National Review’s Latest Health Care Article Fails To Connect the Dots

I’ve decided to add a new feature to this site and occasionally review opinion articles. Basically it seems irresponsible to me that we don’t critically analyze these opinion-making articles and just toss out competing talking points without investigating what motivates the opposition and directly responding. 

A Response to “Romney v. Obamacare” by Yuval Levin & Ramesh Ponnuru

In the latest issue of National Review, Levin and Ponnuru begin the transition from bemoaning the fact that their party’s nominee will be the author of the individual mandate health plan that provided the basis for the Affordable Care Act, to performing the rhetorical gymnastics necessary to justify supporting Romney and opposing “Obamacare.” As one might expect, they fail in this endeavor.

Levin and Ponnuru begin strong by correctly assessing that no GOP contender has a chance without being able to make Obamacare a central point of attack in this election. “Obamacare” is one of the GOP’s greatest successes, having poisoned the well on the legislation to the extent that almost no one in America actually understands the law (e.g. these people think it still includes “death panels!”), but most Americans don’t like it (Levin and Ponnuru point out that the law has become less popular over the last 18 months — part of this is the high profile beating it is taking in the GOP nomination process and part stems from the fact that the law isn’t even in full effect and Americans are blaming the future legal regime for status quo health care woes, which is a failing of Obama’s messaging). While the authors don’t concede that the economy is improving with every day, this is another reason why the GOP will need to concentrate their assault on Obamacare because it is increasingly difficult to attack the President with the steady improvement of the economy.

Romney’s attempts to distance himself from the federal plan have centered on vague federalism concerns, which are hard to grasp for most Americans. As Rick Santorum demonstrated in the last debate, a sustained attack on this argument cripples Romney who has to admit that one of the elements of the law that the conservatives have most vilified — the individual mandate — was the core of his plan in Massachusetts.

But here is where Levin and Ponnuru run headlong into the GOP conundrum — they have no functional solution to the health care cost crisis. They write:

Federal policy strongly encourages third-party provision of health insurance, and penalizes its purchase by individuals, in two ways: It subsidizes employer-provided coverage through the tax code; and it grants states the authority to establish regulatory fiefdoms over individually purchased insurance, thus preventing the emergence of a national market. Thanks to these policies, individuals rarely own their insurance policies and rarely even know their true cost; nor do they often know the costs of medical services, or have much incentive to choose lower-cost options.

This is actually a fair point, but it overlooks two critical facets of the health care system. First, individually purchased insurance is discouraged because it is expensive and an inefficient solution. While healthy individuals may be able to purchase health insurance for less than the cost of a group policy, many Americans would pay more for individual policies, assuming their pre-existing conditions would not bar coverage. If the system promoting group coverage disappears, many of us would be priced out of health care completely. Second, they actually stumble into a truth when they mention that patients do not know the costs of medical services and generally do not shop for care. The problem is they fail to appreciate that this is the whole problem with health insurance in the first place — there is no advantage to the consumer from competition in insurance. Protecting private health insurance won’t help the consumer when it comes to the costs of health services.

Levin and Ponnuru try to blame Medicare for driving up costs, however the reason they cite applies equally to all insurers, who are at the mercy of health care providers when it comes to costs, and they fail to provide any explanation of how the elderly will be cared for without Medicare. And this is the critical question that every citizen should ask when you hear a government program blamed for some national ill — “What would you do instead?” And this is the real problem that Romney will face — ensuring that everyone hears as he denigrates the current health care regime and no one in America thinks to ask that next question.

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