives seem to both want to use tax policy to subsidize some health coverage, or that both would help the poor or protect people with pre-existing conditions—so aren’t they ultimately just doing the same thing? But means have to be understood in relation to ends. As William F. Buckley once put it, pushing an old lady out of the way of an oncoming bus is not the same thing as pushing an old lady into the way of oncoming bus, even though both involve pushing old ladies and oncoming buses.

A failure to see that has long characterized some of the liberal confusion regarding conservative health-care proposals, and we’ve seen it already in response to this latest one, for instance here. It’s a telling blindness, and it’s one that characterizes a fair amount of contemporary progressivism, not only when it comes to health care. 

Yuval Levin is the director of social, cultural, and constitutional studies at the American Enterprise Institute and the editor of National Affairs.

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