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.
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 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.
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.