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Deep Thoughts, By J.D. Vance


J.D. Vance has an analogy about health care to share with readers of the New York Times:

Imagine a young father stepping into the street. He is alert and conscientious. Then, a government truck speeds around the corner. The man lunges out of the way, but it’s too late: The truck runs him over, causing serious injury. Absent government misconduct, the man would have been just fine.

While the primary effect of the government’s conduct is an injured man, there are significant secondary consequences. His children will lose his emotional comfort and financial support. His neighborhood loses a valued contributor to its social fabric. His employer must find at least a temporary replacement for the man’s labor.

Oh I get it — Mitch McConnell and Paul Ryan are driving the truck. The 23 million people they’re trying to take health insurance from to pay for a massive upper-class tax cut are the young fathers. And the unnecessary death, suffering, and/or financial ruin they would impose on individuals and families would have awful indirect effects too — closing rural hospitals, hiring local economies.

Really, the analogy isn’t bad. Maybe I should give Hillbilly Elegy a look despite the convincing arguments that it’s overrated crap and…

This scenario is a simplistic version of how many conservatives view the health care market. According to them, there was a time when the market worked reasonably well: Providers competed to offer quality services and consumers shopped around, curbing prices. Then the government, with its mandates and subsidies and regulations, wounded the market, driving up costs and decreasing quality. Everyone — the poor and elderly, the businesses — lost something significant.

Wait, what? Government is injuring people by insuring people? If we imagine a mythical, non-existent time in which markets effectively delivered health care because people shopped around? This is insane.

As with all such arguments, it completely ignores the fact that every other liberal democracy, by assuming a greater public role in health care, has provided universal coverage for considerably less money and health results that are as good or better. This is an awful lot of contrary evidence to bare assertions that government intervention makes health care worse and more expensive.

What is Vance’s alternative vision to the various models of universal coverage that work better than the American one? He doesn’t have one. He quibbles with some of the Republican proposals, but he makes no attempt to square the circle of providing more coverage than the ACA while decreasing state intervention. And, indeed, it’s pretty obvious that he doesn’t actually know anything about health care policy — but he has obtained a measure of renown, and hence the Times would rather their readers hear from him than an actual expert.

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