Ross Douthat on health care reform

Ross Douthat is one of our most thoughtful commentators on politics and public policy. (In other words, pretty much the opposite of me.)  He also occupies a position on the right side of the political spectrum.  But he somehow ends up in almost the same place as I did, in my “The GOP has fallen and it can’t get up” post.

In normal times, a conservative commentator will propose a set of policy goals that are consistent with conservative principles, and/or leave us in a better place.  Douthat doesn’t do that.  He doesn’t even think the GOP is capable of doing anything useful:

All of this would be tepid and incrementalist, a failure compared to the dreams of full-repeal advocates and the best-laid plans of right-wing wonks.

But the Republican Party is too divided on health care, too incompetently “led” by its president, and too confused about the details of health policy to do something that’s big and sweeping and also smart and decent and defensible.

So if the party insists on doing something, it should do something appropriately timid. The alternative is a big gamble on a bad bill — not just a crime, but a mistake.

This is really a striking admission of defeat.  For years the GOP has made repealing Obamacare the centerpiece of their attack on Obama, and more broadly on big government liberalism.  Now they have seized control of all the major branches of government, and they are shown to be incapable of doing anything serious.  Say what you will about the Dems (and I opposed Obamacare), but at least they had an agenda.

Consider this hypothesis.  The Dems are a mixture of idealistic support for big government, and tribal support for their voters.  The ACA is a policy that addresses both concerns.  The GOP is a mixture of idealistic support for free markets, and tribal support for their voters.  They don’t seem able to coalesce around a reform plan that promotes small government and is appealing to their constituents. So it looks like they’ll do little or nothing, and implicitly end up endorsing Obamacare.

On another topic, I was stunned by a survey of attitudes toward the workplace, published in the NYT.  Most people had no problem with men and women working together (no surprise there, we don’t live in Saudi Arabia).  But it seems like attitudes towards mixing of the sexes are becoming more conservative among the younger generation.

I should clarify that this refers to activities of married people.  Note that among the young (age 18-29), the non-religious are almost as conservative as the religious. And although this graph applies to women, the results for men aren’t much different

As someone who came of age in the 1960s and 1970s, I associate old-fashioned attitudes with older people (like Mike Pence), I had to read the NYT piece several times, to make sure my eyes were not deceiving me.  I guess the world is passing me by—between hysteria over “cultural appropriation” and the return of puritanism, I hardly even recognize the society I live in.  Which is fine, life is for the young.

PS.  What the heck happened to feminism?



21 Responses to “Ross Douthat on health care reform”

  1. Gravatar of Rob Rob
    3. July 2017 at 09:31

    Perhaps it is an age effect, not a cohort effect. Older women are seen as less “on the market” and therefore feel less awkward meeting men in private?

    Also, the idea that 25% of women think it’s inappropriate to meet a man for a work meeting is utterly baffling. Almost makes me doubt the whole survey.

  2. Gravatar of Benny Lava Benny Lava
    3. July 2017 at 11:10

    Those graphs are really hard to read by the way.

    As far as health care reform, what even happened to bending the cost curve? Remember that old chestnut from 2009?

  3. Gravatar of Gordon Gordon
    3. July 2017 at 12:25

    If social media is any indicator, I don’t think it’s necessarily a decline in feminism among young women. Instead, what I’ve seen in social media posts is young women declaring all men as being untrustworthy and potentially dangerous. Ironically, many of these young women are very much against Islamaphobia. Yet, they embrace the “poison M&M” meme when it comes to males and become derisive at any suggestion that not all men are untrustworthy.

  4. Gravatar of Steve F Steve F
    3. July 2017 at 12:56

    Just wait til Gen Z is of age. Their postmodernist parents made a mess of some things and Gen Z sees right through it. Tradition makes a comeback when rejection of tradition doesn’t yield greater life satisfaction.

  5. Gravatar of Jerry Brown Jerry Brown
    3. July 2017 at 13:07

    “Life is for the young.” Sumner getting philosophical – this could be interesting. Where did the hard nosed economist go? Must say, I like it though.

  6. Gravatar of Steve Steve
    3. July 2017 at 13:30

    Republicans are in a difficult spot on health reform. For starters, any cut in funds or drop in CBO scored insureds is going to be portrayed by the media as inhumane, or deadly. IMO, one of the defining characteristics of ‘centrist’ Republicans ike Jeb, Kasich, Collins, etc., is a fear of bad media coverage. They want to be inside the club, just more fiscally responsible! Once you realize that media narratives drive short-term pain aversion, Trump’s behavior starts to seem, dare I say it, somewhat rational.

