Health Care Reform: What Does the Populace Really Want? A Look Back at California in 1994

A couple of weeks ago, I predicted that in pushing through a controversial and arguably ill=conceived health care reform bill, Trump would suffer the fate of Bill Clinton in 1994 and Barack Obama in 2010 — loss of his party’s control of the midterm congressional elections. And just this past Thursday, Peggy Noonan’s Wall Street Journal column explained why. See also Alan Tonelson’s blog post today. (I highly recommend his blog in general. I should cite it more often, but if I did, I’d spend more time citing than on writing my own posts. 🙂 )

Yet with all the hoopla over the health care issue, I would submit that we as a nation have never clearly set out desiradata for it. And, as with most issues, We the People have never been asked, other than the odd state ballot measure such as California’s Proposition 186 in 1994. (More on this below, where it will become the major point of this post.)

I submit the following as axioms:

• Health care is a public good, just like education. Our nation offers free public education because it benefits society as a whole, and the same should hold for health care. Timely treatment of diabetes, for instance, can avoid later blindness and mobility problems, thus saving on welfare costs and so on.
• Even before the advent of Obamacare, we had been providing government-sponsored health care for many, many years, via Medicare, Medicaid, tax-loss writeoffs for emergency room care for the uninsured etc.
• The American people do not want uninsured people dying in the streets.

The ultraconservatives in Congress need to recognize these points, and recognize that the genesis of Obamacare was a proposal by the Heritage Foundation, a prominent conservative think tank, and its implementation in Massachusetts by Republican governor Mitt Romney. The vast majority of Americans would agree to the above axioms. The intransigent members of Congress are letting their hatred of Obamacare (and, perhaps, their hatred of Obama himself) affect their good judgment. Get over it, Freedom Caucus!

For their part, the Democrats are refusing the recognize the failings of Obamacare. To be sure, something had to be done about health care, both in terms of access and rising costs, and arguably the Democrats did the best they could in 2010. But the program lacks long-term viability financially, and is producing victims even in the short term. Open your eyes, Democrats!

Given the axioms, the central question is, just what is it that we all want the government to provide (directly or via subsidies)? Do we, for instance, want to cover maternity benefits and mental health care? It is one thing to force young, healthy people to buy insurance, in order to subsidize the older, more medically expensive segment of society, on the grounds that most of the young people will eventually become seniors. But in this era of declining birth rates, many people will never become parents, or at least will do so much less often than in previous generations. How do the American people feel about that subsidy? What about subsidizing visits to shrinks for those who are merely unhappy, as opposed to those who are alarmingly out of touch with reality? How about the subsidies for heroic treatment of catastrophic diseases? I’ve never seen any polls on such things, but really isn’t this a central issue, Where to draw the line?

Again, arguably maternity care is another public good, as is mental health treatment. But again, where do we draw the line? Many believe the Democrats drew that line too liberally in 1994, and even many of us who don’t hold that view decry the obstinacy of the Democrats in flatly refusing to revisit it, and we resent the failure of both parties to ask us common folk just how much we want to subsidize.

One of the rare instances in which the populace was given a say occurred in California in 1994, in Proposition 186. The much more memorable ballot measure that year was Proposition 187, which would have denied state government services to unauthorized immigrants, but Prop. 186 was quite significant. The proposal would have established single-payer health insurance in the state. California voters, among the most liberal in the nation, overwhelmingly voted No. And though that was more than 20 years ago, my sense is that it would be soundly defeated today as well.

In other words, the problem is less the issue of whether the government gets involved in health care, rather it is, Just how far do we want the government to go?

To make this question concrete, suppose the Republican bill had passed the House yesterday, and later passed by the Senate and signed into law by Pres. Trump, but without coverage of some of the basic types of treatment guaranteed by Obamacare. Would California take up the slack? If there were a ballot proposition to restore all that coverage using taxpayer money,  I submit that the measure would likely be defeated. Again, one of the most liberal states in the Union would vote against (forgive the provocative and possibly unrepresentative example) taxpayer-subsidized use of Viagra.

During that 1994 election campaign for Prop. 186 (on which I voted Yes), there was a striking example of the problem. A Chinese-American physician was a guest on KTSF, a Bay Area TV station specializing in Chinese-interest and other ethnic programming. The doctor was a progressive politically, as was the host of the show, Anni Chung, a Chinatown political activist. The physician was urging viewers to support Prop. 186.

Chung asked the MD, “Would Prop. 186 cover the undocumented?” The doctor immediately answered (emphasis added), “Oh, definitely not. We couldn’t afford it.” In other words, even this ultraliberal doctor was unwilling to draw the line that far.

And that is my point. We the People need to be consulted as to where to draw the line. “All the rest is commentary.” 🙂