Tag: Jonathan Chait

Libya, Limited Government, and Imperfect Duties

Glenn Greenwald observes that we’re hearing a familiar false dilemma from advocates of intervention in Libya—the same one that was trotted out so frequently in the run-up to the war in Iraq: Either you support American military action, or you must be indifferent to the suffering of civilians under Qadaffi. Bracket for a moment the obvious empirical questions about the general efficacy of bombs as reliable means of alleviating suffering. What I find striking is the background assumption that whether the United States military has a role to play here is taken to be a simple function of how much we care about other people’s suffering. One obvious answer is that caring or not caring simply doesn’t come into it: That the function of the U.S. military is to protect the vital interests of the United States, and that it is for this specific purpose that billions of tax dollars are extracted from American citizens, and for which young men and women have volunteered to risk their lives. It is not a general-purpose pool of resources to be drawn on for promoting desirable outcomes around the world.

A parallel argument is quite familiar on the domestic front, however. Pick any morally unattractive outcome or situation, and you will find someone ready to argue that if the federal government plausibly could do something to remedy it, then anyone who denies the federal government should act must simply be indifferent to the problem. My sense is that many more people tend to find this sort of argument convincing in domestic affairs precisely because we seem to have effectively abandoned the conception of the federal government as an entity with clear and defined powers and purposes. We debate whether a particular program will be effective or worth the cost, but over the course of the 20th century, the notion that such debates should be limited to enumerated government functions largely fell out of fashion. Most people—or at least most public intellectuals and policy advocates—now seem to think of Congress as a kind of all-purpose problem solving committee. And I can’t help but suspect that the two are linked. Duties and obligations may be specific, but morality is universal: Other things equal, the suffering of a person in Lebanon counts just as much as that of a person in Lebanon, Pennsylvania. Once we abandon the idea of a limited government with defined powers—justified by reference to a narrow set of functions specified in advance—and instead see it as imbued with a general mandate to do good, it’s much harder for a moral cosmopolitan to resist making the scope of that mandate global, at least in principle.

An analogy with private ethics seems instructive. Most people would probably agree that the well-off have some obligation—as a matter of personal morality, if not “social justice”—to use some portion of their wealth to help the less fortunate. But with respect to humanity in general, we generally treat this as an “imperfect duty,” to use Kant’s phrase. That is, someone might well say: “You really are so rich that you ought to be giving a larger percentage of your income to charity.” But as we scarcely expect anyone to contribute to every worthy cause, any dispute here would properly be about what is an adequate total amount to give, and what general priorities that giving should follow. Someone who gives far less than they could easily afford might be charged with “not caring enough about the badly-off” in general, but it would be bizarre to charge someone with indifference to the plight of Steve in Albuquerque if their (otherwise adequate, by whatever standard you accept) charitable giving did not include an earmark to help poor Steve with his medical bills. Steve’s friends and relatives might owe him a specific duty of assistance, but for everyone else, the only legitimate question is whether they’re doing as much as ethics requires on the whole. With that in mind, The New Republic’s Jonathan Chait seems to me to be rather missing the point in this blog post:

Why intervene in Libya and not elsewhere is a question that needs to be asked. But it’s not a question that needs to be asked to determine the wisdom of intervening in Libya. Should we also spend more money to prevent malaria? Yes, we should. But I see zero reason to believe that not intervening in Libya would lead to an increase in in American assistance to prevent malaria.

Why not intervene in Burma or Yemen or elsewhere? I would say the answer is prudential: for various political, geographic, and military reasons, the United States has the chance to prevent slaughter in Libya at reasonable cost, and does not have the chance to do so in Burma.

But suppose there’s no answer whatsoever. Does it matter? If it were the 1990s, and the Clinton administration were contemplating an expansion of children’s health insurance, would it be important to determine exactly why we’re covering uninsured children but not uninsured adults? No. The question is whether this particular policy intervention is likely to succeed or fail.

Chait is surely right that our failure to intervene in other cases, or to prevent global suffering by other means, doesn’t exactly prove anything about this case. Perhaps those other cases are different, for either practical or moral reasons, or perhaps we simply fail to act in many cases where we ought to. But he’s surely wrong—and I think tellingly wrong—to reject the implicit demand for a general principle to govern those interventions, whether military or otherwise.

