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CNN reports that the RNC has floated a broad ten-point checklist of "key public policy positions [that it] ... expects its public officials and candidates to support...." Dissent on any three or more will disqualify the candidate from RNC funding.
Here's the list:
(1) We support smaller government, smaller national debt, lower deficits and lower taxes by opposing bills like Obama's "stimulus" bill;
(2) We support market-based health care reform and oppose Obama-style government run healthcare;
(3) We support market-based energy reforms by opposing cap and trade legislation;
(4) We support workers' right to secret ballot by opposing card check;
(5) We support legal immigration and assimilation into American society by opposing amnesty for illegal immigrants;
(6) We support victory in Iraq and Afghanistan by supporting military-recommended troop surges;
(7) We support containment of Iran and North Korea, particularly effective action to eliminate their nuclear weapons threat;
(8) We support retention of the Defense of Marriage Act;
(9) We support protecting the lives of vulnerable persons by opposing health care rationing, denial of health care and government funding of abortion; and
(10) We support the right to keep and bear arms by opposing government restrictions on gun ownership; and be further
I am going to assume that this is less a response to heterodox Republicans like Olympia Snowe than it is to quislings like Dede Scozzafava and Arlen Specter. On that basis, and with some caveats (this list is imperfect but serviceable for this 2010 election cycle, for instance) I can tentatively support such a move.
There's a tension in American party politics: a party can't win in America without being inclusive, to an extent, but political parties can't exist without being exclusionary, to an extent. Parties must define what they stand for. Although the definition may have a core and a periphery, parties can't function without defining what they believe; nor can they serve their function in our system without being rough proxies for a set of views (see my footnote here).
Parties allow average voters to identify candidates, but they also allow more engaged and like-minded voters to aggregate money and other resources in service of a political agenda. That function in particular breaks down if the party has no process for controlling how it expends limited resources. Potential RNC donors get gunshy when they find out that money they gave to support Republican candidates has been spent electing people who ultimately rat (Specter) or who had no claim to the Republican mantle in the first place (Scozzafava). How can we be sufficiently exclusionary for the party to efficiently serve its purposes, while not becoming insular and excluding heterodox candidates?
Defining a core set of fairly universal values and conditioning funding on adherence to at least 80% of it seems a reasonable way to go. One interesting feature of this move is that it is only weakly exclusionary. A Scozzafava could still run for office with an R after her name, could still seek funding from other sources (state and local parties, campaign committees, private donors, etc.) but donors could give to the RNC without fear of their money being misappropriated.
By the way: as much as I loathe third parties, I can't help but wonder if it's time for the national GOP to abandon New England and encourage the formation of a regional center-right party. A deal would be cut whereby the GOP and this New England party wouldn't run candidates on one another's turf, and would caucus in one another. This is not a suggestion I like, but we need to get serious about retaking New England, and I can't help but wonder if a party shorn of some of the baggage of the GOP yet in full communion with it, so to speak, might be one way to do it. I'd love to hear some better suggestions.
Post facto:
In defense of parties (12/16/09)
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too much support by opposing
The language is WAY off. The business of supporting ideals by opposing others efforts may be sound rationally, but it's too negative and thereby fails to demonstrate a vision with a positive feel.
The GOP needs to show people that they understand how the people feel and what they want. It all needs more time talking about positive future environments that make people happy when they think about them. And less time talking about opposition.
I understand that the GOP is the minority and thus is stuck opposing what it views as the mistaken vision of the current majority. But it would be a much better approach to first talk positively about a future desirable state. Then you can say, "right now, that means opposing what's on the table blah blah blah, but we can't lose sight of the good vision down the road which is our true motivation." Etc, Etc.
I can agree with most of
I can agree with most of that. The first thing that jumped out at me is that the list is framed in excessively Obamacentric language. As my post indicated, I'd like to see improvements even for the 2010 cycle, certainly beyond that. But I could live with this as a basic 2010 platform.
There's an advantage in phrasing (some of) this list in negative terms. It's more inclusive to demand candidates' opposition to "Obama-style government run healthcare" (everyone, surely, can agree with that!) than to demand that candidates support a specific alternative. Ask ten Republicans what they do want done on healthcare and you'll get probably twelve different answers, but they'll all be against "Obama-style government run healthcare." So in this case, the negative framing properly limits the list's exclusionary effect. The list is intended to exclude people outside the tent from funding, not to make the tent smaller.
Tell me this, Brian...
Not that I disagree with your general points, why is it that Obama can get elected largely on a platform of "I'm not George W. Bush," but Republicans are criticized for being the "party of no"?
As I say, it's not that I disagree with your points. One of the reasons that we're having so many problems with Obamacare right now is that when the GOP controlled the WH and Congress, nobody tried to push modest but conservative reforms. Rather than a prescription drug benefit, Bush could have provided for the tax deductibility of health insurance whether employer-provided or purchased directly by an individual. The fiscal impact of that would have been quite modest, but would have, I believe, had a significant impact on the insurance market. Had that been coupled with, say, a bill allowing health insurance to be sold across state lines, and I think we would have seen insurance costs fall over the past several years. While we might have failed to accomplish some of those things, because the GOP didn't have as big a margin as the Democrats do today, we should have at least tried very hard.
getting elected vs governing
Well, we know that getting elected is different from governing. Every candidate who runs against a 2-term incumbent is going to use a bit of the "I'm not the other guy" to his campaign. That's unavoidable. Bur I'm not sure that Obama got elected just by being the "not Bush." Not per se. I think he got elected because his persona backed up the idea substantially. I think he was perceived as being smarter, more thoughtful, and more competent than Bush.
