Is Obamacare Just an Ego Trip? A Power Grab? A Glory Op?

Robert Samuelson, the eminently sober and serious-minded columnist for The Washington Post, published a slashing attack on Obamacare this morning, under the headline, "The Health-Care Ego Trip."

Samuelson writes, "What's driving the great health debate of 2009 is not a popular clamor for universal insurance." Then he cites a Wall Street Journal poll showing a 41:39 plurality of Americans are opposed to Obamacare, although he does not cite a new Rasmussen poll showing that Americans oppose Obamacare by a 56:41 margin. So what's the explanation for the persistence of Obamacare advocates (and of Clintoncare advocates before them)? "The underlying driver," Samuelson declares, "is politicians' psychological quest for glory." He continues, quoting Montana's Max Baucus:

"My colleagues, this is our opportunity to make history," Chairman Max Baucus implored last week as the Senate Finance Committee opened consideration of his bill. Politicians, in their most self-important moments, see themselves as instruments of national destiny. They yearn to be remembered as the architects and agents of great social and economic transformations. They want to be at the signing ceremony; they want a pen.

Could it all be this simple? Is politics nothing but a wildly expensive subsidy program for the "ego-price-support" of politicos? The economist James M. Buchanan won the 1986 Nobel Prize in Economics for his "public choice" theory, which holds that politicians and other public officials are entrepreneurs of their own kind; they simply use public money to achieve their own private welfare-maximizing ends. (A quick drive through the Northwest DC demonstrates that plenty of people have lived by the old Beltway adage, "They came to do good, and ended up doing well.")

But Samuelson is making more of a psycho-political point, emphasizing the "greatness" incentive of politicians and policy entrepreneurs, not just their financial incentives. Samuelson is saying that healthcare advocates want the psychological high that comes from doing "great" deeds, even if, upon inspection, those deeds are not so great. And so the rest of us have been warned. Samuelson continues:

Ordinary Americans are rightly suspicious of this exercise in collective ego gratification, which has gripped Obama and many of his congressional allies.

To be sure, it's not just healthcare reform that gets politicians giddy. The military also excels at gratifying political egoes. Nobody puts on pomp and circumstance like the brass, and only the Pentagon will honor favored patrons with the naming rights for ships and bases. Thus the opportunity to play civilian master and commander is tempting indeed; that's one reason why we have so many wars. And if we can't have a war, we can at least have the "moral equivalent of war," as Jimmy Carter put it in 1977, echoing William James.

The dilemma, of course, is that healthcare is important. We should encourage our politicians to take constructive steps to improve healthcare, to foster the production of medicine and cures, and to help all of us live long and healthy lives. Those are all wonderful goals, and if politicians get an ego-stroke for helping to achieve them, then in it's a win-win, for both the people and the political class.

But the problem is that it's not so clear that the current crop of political incumbents knows very much about improving health care, to say nothing of medicine and cures. Sure, they have plenty of ideas for spending money and "expanding coverage"--and the most ambitious of them seem possessed by the idea of universalizing coverage into a "single payer" plan--but they all seem preoccupied with health care as a means to an end, not as an end in itself. The means, in this case, is process, and yet the end is more important. The end is better and longer lives for people.

And that preoccupation with means suggests that politicos are easily sidetracked into political projects: If they are Democrats, they are easily seduced into building bureaucracy and protecting trial lawyers; if they are Republicans, they feel compelled to expand the free market, which seems to be defined, in practice, mostly as protecting private insurance companies. Which is to say, neither party seems very interested in actual medical cures. As argued here at Serious Medicine Strategy, if we had more cures, then it would be easy to make health care cheaper, even as it was being made more accessible to people.

It's said that if you are a hammer, the whole world looks like a nail. Or, per Samuelson, if you are a politician with a pen, the whole world looks like a piece of legislation upon which to affix your name. And if that legislation has little to do with actually improving the lives of Americans? If it doesn't actually make anyone healthier? Well, all that is secondary. The main thing is to sign the bill, make a speech, take credit--and hopefully get your name in the history books.

The baleful cycle of political glory-hounding will continue until the voters wise up. But in the meantime, we should at least try to stop politicians from making things worse.