Stipulate, purely for the sake of argument, that Americans do have some collective obligation to prevent suffering elsewhere in the world, and that this obligation is properly met, at least in part, via government. (Perhaps because governments are uniquely able to remedy certain kinds of suffering—such as those requiring the mobilization of a military.) Given that we have finite resources, surely the worst possible way to go about this is by making a series of ad hoc judgments about particular cases—the “how much do I care about Steve?” method. The refusal to consider whatever global duty we might have holistically is precisely what leads to irrational allocations—like spending billions to protect civilians and rebel troops in Libya when many more lives would be saved (again, let’s suppose for the sake of argument) by far less costly malaria eradication efforts. Unless there’s an argument that we have some specific or special obligation to people in Libya—and I certainly haven’t seen it—then any claim about our obligation to intervene in this case is, necessarily, just a specific application of some broader principle about our obligation to alleviate global suffering generally. The suggestion that we ought to evaluate this case in a vacuum, then, starts to seem awfully strange, because if we are ever going to intervene for strictly humanitarian reasons (rather than to protect vital security interests), then the standard for when to do so has to be, in part, a function of the aggregate demands whatever standard we pick would place on our limited resources.

Reading between the lines slightly, here’s what I suspect is behind Chait’s rejection of a more holistic approach. (I hate putting words in people’s mouths, and encourage people to read the full post and judge for themselves, but I don’t think I’m stretching very far here.) Politically, we seem to be rather perversely amenable to pursuing putative humanitarian goals when this entails dropping bombs at massive cost—at least in cases that trigger our collective attention for whatever reason—than we are to more prosaic (and less lethal) interventions, even when these save more lives at lower cost. Chait infers—perhaps correctly—that Americans would reject any general, cost/benefit sensitive principle of intervention that could possibly justify action in this instance. Since Chait thinks Americans aren’t sufficiently willing to risk lives and money on behalf of foreigners as a general matter, but will occasionally go along with an insanely expensive intervention in particular stirring cases, he’d rather not have to generalize explicitly, because the ad hoc approach gets us closer to the level of assistance he thinks is morally required than any politically viable neutral rule.

Those of us who cherish the principle of limited government sometimes conflate it with our specific conception of what the limits should be—we have in mind a particular set of functions that government is uniquely qualified to take on, for one reason or another. But implicit in these last few paragraphs, I think, is a distinct and more abstract argument rooted in a particular ideal of democratic deliberation—one that is in theory equally compatible with any number of different views about the proper role and functions of government. We all know that individuals often make quite different choices on a case-by-case basis than when they formulate general rules of action based on a longer view. We routinely make meta-choices designed to prevent ourselves from making micro-choices not conducive to our interests in the aggregate: We throw out the smokes and the sweets in the cupboard, and even install software that keeps us from surfing the Internet when we’re trying to get work done. Faced with a Twinkie or a hilarious YouTube clip, we may predict that we will often make choices that, when they’re all added up, conflict with our other long-term goals. Marketers, by contrast, often try to induce us to make snap decisions or impulse purchases when, in a cool hour of deliberation, we’d conclude their product isn’t the best use of our money.

Following a diet or a budget is one form of choice; so is the impulse buy or the fast food snack. The meta-choice about which kind of choice to make depends on a judgement about which best comports with one’s ideal of rational autonomy given the facts of human psychology. A marketer who hopes to trigger an impulse buy can legitimately say he’s giving consumers what they choose, but there’s a clear sense in which someone acting in accordance with a general rule, formulated with a view to long-term tradeoffs, often chooses in a more deliberative and fully autonomous fashion than someone who does what seems most appealing in each case unfettered by such rules.

Something analogous, I want to suggest, can be said about democratic deliberation. A polity can establish broad and general principles specifying the conditions under which government may or should act, or it can vote on individual policies and programs on a case-by-case basis (with many gradations in between, of course). Both are clearly in some sense “democratic”; the proper balance between them will depend in part on one’s theory about how democratic deliberation confers legitimacy, just as the weight an individual gives to different types of “choices” will turn on a view about the nature of rational autonomy. Limited government is sometimes painted as constraint on democracy—an obstacle to what a majority might favor at a particular time. But political elites, like marketers, understand how the frame and scope of a choice may radically affect what the very same person or polity would choose—and claims by either that only one counts as true “choice” or “democracy” ought to be viewed with due skepticism.

Jack Conway’s Ugly Campaign

Kentucky attorney general Jack Conway’s Senate campaign, previously chided here for a TV ad’s “dishonest twisting of [Rand] Paul’s statements,” has released another one that is so bigoted it caused even liberal partisan Jonathan Chait of the New Republic to blanch. Chait writes,

The trouble with Conway’s ad is that it comes perilously close to saying that non-belief in Christianity is a disqualification for public office. That’s a pretty sickening premise for a Democratic campaign. [Not that Rand Paul has in fact demonstrated any non-belief in Christianity, but Conway is dredging up allegations from Paul’s college days.]

