Has the Fight Against ObamaCare Morphed into a Fight Against Government-Run Health Care?”

While reading Paul Krugman’s allegation that the Republican plan is to “Eat the Future,” I was tempted to agree with some of the substance of what he wrote.  Namely, that public-opinion polls reveal an extremely poorly informed public with no coherent vision of what parts of Big Government have to shrink or disappear.

But what else is new? This is well understood: The average citizen is rationally ignorant about government action over which he has zero real influence.  So, he mistakenly believes that the U.S. can balance the budget by cutting foreign aid, which goes to tin-pot dictators, even though it is a trivial part of spending.  However, when it comes to the real cost drivers of the federal budget, especially Social Security or Medicare – politician beware!

The politician who challenges the entitlement state will have a short career.  As William Voegli of the Claremont Institute recently reminded us, conservatism has “clear, categorical arguments against permitting American government to take up any task it did not perform during Jefferson’s presidency.”  However, “In 1936 and 1964, the Republicans’ presidential candidates, after repeatedly expressing their commitment to these principles, won 36.5% and 38.5% of the popular vote, respectively” [“Neoconservatism and the New Frontier,” Claremont Review of Books, Vol. X, No. 4 (Fall 2010) p. 20, gated].

This undoubtedly explains why the current Republican caucus on Capitol Hill is so reticent about introducing real reform to these entitlements.  I can’t blame them: It is pretty easy to get the seniors onboard the anti-ObamaCare Express by simply attacking the president for cutting half a trillion dollars from Medicare to finance ObamaCare.  Furthermore, except for the martyrdom of Alf Landon in 1936 and Barry Goldwater in 1964, Republican “founding mythology” does not provide strong grounds for rolling back the entitlement state. 81 of 102 Republican Representatives and 16 of 25 Senators voted in favor of the Social Security Act in 1935.  As for Medicare and Medicaid, a narrow majority of Republicans in the House voted in favor of the 1965 Social Security amendments, as did almost half of those in the Senate.  When Ronald Reagan had to deal with Medicare, he accepted an increase in payroll taxes and imposed centrally fixed prices for medical procedures (laying the ground for today’s ridiculous, never-ending sequence of “doc fixes”).  Let’s not get started on the Medicare Part D drug benefit, a solely Republican expansion of Medicare passed in 2003.

But I think that the fight against ObamaCare may have delivered a shock to the system that goes beyond the battle cry of “repeal and replace”.  Published last week, the latest Pew Research Center survey of voters’ budget-cutting priorities shows that Americans are far less enamored of surrendering control of their access to medical care to the federal government than they were.  Yes, 40% want to increase Medicare spending, versus only 12% who want to cut it.  But this is a reduction of one quarter from the 53% who wanted to increase spending in 2009.  With respect to health care in general, 41% want to increase spending, versus 24% who want it cut.  However, this is a one third reduction from 2009, when 61 wanted the federal government to increase health spending.

Whether these shifts presage a trend I cannot say, but I have little doubt that the population has generalized the arguments against ObamaCare to other government health programs, especially Medicare and Medicaid.  This is supported by the fact that the shift of opinion on education spending was far smaller: 62% of respondents wanted to increase federal education spending, versus 67% in 2009.

It’s easy for me to write this, because I’m not running for office, but I suspect that the time is coming when Republicans will take more risk on health reform.  The ambitious conservative politician who proposes (inter alia) replacing tax-subsidized employer-provided benefits with individual tax credits, voucherizing Medicare and Medicaid, or eliminating the federal role in regulating private health insurance entirely, might discover — with surprise — that he is pushing against an increasingly open door.

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