The GOP strategist had been joking about the upcoming presidential election and giving his humorous assessments of the candidates. Then he suddenly cut out the schtick and got scary serious. "Let me tell you something, if Democrats take the White House and pass a big-government healthcare plan, that's it. Game over. Government will dominate the economy like it does in Europe. Conservatives will spend the rest of their lives trying to turn things around and they will fail."
And it turns out that the fearsome harbinger of free-market doom is the mild-mannered ex-U.S. senator with the little, red glasses, Tom Daschle. He'll be the guy shepherding President Barack Obama's healthcare plan through Congress via his probable role as secretary of health and human services. At the core of Daschle's thinking on the subject is the creation of a "Federal Health Board that would resemble our current Federal Reserve Board" and ensure "harmonization across public programs of health-care protocols, benefits, and transparency." (Forget secretary of state, Hillary Clinton should shoot for chairman of Fed Health and run one seventh of the U.S. economy.) And the subject of that "harmonization" would be a $100 billion to $150 billion a year plan that would let individuals (and small businesses) buy insurance from private companies or from a government plan.
Daschle and the Obamacrats certainly have the momentum: a near-landslide presidential election victory, at least 58 Democratic votes in the Senate, and a nasty recession that will make many Americans yearn for economic security. Already the health insurance companies seem set back on their heels. The industry's trade organization now says it would accept new rules requiring them to cover pre-existing conditions as long as there was a universal mandate for all Americans to have health insurance. On top of all that, Obama clearly wants to make healthcare reform a priority in his first term, as evidenced by the selection of a heavy hitter like Daschle. And even if he wasn't interested, Congress sure is, with Max Baucus and Ted Kennedy readying a plan in the Senate. A few observations:
1) Passage would be a political gamechanger. Recently, I stumbled across this analysis of how nationalized healthcare in Great Britain affected the political environment there. As Norman Markowitz in Political Affairs, a journal of "Marxist thought," puts it: "After the Labor Party established the National Health Service after World War II, supposedly conservative workers and low-income people under religious and other influences who tended to support the Conservatives were much more likely to vote for the Labor Party when health care, social welfare, education and pro-working class policies were enacted by labor-supported governments."
Passing Obamacare would be like performing exactly the opposite function of turning people into investors. Whereas the Investor Class is more conservative than the rest of America, creating the Obamacare Class would pull America to the left. Michael Cannon of the Cato Institute, who first found that wonderful Markowitz quote, puts it succinctly in a recent blog post: "Blocking Obama's health plan is key to the GOP's survival."
2) Shrinking government would get exponentially tougher. Republicans would face the same problem with healthcare that they currently do with Social Security, persuading people to trade one in the hand (the current system) for two in the bush (a reformed system). And we see how well that has worked out. Combine Obamacare with plans to take away the tax-advantaged status of 401(k) plans and IRAs and you would end up with government responsible for both healthcare and retirement. The big-government constituency would grow and deepen. And remember that fewer and fewer people are paying the incomes taxes that would help pay for increased government services. That breakage of the linkage between taxes and government "benefits" creates toxic incentives for more of both — and an economy more shackled than ever by taxes, debt, and regulation.
3) Republicans better earn to competently talk healthcare. John McCain's healthcare plan was perhaps the most provocative policy proposal of the entire 2008 campaign. Too bad he could neither fully explain how it worked nor persuasively argue why it was better than Barack Obama's plan. Also too bad since his plan would have smartly reduced healthcare costs by getting companies out of the healthcare benefits business and empowering individuals to buy insurance on their own. This would have helped fix what economist Arnold Kling calls the insurance vs. insulation problem: "Insulation relieves the patient of the stress of making decisions about treatment. The patient also does not have to worry about shopping around for the best price. The problem with insulation is that it is not a sustainable form of healthcare finance."
Another interesting healthcare reform option is highlighted by Ross Douthat and Reihan Salam in the book Grand New Party. Uncle Sam would require individuals and families to put 15 percent of their income into health savings accounts. If you run out of money before year-end, the government steps in. If you don't, you get the money back or it rolls over into a retirement account. Of course, any conservative alternative would be easier to implement if it doesn't first have to kill an existing nationalized health plan. But thanks to Tom Daschle, that is just what might have to happen.