Here’s the ad:

It puts one in mind of Bob Schieffer’s stunned question to David Axelrod: Is that the best you can do?

Rand Paul is not a perfect libertarian, as Cato colleagues and others have noted. And surely Jack Conway could engage him in robust debate on legitimate issues from Obamacare to the national debt and the Iraq war. But looking at the actual ads Conway has chosen to run, I’ll repeat what I said about the previous ad: “the attorney general of the Commonwealth of Kentucky should be embarrassed.”

Shifting the Blame for America’s Health Care Woes

I must be losing my touch. I’ve let nearly two months pass without responding to Ezra Klein’s defense of RomneyCare, ObamaCare, and other centrally planned health care systems.  (For those who want to get up to speed: his original post, my reply, and his response.)  So here goes.

Klein notes that he and I had each used flawed measures of RomneyCare’s impact on health insurance premiums in Massachusetts.  Fair enough.  But Klein ignores the study I cited by John Cogan, Glenn Hubbard, and Dan Kessler, which estimates that RomneyCare increased premiums in Massachusetts by 6 percent.  The CHK study has limitations, but it is the best estimate available.  I hope Klein addresses it.

Klein’s fallback position is that even if RomneyCare increases premiums, that’s not an indictment of the law because cost-control was not one of its goals.  Never mind that Mitt Romney boasted, “the costs of health care will be reduced.”  Klein knows political rhetoric when he sees it.  Yet he oddly sees no parallels between the phony-baloney promises of cost-control used to sell RomneyCare and the phony-baloney promises of cost-control used to sell ObamaCare – despite ample assistance from people like Medicare’s chief actuary and Alain Enthoven (“the American people are being deceived”).

Then Klein throws down his trump card:

[E]ven a cursory read of the evidence would show that whatever the drawbacks of central planning, it covers people at an extremely low cost. Romney Care’s cost problem is a result of pasting a coverage-oriented quick fix atop our insane health-care system. Compare its costs to the British system, the French system, the German system, or any other system, and whatever your conclusions, you won’t walk away unimpressed by the ability of centralized systems to cover whole populations for much less money than we spend.

Oy, where to begin?  First, Klein violates Cannon’s First Rule of Economic Literacy: he writes that centrally planned systems cost less, when what he means is that they spend less.

Second, the phrase “whatever the drawbacks of central planning” is some serious hand-waving.  Those “drawbacks” include (among other things): the Medicare program’s suppression of comparative-effectiveness research, error-reduction efforts, care coordination, and other delivery innovations; Canada’s human-rights violating Medicare system; and the suppression of untold innovations in health insurance and medical treatment by government price controls.  Other than a few drawbacks, Mrs. Lincoln…

Third, our “insane health-care system,” as I blogged previously, “is the product of the old raft of government price & exchange controls, mandates, and subsidies.”  Prior to ObamaCare, government already controlled half of all U.S. health care spending directly, granted control over another quarter to employers, and regulated health care more heavily than perhaps any other sector of the economy.  Klein and his fellow central planners can’t deny paternity.  Our “insane health-care system” is the product of central planning.

Finally, only a cursory read of the evidence could lead to the conclusion that central planning contains health care spending.  Klein posts the following charts and concludes that since all those (other) centrally planned systems spend less on health care than the United States, central planning must result in lower health care spending.

Photo credit: By Robert Giroux/Getty Images

But if that were true, then one would expect per-capita spending on elderly Americans – who have universal coverage through the centrally planned Medicare program – would not be far out of line when compared to how much other nations spend per elderly resident.  Yet the United States is just as far out of here as overall.  According to the OECD, the United States spends about twice as much per elderly person as Canada, and more than twice as much as Australia spends.  (Alas, I’m not cherry-picking; these are the only four nations for which the OECD provides recent data.)

Source: OECD, author’s calculations

(One could argue that the reason for this is that Medicare exists alongside the world’s largest (ostensibly) private health care sector, whose evils spill over into Medicare.  If that were the case, then moving all Americans into Medicare should reduce U.S. health care spending, bringing it back into line with other nations.  But consider that Klein and The New Republic’s Jonathan Chait both acknowledge that Congress had to throw $2 at the health care industry for every $1 that ObamaCare cut from future Medicare spending. How exactly could Congress move 250 million Americans into Medicare (which presumably would reduce overall spending), or reduce Medicare spending later, given those constraints?  How, exactly, would an independent rationing board survive the political dynamics that produce such outcomes? Prediction: it won’t.  The narrative that central planning contains health care spending just doesn’t hold water.)

