Beez in the Capitation: How Nicki Minaj and John Roberts are Both Constructionists at Heart [Obamacare]
Moe is one of my favorite writers.
Moe is one of my favorite writers.
This shift—Democrats lining up behind the Republican-crafted mandate, and Republicans declaring it not just inappropriate policy but contrary to the wishes of the Founders—shocked Wyden. “I would characterize the Washington, D.C., relationship with the individual mandate as truly schizophrenic,” he said.
It was not an isolated case. In 2007, both Newt Gingrich and John McCain wanted a cap-and-trade program in order to reduce carbon emissions. Today, neither they nor any other leading Republicans support cap-and-trade. In 2008, the Bush Administration proposed, pushed, and signed the Economic Stimulus Act, a deficit-financed tax cut designed to boost the flagging economy. Today, few Republicans admit that a deficit-financed stimulus can work. Indeed, with the exception of raising taxes on the rich, virtually every major policy currently associated with the Obama Administration was, within the past decade, a Republican idea in good standing.
Coming to any conclusion about that requires disentangling the mechanisms by which these shifts are happening. One popular perspective — see this post by Brad DeLong — is that this is rank cynicism. The Republican Party hasn’t changed any of its positions, or if it did, it didn’t hold those positions in the first place. Rather, the Republican Party is coldly taking whatever position happens to be most strategically convenient, and if that requires pretending to jettison their previous beliefs, then so be it.
My view — based both on my experience as a reporter in Washington and on an increasingly voluminous psychological literature about how partisans form opinions — is that human beings are very good at convincing themselves of whatever their self-interest would have them believe, and that Washington has become an increasingly sophisticated machine for encouraging and accelerating this sort of “motivated reasoning.” That is to say, strategic incentives do drive shifts in opinion, but the new opinions are sincerely held.
Medical tourism can be considered a kind of import: instead of the product coming to the consumer, as it does with cars or sneakers, the consumer is going to the product. More medical tourism would increase free trade in medical services, something there has not been much of in the past. The U.S. has been religious about breaking down barriers to free trade, especially in manufacturing and service industries, exposing ordinary workers to foreign competition. But health care has been insulated from the forces of globalization. This has been great for hospitals and doctors, but less good for consumers. It’s one reason that the cost of health care has risen so much faster than that of almost everything else.
“In my view, health is a business in the United States in quite a different way than it is elsewhere,” says Tom Sackville, who served in Margaret Thatcher’s government and now directs the IFHP. “It’s very much something people make money out of. There isn’t too much embarrassment about that compared to Europe and elsewhere.”
The result is that, unlike in other countries, sellers of health-care services in America have considerable power to set prices, and so they set them quite high. Two of the five most profitable industries in the United States — the pharmaceuticals industry and the medical device industry — sell health care. With margins of almost 20 percent, they beat out even the financial sector for sheer profitability.
The players sitting across the table from them — the health insurers — are not so profitable. In 2009, their profit margins were a mere 2.2 percent. That’s a signal that the sellers have the upper hand over the buyers.
This is a good deal for residents of other countries, as our high spending makes medical innovations more profitable. “We end up with the benefits of your investment,” Sackville says. “You’re subsidizing the rest of the world by doing the front-end research.”