Who defines conservatism today?

Barack Obama.

How does he do it?

By advocating a particular policy. The conservative position then automatically becomes the reverse.

The most hilarious example of this was when, during the Republican primaries, the Milwaukee Journal Sentinel asked then-presidential candidate Herman Cain whether he agreed with President Obama's policy on Libya, which, in the unlikely event you haven't seen it, you can watch here. "I disagree with how he handled it for the following reason," Cain began, before realizing that - troubled by "all the stuff twirling around in my head" - he couldn't quite remember what the Libyan situation was about. After getting his feet a little more firmly on the ground, Cain remained adamant that he disagreed with Obama's Libyan policy though he could not explain anything he would have done differently.  

A more consequential example is health care. We must reform health care; we have no choice (more about that in a future post). The President pursued what had previously been a conservative approach, namely, mandating universal insurance coverage through the existing private insurance system, and making it easier for consumers to compare and select an insurance company through user-friendly insurance exchanges. This approach attempts to generate cost savings through competition among private insurance companies. It also attempts to ensure that everyone who benefits from the health care system – and that, quite simply, is everyone – pays his or her fair share. When he proposed the same basic program in Massachusetts, Mitt Romney called it “the ultimate conservative idea.”

Presto! As soon as President Obama endorsed it, a conservative position was instantly transformed into a liberal – indeed, socialist – idea.

It is now a fundamental tenet of conservatism that requiring people to pay, through the private insurance system, for what they receive from private health care providers is unAmerican and unconstitutional.   

            I’m annoyed by a front-page article in today’s Washington Post.

            The article is titled “Panetta says he regrets cost of his flights home.” The first sentence reads: “Defense Secretary Leon E. Panetta said Monday that he regrets that his frequent flights home to California on a military jet have cost taxpayers more than $800,000 since July.”

            What bothers me about the article? That the Post placed it on page one – above the fold on the right-hand side of the paper to boot – suggesting it’s one of the most important articles in today’s paper.

            The reader who follows the article to the jump page learns that under government rules: (1) Panetta, as defense secretary, is required to fly exclusively on military aircraft equipped with secure communications links to the Pentagon and the White House, and (2) when he flies for personal reasons he is required to reimburse the government for what it would cost to fly on a commercial airline – which he has done. (Those rules, incidentally, were adopted under the prior administration.)

            On weekends, Panetta frequently flies home to California, where his wife and family live. He has followed the same routine during his forty years in government. When he was a member of Congress, he paid for flights home himself. Over the past eight months, Panetta has made 27 trips home, and reimbursed the government $17,000.

            Has Panetta done anything wrong? No, he has not. But while the words in the article do not suggest otherwise, its placement suggests that the Post is reporting on a scandal of some sort.

            I have no doubt that the cost of Panetta’s security detail well exceeds costs of his flights home, but the Post is unlikely to place an article about that above-the-fold on A1. If it did, readers would find the placement jarring. We know that taxpayers pay considerable sums to protect, not only the president and vice president, but cabinet secretaries as well. Of course, these individuals personally benefit by the protection; but that’s not why taxpayers foot the bill. The nation benefits by protecting cabinet secretaries.

            The regulations requiring the secretary of defense to travel on military aircraft with secure communications also benefit the nation. I, for one, don’t want the defense secretary out of touch during a three-hour flight when a military crisis – an unexpected missile launch from a hostile nation, a foreign submarine detected in U.S. waters, a coup in Pakistan – suddenly arises.

            I also find Panetta’s reaction entirely appropriate: He regrets the cost to taxpayers. Yes, the cost is unfortunate, but it’s better than the alternatives. He’s entitled to weekends at home with his family – indeed, citizens should want Panetta to spend weekends at home with his family because with this personal sustenance he’ll perform better in his job – and the costs are what they are.

            I’m not suggesting that the article should not have been published elsewhere in the paper. Taxpayers know that they pay a lot for Secret Service and other security force protection for high government officials. I don’t know how much those security costs run, and I might find that interesting, especially if the protection is arguably too much or too little. I didn’t know that we are paying for Leon Panetta’s trips home – so arguably there may be some newsworthiness to the story – though now I know, I don’t care. To my mind, Panetta’s trips home and the regulations relating to his mode of travel and reimbursement rate are appropriate.

            Maybe a few souls – I doubt it will be many – will believe that rather than fly home to his family, Panetta should effectively be imprisoned in Washington, or that his family should have moved to Washington, or that he should not have accepted the job. That’s why the article may have merited a spot on, say, page A13.

            But I think most readers will find the article a yawn. Except for the editors’ decision on placement, that is.

         Donna Dubinsky had a wonderful op-ed titled “Health Care Isn’t Like Broccoli” in the Washington Post on April 6, 2012 (the title for the on-line version is "What Makes Health Care Different").

            If the federal government can mandate that individuals purchase health insurance, why can’t the federal government require that people purchase other things too? Dubinsky argues, “There are two simple limiting conditions, both of which must be present: (1) it must be a service or product that everybody must have at some point in their lives and (2) the market for that service or product does not function, meaning that sellers turn away buyers. In other words, you need something, but you may not be able to buy it.”

            She then tests these principles against broccoli, burial services, and health insurance. Only for health insurance are both conditions present.

            Elegant, simple, and sensible.

            There are, however, two ways at looking at the problem. Dubinsky sees the mandate as a means of protecting people who will need health insurance some day, but when that day arrives will not be able to purchase it because, for example, they are sick and insurance companies won’t cover pre-existing conditions.

            But there is another way to view the mandate: as a device to protect citizens from having to pay for health care to other people who could have purchased insurance earlier but chose not to do so.[*]

            I expect that conservatives on the Court will find an argument based on the second perspective more persuasive. While everyone can sympathize with people who did not purchase health insurance earlier, and cannot do so when they are sick, there are still the dual problems of liberty and individual responsibility. “Someone who made a choice cannot complain about the consequences of their choice,” I imagine conservative justices thinking. It’s a fair point. Liberty is a wonderful gift, but it can also be a difficult gift. Liberty means we can’t expect others to take care of us.

            Dubinsky is correct when she says the market fails in this area. It fails, in part, because of the disjunction between consuming health services and paying for those services. Someone who arrives at a hospital emergency room in critical condition is going to receive medical care whether or not he can pay for it. Why should responsible citizens who paid for health insurance for themselves and their families be compelled to pay for the health care costs of irresponsible citizens who did not purchase insurance? What about the liberty of responsible citizens who are being compelled to carry the irresponsible on their backs?

            At oral argument, Justice Scalia suggested that solution would be to change the law to allow hospital emergency rooms turn away the uninsured. That does not comport with social mores and values, he was told. Then change the social mores, Scalia responded. But, of course, the Court must decide the case for the America that exists, not a different America that Justice Scalia may (or when he is thinking clearly, may not) prefer.

            The law requires that hospitals provide emergency care because Americans find it abhorrent that people in dire need be turned away at the emergency room door because they cannot afford care. But Americans also want people to pay their fair share of essential services. Because of the special characteristics of health care, the market does not work to honor both values. That is why governmental correction to the market is necessary.[†]

            Dubinsky’s two conditions – set forth above in the second paragraph of this post – still work. All we have to do is delete the phrase “sellers turn away buyers” at the end of her second condition. That is, market failure does not only occur because some people are unable to purchase health insurance when they want it. Market failure also occurs because Americans find it unacceptable to deny emergency care to those who need it.