Monday, September 28, 2009

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.


  1. And if you're interested in data, the whole world looks like a data problem! With that admission, an op-ed in the Austin-American Statesman this morning by Sen. Kay Bailey Hutchison, is an exception to the concern that the GOP wants to protect insurance companies. Excerpt:

    "A state-level health exchange would allow consumers to compare plans at a single shopping point. Just as many travel Web sites are a commercial compendium for multiple airlines, a health exchange is an online marketplace for health insurance coverage options. Plan information is presented in a standard format, and consumers can complete an electronic application and enroll online."--

    To the extent health insurance companies are similar to what travel agents were before the invention of on-line travel Web sites completely disrupted their revenue models, this does not, to put it mildly, seem to be a proposal that would result in "protecting the insurance companies." With health exchanges, insurance company revenue models would tend to share the same fate as travel agent revenue models. Travel agents have seen their ranks shrink thanks to more transparent and efficient competition stemming from increased choice and better consumer information. Smart travel agents have found ways to sell value to consumers by providing better service -- but in a more competitive environment resulting in lower overhead and better quality.

    Meanwhile, on the airline side, the one-size-fits-all government solution called TSA makes flying a painful experience and deters unnecessary travel -- the sort of travel that would enhance quality-based competition among airlines, which frequent fliers know is sorely lacking. Hmmmm, now that you mention it, having watched the TSA train wreck in the making, the ego trip theory has lots of applications.

  2. In Washington it is all about Ego, Power & Corruption.
    Come the next few Novembers & we will exterminate the vermin presently occupying 535 seats. We the people are not fools. Fixing Health Care is as easy as: A, B, C, D as you cited in your last article.
    We can start with the first bill: Losers Pay.
    Until we see such plain and stand alone bills, we the people will not trust the Gonifs.
    Keep plugging away Jim, Thanks!

  3. RE: Paul
    I'm afraid the corollary for travel agents in a so-called "health exchange" would not be the insurance companies but the insurance agents/brokers. They are the ones that stand to lose out. Insurance companies would maintain their monopoly.

  4. Fellow DC Exile,

    As bad as things are, there's not an insurance company monopoly at present. In fact, the tax laws cause insurance industry "customers" to suffer imperfect competition, similar to what exists in the case of oligopoly (degree of oligopoly varies from state to state and employer to employer -- that's why the federal employee health insurance program works relatively well, i.e., there's lots of competition among plans from which federal employees may choose).

    (By customer, I mean users of insurance services, not necessarily the party that pays the largest share of the price, typically employers -- although both types of customer would benefit from increased market competition.)

    The basic economic concept of a willing buyer and a willing seller is distorted in the case of typical employer-paid health care, since employees may or may not be willing buyers of a particular product. While we probably can't accurately predict the precise consequences of KBH's proposal on particular institutions in the current distorted market, it's usually the case that individuals are happier making choices for goods and services on their own than they are having third parties do so. For price and quality signals to work as effectively as possible, the people with the most direct exposure to price and quality must be the decision makers.

    The travel industry analogy used by KBH may not be perfect, but it helps make the point about the power of market dynamics. Ideally, we would fix the tax system to make it neutral toward insurance structure -- and more to the point of this blog, also to create powerful incentives for Serious Medicine. That would be Serious Tax Reform, which we haven't had since 1986. In the interim, KBH's idea may be more attainable more quickly, although even a seemingly easy lift like health exchanges in Texas may need to wait for voter repudiation of the current ego trip proposals.