Peace In The Culture Wars — If The Right Wants It

Tim Carney has an idea for how to deal with the culture war problems surrounding the strange contraception kerfuffle that he says should be good for the left and right:

Your boss shouldn't be telling you what pills to take, and he shouldn't be paying for your pills. To get peace in this arena, we have to disentangle employment from health care, which requires repealing parts of Obamacare and scrapping the tax preferences for employer-based insurance.

Assuming Carney is serious here, I think we can actually strike a deal. Scrap all employer health insurance. Then scrap all private health insurance. Create a single payer Medicare-for-all health care system like the one Canada has. This is something that should appeal to conservatives for the reasons Carney has laid out: it respects the deeply-held religious beliefs of the non-human legal constructs called corporations. But it should also appeal to conservatives for a number of other reasons as well:

  1. It eliminates Medicaid. Conservatives do not like Medicaid because they think it is ineffective and because its means-tested nature can create poverty traps wherein people cannot increase their incomes without losing their health insurance.
  2. It reduces health care costs. Conservatives are very concerned about Medicare bankrupting the government. It will only do so if health care costs continue to spiral out of control. A single payer system is able to utilize monopsony bargaining to keep that from happening.
  3. It liberates employers. Employers have so much to deal with already, what with aggregate demand so lackluster on account of inadequate fiscal stimulus. Get this off their plate. Save them money.
  4. It liberates employees. Employees need to be freed from job lock in order to be entrepreneurs and thereby become job creators. This is the only way to truly reduce health-care-related job lock because, under single payer, you don't even need an income to receive health care.

If this contraception thing is really that important to conservatives, we have a solution right here that avoids it altogether. It also comes with tons of pro-conservative bonus goodies. The culture war on this topic can be over, if the Right wants it. If Boehner and a united GOP brought single payer to the floor, I have great confidence they could win enough DNC votes to make it law.

I understand why they don't do this. But, in all seriousness, this shows you where their priorities on these issues lie. The GOP could have a health care system that avoided all of these issues if it was willing to sacrifice its anti-government-health-insurance stuff. But it isn't willing to do so. The GOP prioritizes their opposition to single payer over their opposition to the contraception stuff. That's on them.

These kinds of entanglements are almost always a function of politics that have been pulled to the right. It is the Right that goes on about how government-administered benefits and transfer incomes aren't real incomes, that people's real compensation that truly belongs to them is the stuff that comes from their job. This might seem like a good rhetorical strategy to "limit government," but it all it really does is cause people to support policies that deliver benefits most leftists want the government to provide through the employer and other submerged mechanisms.

Government healthcare is provided through the employer channel with insurance subsidies. Government retirement security is provided through the employer channel with 401(k) subsidies, among others. Government low-end income security is provided through the employer channel with the minimum wage. The Left I am familiar with would much rather have universal single payer health care, universal public pension, and universal basic income. It is conservatism that drags us to this compromised middle where so much is being punched through employment arrangements, where the Real Income(TM) of the Makers is said to come from.

If the Right really wants to rationalize our hodge-podge system of social benefits and free up employers and so on, that is a totally doable thing. There are a great deal of European states with very efficiently organized social welfare designs. We could have universal public vacations, freeing employers from having to pay for them. We could have universal parental leave, also freeing employers from having to pay for it. All of these things can be detached from employment, which would create maximal freedom and flexibility for employees and employers. But that's not going to happen when the conservatives' position is actually to get rid of the social state altogether. In that world, we'll tend towards compromise and this ugly channeling of the social state through the employment relationship.