    Second, health care in this country is held hostage by the employer system. No one wants to see their networks disrupted or their deductibles raised like what happened in the individual market. Make no mistake, this is a thorough repudiation of Obamacare, but it’s one where the majority is willing to leave health coverage permanently trashed for 10-20 million individuals in order to protect the status quo from more turmoil.

    That’s why the Cruz/Paul proposal of replacing guaranteed issue and a penalty with continuous coverage issue sans penalty actually has a chance.

    Finally the poor consume health differently from the wealthy. Many view doctors appointments as entitlements to take back from the man, rather than scarce health-improvement opportunities. They don’t care about efficiency as long as it’s free. In the long run, more affluent small business types aren’t going to stand for being in the same networks and risk pools; failure to repeal Obamacare will drive demand for direct primary care and concierge care.

    But politicians, driven and whipped by the media, have a profoundly short-term orientation such that the secular erosion of both doctor access and fiscal solvency under the status quo are afterthoughts, compared to the need to appear compassionate for another news cycle.

  7. Gravatar of Jerry Brown Jerry Brown
    3. July 2017 at 13:49

    Steve @13:30,
    You make a lot of good points and I especially agree with your 2nd paragraph.

    I also agree that the poor consume health (care) differently from the wealthy. I would just say they consume and get less of it, unless it was some illness that made them poor in the first place. Perhaps the poor don’t mind sitting in doctor’s offices and hospitals as much as the wealthy do- maybe they have fewer options and therefore aren’t as concerned with efficiency.

    And I agree that politicians often want to appear compassionate, or at least reasonable (well except for Trump). But that is not always such a bad thing.

  8. Gravatar of Massimo Heitor Massimo Heitor
    3. July 2017 at 13:59

    The modest bill that Ross Douthat proposes:
    – Repeal individual insurance mandate, replace with waiting period.
    – Repeal some of the new Obamacare taxes
    – Medicaid finance reform.

    The Senate bill does exactly those three things.

    Republicans have failed to attempt anything dramatic and amazing like right wing wonks have proposed. That argument is widely made and is valid.

    I don’t see a strong argument for faulting Trump in this. The big right wing health care wonks, even those that openly dislike Trump, are not blaming Trump.

    Avik Roy is a conservative health care specialist, a big Trump critic, and he is extremely positive about the Senate bill, but he is an outlier on that.

  9. Gravatar of ssumner ssumner
    3. July 2017 at 15:16

    Gordon, You said:

    “Instead, what I’ve seen in social media posts is young women declaring all men as being untrustworthy and potentially dangerous.”

    Maybe, but that’s not the feminism I grew up with, which claimed men and women were equal.

    Steve, Men and women working together “made a mess”? Who knew?

    Steve, Jeb would not have walked into the White House with no clue as to what he wanted to do with health care. Please don’t compare him to an idiot like Trump.

    Massimo, Don’t confuse Douthat’s proposal with the Senate bill.

    Everyone, Lots of rationalizing, just as I expected.

  10. Gravatar of John Hall John Hall
    3. July 2017 at 15:23

    Rob’s comment is spot on. You would really need some kind of comparison to a previous point in history to make much sense of this. What was the attitude in 1950, 60, …, etc. If there was a different relationship in the past, then maybe you could say people are more conservative than in the 80s or something. For instance, you could make the case that young people are more conservative (on some dimensions) by showing that sexual behavior among young people has significantly declined in the past twenty years. Pretty sure that data is available.

    Of course, there are several explanations that could explain the data. One is that men have become worse in some way that has led women to change their behavior. I don’t know if that’s true, but my sense is that the opposite is true. Another is that women perceive men in a worse light than women previously did. A related conjecture is that women are less willing to tolerate bad behavior in the past, but I would think would not apply to all men, just the ones with bad behavior. There are probably several other reasonable conjectures.

  11. Gravatar of John Hall John Hall
    3. July 2017 at 15:39

    “Maybe, but that’s not the feminism I grew up with, which claimed men and women were equal.”

    The feminism you grew up with would have been second wave feminism. It is a more radical feminism that has become increasingly popular among young women, particularly on the left. You would not believe some of the Facebook posts I see.

