The Conservative Rebuttal

I don't normally read Ross Douthat's work in the New York Times. Though I celebrate David Brook's conservatism, I usually find Douthat to be a bit dull. Having said that, in his weekend piece, Douthat lays out a very strong conservative rebuttal to Obamacare, and one that his (presumed) party would be wise to study.

Douthat's point revolves around a 2008 study done in Oregon which showed that access to Medicaid did not affect health outcomes, that is, having health insurance may help people afford healthcare, but it didn't actually make them healthier. This is not by itself necessarily surprising. Obviously having healthcare doesn't mean you can avoid ruinous injuries or illnesses.

As Douthat himself points out, saving low-income Americans from illness-induced financial calamity would still be a major policy achievement. But the the purpose of health insurance is indeed twofold; there is a moral obligation to make life better as well as a fiscal imperative to reduce costs.

So where is this going? Douthat traces his argument to the benefits of insurance, if the benefit is mostly financial, then shouldn't health insurance be like auto insurance or home insurance and only cover disasters, not check ups? I think one could make the case that Medicare ought to be disaster insurance, but of course, what constitutes a medical disaster? I will not attempt to answer that question here.
 
Douthat continues by making the claim that if insurance does not actually prevent illness or death, and insurance is expensive, then we should be doing some sort of cost benefit analysis on health insurance as opposed to tax credits or even new kinds of healthcare plans. I would add to this list improved educational outcomes.

This argument is a strong one, and I think it carries much weight. As we think about ways to reduce cost means testing disaster insurance might not be a bad idea. And certainly, as Douthat mentions, in all of our endeavors, we should link funds to outcomes, in other words if health insurance isn't saving lives, we should probably find other ways to use those funds that would do more to achieve that goal.

As much as I agree with the basic ideas Douthat lays out, I do have some pushes, one of which he himself points out, which is that the Republican party is not advocating his approach; it remains a mindless mob incapable of being solutions-oriented and at war with anything Obama. So while I would support some of the ideas included in this piece if they were real policy options, I bemoan the fact that they are not real policy options.

But aside from the issue that the ideas Douthat espouses are his own and not his party's, I also question the efficacy of the study, not because I believe it is flawed, but because I believe we can achieve better results.

One of the major problems with healthcare - and indeed in many areas - is that we treat issues retroactively rather than proactively. Indeed, one of the big focus areas in Obamacare is preventative treatment. We clearly cannot make people go in for check ups any more than we can prevent them from eating Big Macs (or force them to eat broccoli), but we can invest in education, and we can enact policy that promotes healthy behavior. Public health initiatives in New York have been very effective at curbing smoking, and even though I would have preferred a tax to an outright ban, I agree with the idea behind Mayor Bloomberg's failed attempt to ban soda. Basically, while I accept that people may not use their health insurance to obtain better health outcomes, I think people could and would if they had the education, the incentive, and of course the insurance.

I'd like to see some of Douthat's ideas talked about and perhaps incorporated. Why not means test Medicare for emergency insurance? But I also think that we have a moral and economic obligation to protect our citizens, and I think the educated and proactive use of health insurance to access healthcare is the path we ought to pursue to achieve this end.