Klein, The New Republic’s Jonathan Cohn, and others have taken a big step by acknowledging that RomneyCare is struggling.  When they shift the blame to “the American health care system,” however, they obscure what’s really happening.  As I closed my previous post: “RomneyCare and its progeny ObamaCare are attempts by the Left’s central planners to clean up their own mess.  If Klein and Cohn want to defend those laws, pointing to the damage already caused by their economic policies won’t do the trick.  They need to explain why government price & exchange controls, mandates, and subsidies will produce something other than what they have always produced.”

The New Republic and Guilt by Association

I watched with interest the J Street debate between Matt Yglesias and The New Republic’s Jonathan Chait over the question “what it means to be pro-Israel.”  Matt’s a very efficient thinker, and Chait’s a particularly sharp debater.  I witnessed him slug it out at length in a debate with David Boaz a while back, not something I’d like to do.

Chait made a straightforward argument: to be pro-Israel, someone has to accept two premises.  First, one has to believe that historically, Israel is the more sympathetic party in the Middle East.  Second, one has to believe that the U.S. should not be even-handed in the Middle East, but rather should be on Israel’s side.

But what was most interesting about his argument was his accusation of guilt by association against J Street.  It was a problem, Chait argued, that J Street had been embraced by people who did not meet his definition of pro-Israel.  Chait rang the alarum that “The American Conservative magazine, which was founded by Pat Buchanan, …has been saying nice things about J Street.”  In addition, “the famous Walt and Mearsheimer have been saying extremely nice things about J Street — embracing J Street.”

This is a pretty straightforward guilt-by-association argument: The American Conservative doesn’t meet Chait’s definition of pro-Israel, therefore, for that magazine to praise J Street tarnishes its pro-Israel bona fides.  Same story with John Mearsheimer and Steve Walt.

First, the person at TAC who’s been praising J Street has a name: Scott McConnell.  Scott has a PhD in history from Columbia, and is the current editor-at-large (previously the editor) of the magazine.  I don’t know in great detail Scott’s views on Israel, but I think it’s fair to say that he thinks it’s very important for America, for Israel, and for the Palestinians to get a two-state solution set up, and sooner rather than later.  He also believes, I think, that in order for this to happen, Washington will have to put pressure on both Israel and the Palestinians to give up things they don’t want to give up.  The same view is held by Mearsheimer and Walt.  So the allegedly guilty parties’ view is certainly less zero-sum than Chait’s (would Chait characterize himself as “anti-Palestinian,” I wonder?), maybe even positive-sum.  But I don’t think that receiving praise from a person with such views on the matter necessarily should serve to taint J Street’s pro-Israel bona fides.

But beyond this, is guilt-by-association really something that Chait wants to engage in at all?  For instance, Chait’s boss at The New Republic, Martin Peretz, wrote last March that Mexican people suffer from “congenital corruption” and possess “near-tropical work habits.”  (The piece is no longer available on TNR‘swebsite, but the passage in question can be found here.)  Should we be asking what Chait’s views on Mexicans are, since he is a writer at TNR under Mr. Peretz?  When Peretz suggested two days ago that President Obama’s views on foreign policy are infused with an ideological narrative, and “Obama’s narrative is assumedly third world, maybe just by dint of his skin complexion,” should we be asking Chait to clarify his views on African-Americans?  Finally, although I’m no expert on Mr. Peretz’s views on Arab people, those who’ve paid closer attention make a good case that he has said some reasonably provocative things about them, as well.  Should Chait be brought in for questioning on these matters?

If people only wrote for magazines every word of which they agreed with, few people would write for magazines.  Even if people took the much more modest step of steering clear of writing for magazines that regularly publish offensive material like the above, consumers of magazines like The New Republic would suffer.  But the fact that Chait doesn’t feel the need to distance himself from Mr. Peretz’s various racial foibles ought to raise either questions about his views on Mexicans, blacks, and Arabs, or else questions about his standing to level charges of guilt by association.

Wrong, Wrong, Wrong, Wrong, WRONG!!

The Pittsburgh Tribune-Review quotes Republican National Committee chairman Michael Steele on how Congress should go about reforming health care:

Having Congress reshape health care puts “the wrong people at the table,” Steele said. He said stakeholders — “doctors, lawyers, health care employees, insurance companies” — should develop a solution and present it to Congress, rather than the other way around.

