Ramblings & ephemera

Conservatives cannot govern well; reason #1: Medicare reform

From Alan Wolfe’s “Why Conservatives Can’t Govern” (The Washington Monthly: July/August 2006):

If government is necessary, bad government, at least for conservatives, is inevitable, and conservatives have been exceptionally good at showing just how bad it can be. Hence the truth revealed by the Bush years: Bad government–indeed, bloated, inefficient, corrupt, and unfair government–is the only kind of conservative government there is. Conservatives cannot govern well for the same reason that vegetarians cannot prepare a world-class boeuf bourguignon: If you believe that what you are called upon to do is wrong, you are not likely to do it very well.

Three examples–FEMA, Medicare, and Iraq– should be sufficient to make this point. …

The question of whether Medicare reform will prove politically fruitful for Republicans is still open. But the question of whether it has proven to be an administrative nightmare is not. There were two paths open to Republicans if they had been interested in creating an administratively coherent system of paying for the prescription drugs of the elderly. One was to give the elderly nothing and insist that every person assume the full cost of his or her medication. The other was to have government assume responsibility for the costs of those drugs.

It is significant that in America’s recent debates over prescription drugs, no one, not even the Cato Institute, argued that government should simply not be in the business at all. As a society, we accept–indeed, we celebrate–the fact that older people can live longer and better lives thanks to radically improved medical technology as well as awe-inspiring advances in pharmacology. A political party which consigned to death anyone who could not afford to participate in this medical revolution would die an early death itself.

But Republicans were just as unwilling to design a sensible program as they were unable to eliminate the existing one. To prove their faith in the market, they gave people choices, when what they wanted was predictability. To pay off the pharmaceutical industry, they refused to allow government to negotiate drug prices downward, thereby vastly inflating the program’s costs. To make sure government agencies didn’t administer the benefit, they lured in insurance companies with massive subsidies and imposed almost no rules on what benefits they could and could not offer. The lack of rules led to a frustrating chaos of choices. And the extra costs had to be made up by carving out a so-called “doughnut hole” in which the elderly, after having their drug purchases subsidized up to a certain point, would suddenly find themselves without federal assistance at all, only to have their drugs subsidized once again at a later point. Caught between the market and the state, Republicans picked the worst features of each. No single human being could have designed a program as unwieldy as this one. It took the combined efforts of every faction in today’s conservative movement to produce a public policy so removed from common sense.

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