Practicalities

Politics is the art of the possible. There is a lot in the state budget compromise that I don't like. I am particularly turned off by the cigarette tax increase because it seems to me to be a prime example of NIMBY taxation. Let's stick it to some other people. But if the revenue that the tax will provide is really needed, shouldn't we all be willing to pay it? I understand the argument that smokers increase health costs but I am also aware that, strictly speaking, the net effect of smoking may be to decrease and not increase health costs. I am aware that a tax increase might make some people quit, but sticking it to people who presumably have an addiction and will find it very difficult not to pay is a tad sleazy.

On the other hand, it's not the fox hole that I want to die over.

I also think that conservatives and the GOP need to think hard about just what our position on health care reform ought to be. HSAs and consumer choice are important but we are kidding ourselves if we think that's going to carry the day.

I have blogged before that we may need to tolerate a certain amount of government control of the market in recognition of the realities of health care. Unfettered markets require allowing people to fail. If you can't sell widgets, you go out of business. If you are employed by a company that makes film for cameras, you are likely to be laid off.

But we aren't going to let you die of an easily treatable disease because your business failed or your employee needed to deploy its resources elsewhere. We can argue about whether Graeme Frost's parents should have made the choices that they did, but, while we talk, we want the kid to see a doctor.

Because we aren't going to let you fail in this way, it may well be that we have to require you to insure yourself. Because everyone won't be able to afford it, we may have to provide subsidies. And because everyone may not be able to qualify for insurance, we may have to prohibit - or limit - individual underwriting.

The key, it seems to me, is to realize that these interferences in the market create inefficiencies and ought to be minimized. Thus, I am skeptical that the health proposal announced today by a group that includes business leaders ought to be considered close kin to Healthy Wisconsin.

If we must have a health care mandate, it seems to me that the minimum plan must have few or minimal mandates (devising a method for evaluation of plans will be a challenge)and high deductibles. Any subsidies ought to be means tested. The government ought not to be setting prices.

But, at the end of the day, conservatives ought to agree that the present system (which is rife with inefficiencies) needs to be changed. We should not allow ourselves to be identified with the status quo.