Steele needs to brush up on his Adam Smith:

People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices.

Like I said, Jonathan Chait was on to something.

Chait Calls Out Conservatives on Rationing

I’ve been struggling with how to respond to an article by The New Republic’s Jonathan Chait, who accuses conservatives of hypocrisy and Republicans of whorishness when it comes to wasteful spending in Medicare and other government health programs.  I have grudgingly decided that a good fisking is the only way to go.

Chait writes:

Two weeks ago, President Obama offered to cut several hundred billion more dollars out of the Medicare and Medicaid budget to help make room for health care reform. This sort of gesture ought to appeal to conservatives, right? Apparently not. The Heritage Foundation warned, “At a time when Medicare is dangerously close to bankruptcy, it is shortsighted to funnel funds into the creation of another government-run program instead of shoring up Medicare.” A National Review editorial complained, “These cuts in Medicare and Medicaid payments are nothing more than reimbursement reductions with no empirical or economic basis to justify them.”

A couple of problems here.  Chait takes the National Review quote out of context.  The magazine’s most recent issue states: “Republicans should not have only harsh words for Obama’s ideas. If he truly believes that he can squeeze hundreds of billions of dollars from federal health programs, then he should be encouraged to do so. But the savings should be banked before they are spent.”  The Heritage quote is odd in that it suggests that conservatives should make “shoring up Medicare” a priority.  But it makes essentially the same argument.  Chait gives a false impression when he suggests that all conservatives are knee-jerk opponents of reducing wasteful Medicare spending.

No empirical basis to justify them? Since when do conservatives require an empirical basis to justify cutting social spending?

Ah, the gratuitous swipe.  Chait actually has something useful to say about conservatives’ approach to health care.  Too bad they just stopped listening.

The health care debate has been presented as a conflict between spendthrift Democrats and skinflint Republicans. The reality is closer to the opposite. Conservatives may make up the strongest opponents of new government spending (to cover the uninsured), but they also make up the strongest opponents of cutting existing spending. Health care has become the new defense spending–a category of public outlay that the right has trained itself to defend in even the most wasteful iterations.

Actually, the conventional wisdom fits the reality pretty well.  Democrats’ desire to reduce the rate of growth in projected Medicare and Medicaid spending is not a sign of parsimony.  They want that money so they can hand out new government subsidies, and they then want to raise taxes to hand out even more new subsidies.  Mo’ money, mo’ money.  I defy Chait to find me a conservative so eager to spend other people’s money.  As for the Right defending wasteful health care spending, see the National Review quote above.

The U.S. health care system, as you probably realize, is a vast cesspool of waste… Alas, every dollar of what we call waste is what somebody in the industry calls “income.” So anything that makes the system more efficient makes somebody unhappy, and that somebody has a team of lobbyists.

I have no quibble with this, except that the Left endlessly bleats that the U.S. health care sector is wasteful, but never draws any connection to the fact that government controls half of it directly and even more indirectly.

This may help explain why conservatives have embraced the rather unlikely cause of stopping cuts in Medicare payments to doctors and hospitals. It would also explain the conservative attachment to “Medicare Advantage”–the program created in 2003 that enrolls some Medicare prescription-drug recipients into private insurance rather than traditional Medicare. Medicare Advantage costs $922 more per recipient than traditional Medicare, which makes it a lucrative boondoggle for the insurance industry. Conservatives defend it on the grounds that it offers “better benefits and better value,” as the Heritage Foundation puts it.

Medicare pays for things using price controls.  At present, those price controls unjustly enrich doctors, hospitals, and insurers.  Obama proposes to reduce future Medicare spending by ratcheting down those price controls.  Conservatives object.  Chait suggests the reason is because conservatives are in bed with the doctors, hospitals, and insurers.  Yet there are other potential explanations.

One, conservatives may be indifferent to how Medicare’s price controls look. (Does anyone really expect Washington to come up with the right price, or the right per-unit measurement?)  But since they object to the overall direction of Obama’s health care reforms, they may want to highlight the downsides of these particular changes.  That’s exactly what Obama did to Sen. John McCain (R-AZ) during the 2008 presidential election: “Senator McCain would pay for part of his plan by making drastic cuts in Medicare.”

Two, the Heritage Foundation may be right that the controlled prices that Medicare Advantage plans receive are closer to optimality than what Obama proposes.  The cost comparisons Chait and others use typically omit some of the benefits of Medicare Advantage and some costs of traditional Medicare.  (Medicare Advantage plans do more than just dispense drugs.)

