The health care bill with its mandates, new regulations and increased spending has brought forth a surge against the state, but sensible health care reform requires more than just saying no.
From a purely libertarian perspective, the status quo — with its vast and growing public health care expenditures — was no nirvana. Pure libertarians will never succeed in just wishing the government out of health care, but pragmatic libertarians may be able to push more modest reforms that can make the public role in health care less expensive.
I’ve tapped out more than a few posts on the theme of political feasibility and arrived at similar conclusions. There are ideologically or technocratically motivated policy ideals and then there is the real world in which not everyone shares the same notion of what is “ideal.” One can rage against the system and denounce everything as imperfect, impure, and worse than nothing. Or one can accept the reality that the perfect doesn’t objectively exist, roll up one’s sleeves, and try to actually accomplish something.
(By the way rejecting the good, bad, and ugly in pursuit of the perfect is the functional equivalent of choosing the status quo, and I’ll note that few who harshly criticize policy give the status quo a free pass. So something must be done.)
Glaeser and I agree that running mostly with the crowd (or the majority, or even plurality, of it) while attempting to tinker with the direction where opportunities arise is the most practical way to influence policy. In the case of health care, I would have accepted many possible sets of comprehensive reforms, some far more government dominated, some far more market based. My principal criteria were that the reforms be internally consistent (i.e. technically sound to the point that they’d plausibly work and with support from empirical evidence) and politically feasible (i.e. not obviously counter to large interest groups so they had a chance of surviving the congressional gauntlet). But whatever comprehensive set of reforms satisfied those, that was the vehicle to try to steer, not too much so as to take it off-road, but just enough to improve the ride.
And there’s still time to do that. Health reform is a work in progress. The bill that will be signed into law today is not the end of reform. With it as a starting point many improvements, now more incremental though by no means politically easy, can be made. Trashing it and starting over is a recipe for disaster. Or maybe it is somebody’s ideal. But a world in which the ranks of the uninsured grow (and you could be next!) along with health care costs strikes me as a very odd utopia.