First, congratulations to President-Elect Joe Biden. He’ll have the House on his side, but it’s starting to look like the Senate may be his barrier to moving any of his major healthcare plans forward. Now that he’s been elected, my recent evaluation of his healthcare plan takes on new relevance.
In every election season, people want to know what everyone’s political preferences are. This is a precarious topic especially for me, as someone interested in helping leaders fix healthcare, because any expressed preference risks closing doors. But so does remaining completely ambiguous.
I think readers can guess some of my preferences based on my writings, but I fear there are incorrect assumptions made as well. So let me answer the question as directly as nuance allows.
First, as usual, I will frame this discussion. I believe that all opinions about government can be divided into five major categories, which I explained a year ago in my post describing my framework for categorizing governments. I won’t re-explain the categories or their respective spectra here–go read the explanatory post. It’s super short.
The three spectra most relevant to opinions about how to fix healthcare are the economic spectrum, the welfare spectrum, and the liberty spectrum.
Economic spectrum. I believe in a decentralized locus of decision making. The economic rationale for this is incredibly persuasive to me–the aggregate information conveyed by self-optimizing decisions made by millions of people every day adds up to way more market insight than a central deliberate overseer could ever have. That doesn’t mean I believe there are no benefits to the occasional centralized decision, nor does it mean the end result of the aggregation of all the individual decisions is always optimal, but I do believe that long-term success in a market is far superior when we rely on that information. This assumes people have the information requisite to make self-optimizing decisions, which has mostly not been the case in healthcare. In a case like that, my preferred solution is not to centralize the locus of decision making; rather, it would be to get people the information they need. A major implication of this for our healthcare system is that I do not believe the government should set fixed prices. You will notice that even a U.K.-style system or a single-payer system can be implemented in a way that adheres to this.
[Edit 11/17/2024: As I’m looking through this post again, I don’t think I clarified well enough that for a centralized decision to be made by a government, it has to have an incredibly good reason because the guaranteed economic cost of that decision is going to be way larger than is usually predicted or recognized. Mostly the role of government overseeing an economy should be one of eliminating market failures, not getting actively involved. This has been my opinion all along.]
Welfare spectrum. This is the one I have the hardest time with. I have been in dozens of homes and seen first hand the depravities of entitled attitudes and multi-generational government dependence. But I have worked as a physician in community hospitals and seen the tragic consequences of being uninsured. I have served in religious capacities and seen the dignity that comes from achieving self-sufficiency. But I have personally experienced the burden lifted by food stamps and Medicaid. In short, I am pulled in different directions, and where I place myself on this spectrum depends less on the amount of wealth redistribution involved and more on the principles upon which those programs are based. I’ll write more about this soon.
Liberty spectrum. This one also pulls me in a couple different ways. I have strong moral beliefs that I would love for everyone else to espouse, and at the same time I feel just as strongly that we must show an equal amount of love and consideration to all people completely independent of how similar or different their actions and beliefs are to ours. I also believe in allowing people their own agency to live their lives how they feel is best, which makes me very hesitant to support government policies that enforce or subsidize one set of beliefs over another. So, when it comes to moral laws, my opinion depends on the specifics of the law. All that aside, here’s a clear bias I have: I strongly prefer overall minimalism and simplicity. Each additional law and regulation results in additional complexity in our already overly complex modern lives. This pains me, and I believe the cumulative burden of complexity on us and on businesses is completely ignored when discussions of individual policies are undertaken. Therefore, the threshold benefit for me to be willing to support yet another complexity-increasing regulation is very high, and I am predisposed to support changes that lead to overall simplification.
[Edit 11/17/2024: My opinions on legislating morality have shifted a little bit since I wrote that. I’m now more firmly in the camp of not legislating morality, nor actively supporting any specific morality in any way. This includes (1) not letting the majority make laws that abridge the freedoms of people living a moral code that doesn’t align with the them and (2) not preferencing minorities’ moral codes to try to make up for any rejection they receive now or in the past from society at large.]
I’m not sure that will adequately sate anyone’s curiosity about my voting record, but those are some of the major principles upon which I rely to make my decisions.
Two last thoughts about my biases. First, I make a point to suspend judgment on any issue until I feel I have thoroughly grasped the arguments–and especially the values that undergird those arguments–from all sides. Second, when one gains additional understanding about an issue, I believe it’s ok for them to change their opinion without it undermining their credibility; a well-reasoned change in opinion should be seen as the mark of a person in the pursuit of greater understanding who also has the intellectual integrity to admit prior ignorance.
[Edit 11/17/2024: Haha I wrote that in 2020 not knowing I would come back years later and update it slightly to better reflect my current opinions. Also, since I didn’t mention my opinions on the legal spectrum or the political spectrum, I think it’s worth adding a few comments about those.
As for the legal spectrum, I firmly believe in the rule of law, so I’m never going to support a system based on the rule of man, even if it’s the rule of a human I wholeheartedly support. Although when too many laws are made, that increases complexity, which goes against my other core belief about simplicity. So, my preferred legal system is one that is (1) based on the core belief that the rule of law is best but that (2) can avoid too much complexity by determining the areas where it makes more sense to describe the principles upon which decisions will be made and then give judges and juries leeway to figure out how best to apply the applicable principles to specific situations.
As for the political spectrum, I believe in a democracy that has a reasonable mix of direct and representative aspects. Direct democracy isn’t feasible for every single issue in a society this large; people would not have time to be adequately informed on every single issue, so an overly direct democracy would weaken the connection between the voting result and the true opinions of the people. That’s where representative democracy steps in, to cover all the issues that aren’t general-interest issues and that require more information and analysis to have a well-reasoned opinion. And when it comes to choosing a representative, having a variety of options is much better than just two options because you’re more likely to have an option that you align with pretty well on all the major issues. So that’s why I strongly support breaking the current power-wresting duopoly (Republican party and Democratic party) by implementing ranked-choice voting.]
Clear Thinking on Healthcare 