  12. Gravatar of Benjamin Cole Benjamin Cole
    3. July 2017 at 17:09

    The GOP is a mixture of idealistic support for free markets, and tribal support for their voters. They don’t seem able to coalesce around a reform plan that promotes small government and is appealing to their constituent–Sumner

    The GOP voter completely bulldozed party icons such as Jeb!

    In favor of Trump.

    In his miserable campaign, Trump went light on healthcare but seemed to talk about tighter labor markets in the US and avoiding foreign entanglements. That is how he won the nomination.

    I doubt the GOP rank and file wants to reduce Obamacare much. Maybe change the name.

  13. Gravatar of Steve Steve
    3. July 2017 at 17:21

    Jeb would not have walked into the White House with no clue as to what he wanted to do with health care. Please don’t compare him to an idiot like Trump.

    Give me a break Scott. Jeb’s plan*** is almost the same as Ryan’s ACA. How would Jeb have responded to 15% approval ratings, the media calling him mean and murderous, a bad CBO score, and Congressional defections? Reminder: GOP Congress has lower approval ratings than the admittedly clownish Trump.

    Nothing you said addresses my observations regarding the dynamics of health reform.

    ***Jeb’s plan
    high deductible plans
    replace means-tested subsidies with tax credits
    cut essential health benefits
    tax expensive employer plans
    cut medicaid spend and block grant medicaid to states

  14. Gravatar of Jerry Brown Jerry Brown
    3. July 2017 at 19:13

    But Steve, Jeb did not get elected along with his plan, contrary to Donald who promised his plan would provide better health care and be much cheaper with lower deductibles and be all around fantastic. Give us a break- Trump had no idea what he planned but promised the world, Jeb Bush knew what he was going to propose and was at least honest about it.

  15. Gravatar of Steve Steve
    3. July 2017 at 20:07

    Jerry, Hillary said premiums weren’t going up, people just weren’t shopping hard enough! (for shorter work hours????) Bernie promised freeeee stuffffff for everyone! Trump said it’ll be bigly, and great, believe me! 2016 is the year we should have debated health pol….BREAKING interrupting this town hall: protesters are gathering on I-10 outside Phoenix as Trump scheduled to arrive! Wolf, this is the man Republicans want, yes it is!

  16. Gravatar of Massimo Heitor Massimo Heitor
    4. July 2017 at 00:41

    While Republicans have both the executive branch and congress (which Sumner says they “seized”), they have a very narrow majority.

    Avik Roy’s full article supporting senate bill:

  17. Gravatar of ssumner ssumner
    4. July 2017 at 07:11

    Ben, You seem to have overlooked the fact that Trump promised us that he would repeal Obamacare. Loudly and often. It was always a big part of his campaign speeches.

    It continues to amaze me that people took anything Trump said during the campaign seriously. How hard is it to recognize a bullshitter who simply says what he thinks his fans want to hear?

    You said:

    “I doubt the GOP rank and file wants to reduce Obamacare much.”

    How many Republicans do you know? It’s the number one issue they complain about.

    Steve, The current proposals CUT taxes on expensive employer health care plans.

    As far as comparing Jeb! to an incompetent buffoon like Trump, if you can’t immediately see the difference, then nothing I say is going to change your mind.

  18. Gravatar of rayward rayward
    4. July 2017 at 10:43

    I’ve yet to understand how a market monetarist (support asset prices with monetary intervention) can be part of an Austrian school think tank (let asset prices collapse!). That women might believe that dinner with a man could lead to sex is understandable (I suppose the assumption is the bastard paid for dinner and expects something in return), but a work meeting I don’t understand. Could it be the women don’t trust themselves after a work meeting with an alpha male with high earnings potential? Which is odder: the market monetarist hanging with Austrians or women afraid of hanging with men?

  19. Gravatar of ssumner ssumner
    5. July 2017 at 18:59

    Rayward, Since when is Mercatus an Austrian think tank? I was told they were a free market-oriented research institute.

  20. Gravatar of Uday Uday
    7. July 2017 at 07:30

    Central problem with healthcare is a lack of transparency. People don’t know what they’re paying for. Instead, we get the bureaucracy of health insurance, which really isn’t insurance, but the inefficient means of having to pay for healthcare.

    Was the survey about female attitudes replicated? I find the results hard to believe, especially if this was the only survey documented.

  21. Gravatar of Scott Sumner Scott Sumner
    8. July 2017 at 07:17

    Uday, Good question. It would not surprise me if the survey did not hold up. The finding is so bizarre that someone should certainly do a follow-up poll.

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