So the right defends having the government shell out more money in order to have (allegedly) better entitlement programs.

A third explanation is that conservatives fear a government that has the power to make people’s medical decisions more than they fear the higher taxes that result from lots of wasteful Medicare spending.  I rather suspect that is how most conservatives feel.  Most Americans, too.  Sure would explain why Medicare looks the way it does.

Even the staunchest free marketers have started to sound like the AARP. The Cato Institute’s Michael Cannon protested that Obama “ought not begin the [health care reform] effort by proposing to take something away from seniors, America’s largest and most politically active voting block.”

I don’t know which upsets me more: being lumped in with the Right or likened to the AARP.  Either way, it appears Chait was casting about for evidence to confirm his thesis and missed the fact that I was making a tactical point rather than a policy argument.  (I’m all for putting geezers on ice floes, but you don’t want to say that’s what you’re doing.)

And then you have the conservative apoplexy over “comparative-effectiveness research,” or CER. Right now, the federal government has little solid information to help figure out what treatments to fund under Medicare. That’s one reason why Medicare winds up finding so many unnecessarily costly medical interventions like expensive copycat drugs–or even interventions that do no good at all. In the stimulus bill, Obama got $1 billion to fund comparative-effectiveness research, which, as you may have deduced, helps compare the effectiveness of different medical interventions.

GOP Senate Minority Leader Mitch McConnell is co-sponsoring a bill to prohibit federal health care programs from using this research. Fellow Republican Jon Kyl, the bill’s sponsor, demands that CER not be used “to deny coverage of an item or service under a federal health care program.” The really silly thing here is that Medicare already has the ability to deny coverage for services it deems cost-ineffective. CER would merely arm the government with facts to make better-informed decisions…

I see three really silly things here.  The first is the Left’s approach to CER; I won’t get into it here, because I wrote a whole paper about it.

The second is Chait’s claim that Medicare already has the ability to make coverage decisions based on cost-effectiveness. Medicare has the legal authority to do so, but it definitely does not have the ability.

The third really silly thing is that Chait blames that inability — and the resulting wasteful spending — on industry lobbying or conservatives whipping up public fears about government rationing.  Chait and other Medicare supporters have no one to blame for wasteful Medicare spending but themselves.  If you support putting health care under the control of the political system, you cannot then blame that system (or the actors within) for doing what it always does.  You might as well blame a cow for going moo.  As I tried, tried, tried to explain to Paul Krugman: “Unless you have a plan to abolish Republicans, they’re part of your plan.”

Conservatives CERtainly [ha!] have understandable ideological reasons to oppose the Obama health care reform as a whole. It’s the particulars of their opposition that arouse curiosity. The right has presented its opposition to health care reform as principled disagreement with “big government.” But opposing “big government” can mean different things… The Republican Party and its ideological allies have defined it increasingly as whatever suits the profitability of the health care industry…

The health care industry has spent vast sums to influence politicians and opinion leaders, mostly on the right. Health care is an issue where precious few conservatives have paid any attention to the details of policy. And the industry is a natural ally of the conservative goal of preventing single-payer health care. So the industry has managed to define its self-interest as the conservative position on health care.

For the most part, I have to agree.  With precious few exceptions, conservatives couldn’t care less about health care.  (How else can we explain why the GOP tolerates things like Medicare Part D and Mitt Romney?)  When Democrats try to reform health care, many conservatives have no more to add to the conversation than “government rationing — bad.”

And therein lies the danger that Chait reveals.  If conservatives do nothing but object to government rationing — if they decide they prefer (A) high taxes and wasteful government spending to (B) a government that has the power to make people’s medical decisions — the growing cost of health care will generate public support for a government-takes-all solution, by which time conservatives will be seen as apologists for a pack of rent-seeking weasels.  If conservatives continue to ignore the details of health policy, they will increasingly fall prey to the fallacy that anything “private” is good.  Universal coverage through the private sector?  No problem.  Government subsidies for private insurers?  Hey, at least it isn’t socialized medicine.  Doctors/hospitals/drugmakers/devicemakers complaining the government isn’t paying them enough?  Well, if they’re in the private sector, they must be right.

But they’re not right.  People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices.

If conservatives choose either (A) or (B), the Left wins.  Conservatives need a way out of that box: (C) let seniors control the money and let markets set prices.  I can’t remember the last time I heard a movement conservative articulate that approach to Medicare reform.