Over at The New Republic, Josh Patashnik responds to my post on Gov. Arnold Schwarzenegger's (R-CA) universal coverage plan. Over at Washington Monthly, Kevin Drum gave Patashnik Tuesday's quote of the day.
It would be an understatement to say Patashnik and I don't see eye to eye. I don't even think we speak the same language. For example...
Market-friendly reforms? Patashnik describes the Schwarzenegger plan as a collection of "market-friendly" health care reforms. Really.
The plan would banish market prices for health insurance. It would override market allocations of wages and benefits. It would let the state, rather than the market, decide what share of health insurance premiums will be spent on administrative costs vs. claims. It would expand government coverage at the expense of private markets. Every plank of Schwarzenegger's plan would reduce the number of decisions made by the market and increase the number of decisions made by government.
Certainly some insurance companies and employers would benefit, because the plan would cripple their competitors. But that makes the plan anti-competitive, special-interest legislation — not market-friendly.
Patashnik claims the plan contains a "variety" of market-friendly reforms. If he can find even one, I'll buy him lunch.
Libertarians = conservatives? Patashnik writes:
I can't say I'm surprised Cato doesn't like [Schwarzenegger's plan], though. The conservative health care strategy works like this...
Patashnik perhaps believes that conservatives and libertarians are the same thing, or that the latter are a subset of the former. This is a source of irritation for libertarians (and probably conservatives too), for the same reasons it would irritate TNR staff to be called communists: not only is it dismissive, it's just plain inaccurate.
...endorse subsidies in theory, since it would seem unacceptably heartless to simply say that people who can't afford medical care shouldn't get it....
Libertarians endorse voluntary subsidies, in the abstract and the concrete, for those who cannot afford medical care. This is not because "it would seem unacceptably heartless to simply say that people who can't afford medical care shouldn't get it," but because that is unacceptably heartless.
Libertarians oppose coerced subsidies, such as the Medicaid program that Schwarzenegger proposes to defraud, because it is immoral to put someone in jail if he doesn't want to contribute to Medicaid. Coerced subsidies are also counter-productive. (Need evidence? Look around.)
Mind you, we don't think these things because we're libertarians; we're libertarians because we think these things.
...Then, whenever anybody proposes a plan to actually implement subsidies, vehemently oppose it without offering any alternative plan to expand coverage.
Three things: First, a libertarian who opposes coerced subsidies is being entirely consistent. Second, libertarians have no obligation to offer an alternative plan to expand coverage, because libertarians reject that as a legitimate role for government. Third, were Patashnik to peruse the offerings of Cato health policy scholars, he would notice that most of our proposals nevertheless would expand coverage — simply because more people would have health insurance if government got out of the way.
State experimentation Patashnik concludes:
...In other words, let states experiment — except when they actually do.
Yeah — if libertarians (or conservatives?) prefer state-level economic regulation to federal regulation, why do they complain about it when they see it? Two responses:
First, one might believe that gay marriage is an issue for the states rather than Congress, but still oppose a particular state's proposal to suppress that freedom. My guess is that Patashnik sees hypocrisy only because he does not value the freedom to choose his health insurance or how to provide charitable care as much as he values the freedom to marry someone of the same sex.
Second, Schwarzenegger is experimenting with the money of non-Californians. By law, half of California's Medicaid budget comes from the feds. So the non-Californians funding his grand designs have every right to object. Moreover, Schwarzenegger proposes — in broad daylight — to further pick the pockets of non-Californians by defrauding Medicaid.
I wonder, does that bother Patashnik? I'm interested to know the answer.