Now that he is President, I think the mileage he gets from not being Bush diminishes every day. Republicans have something of a "party of no" problem because of the length of time for which they are stuck in this role. Suppose folks perceive that "all these guys ever do is say no." Leaving aside any argument over how true that feeling might be and why, I think that the "all these guys ever do " part is more of a problem than the "say no" part.
We'll never know whether the reforms you suggest could have cut costs. I think they might have had some beneficial impact, but I tend to doubt they would have actually driven costs downward. And they would not have done much if anything to shrink the ranks of the uninsured. I view the current state of weak access to healthcare for poor Americans to be a serious moral failing worth addressing.
As time passes, I continue to wonder whether healthcare is an appropriate domain to apply a free market. The asymmetry of information between patients and providers is extraordinarily vast. This makes insurance middlemen the only ones capable of making bridging that gap, and the only way a for-profit enterprise will bridge it is with a bottom line orientation.
Over at Donklephant, old friend WHQ posted a link to a great article comparing practices in different places that consumed medicare dollars at grossly different rates.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all
Give it a read, I'm sure you'll enjoy it. If you do read it, I am sure you'll come away thinking that free market reforms would fix many of these problems. And I wouldn't entirely disagree. At the same time, I think it points out a serious cultural problem.
Asymmetry of information
The asymmetry of information in most markets is pretty vast. The unaided consumer has no way of analyzing, say, a dishwasher's construction to determine whether it will last 1 year or 5 years. But the consumer can buy a subscription to Consumer Reports to find out the odds on how long the dishwasher will last.
Lots of folks no very little about computers. But they manage to buy decent ones anyway and (more importantly), in the long run quality of all the components goes up because of market forces. People ask friends for help, they read reviews, etc. Sure, it doesn't work perfectly every time, not by a long shot. Good people get snookered from time to time, or a company capitalizes on its brand reputation to make a big one-time profit before it completely tanks. But on the whole, it works quite well to get us more goods and services, for cheaper, than any other system that's ever been tried, in the history of humanity.
Don't you ask your friends and co-workers for advice on who they think the best doctor is? Dentist? There are growing numbers of tools available to rate hospitals and other medical providers on quality of care over time.
Yes, there's cases where there's not time for comparison shopping. You get hit by a car, you go to the closest ER, and have little choice but to pay what they say you owe. But that's a pretty small part of total healthcare spending. Do you take the name-brand pill or the generic one? Your cardiologist says you need a bypass, and he'll schedule you next week. Do you want it done at hospital X or hospital Y? You can go here, drill through to hospitals in your area, and see how they rank for inhosptial mortality, +1 month mortality, and +6 month mortality. Or check with Consumer Reports. Your doctor says you need surgery to fix condition X. Today, you can go on the internet and search for condition X and find out whether your doctor really knows what he is talking about or not.
Most medical bills do not result from procedures which must be performed immediately, with no time for contemplation or thought or even comparison shopping. They stem from decisions like taking Lipitor, or because you've got a cold that hasn't broken for a week and it's time you got around to seeing a doctor, or from annual check-ups which result in being told to have a procedure done in the next week or two. One does not have to rely on one's insurance company for any of this information. Of course, if the policy is structured so that it pays almost all the costs, you have no reason to be particularly concerned about the costs. The fact that such a huge part of even the most basic care is paid predominantly by government or insurance today does make it more difficult for individuals to negotiate with healthcare providers, simply because they have no mechanism set up for it.
AS for shrinking the ranks of the uninsured, if you bring costs down, more people are able to afford the health insurance. That's pretty basic. More to the point, however, which uninsured do you desire to help? The 25 - 75% who really should be able to afford coverage but choose not to get it? The perhaps 26% of people who qualify for current government programs but have not enrolled? The 20% who aren't American citizens? The 40% who are between the ages of 18 and 34, many of whom may choose not to purchase insurance because they don't think they need it at the moment?
As I've been saying for several years here now, "healthcare" is not one big giant problem calling for one big giant solution. How we should handle treatment of chronic diseases is different, most likely, from how we should handle treatment of long-term end-of-life care, which is different from how we should handle treatment of emergency care. One of many reasons to oppose the political monstrosities the President and Congress are trying to jam down our throats.
asymmetry can't be dismissed
I agree that asymmetry can be vast in many domains. In fact you mentioned several that I was musing about earlier today.I think its undeniably more of a negative to consumers as stakes get higher.As you point out, its quite true that motivated intelligent people with time can do things to bridge the gap. Still, in a competitive market this assymetry generally benefits competitors at the expense of consumers, and I find that much more troubling in healthcare than in most other domains.
Which americans do I think most need help with healthcare? Families with incomes below the median. The problem with tax cuts is that they least help those who need it most, in ther snes that really low-income folks aren't helped by tax cuts. I think a subsidy for poor families is quite defensible.
The other Americans who need help are the rest who are experiencing high cost growth and who lack protection from the costs of overutilization such as is described in the article I cited previously about McAllen Texas.
I actually have no problem
I actually have no problem mandating that everyone should get insurance. The whole idea of insurance works better when you have a larger pool to pull from. That is simple actuarial tables. However, Pat is right that a comprehensive catch all approach is wrong.
The system is structured wrong. However, that is a problem with insurance as a whole. Insurance is suppose to protect you when things go wrong. However, it is not a good system of prevention. It never has been and never will be. It is like the old tree over the house. The owner knows it is going to fall in a bad storm; but insurance won't pay the $2000 needed to take it down. However, the insurance will pay to fix the house when it falls and the deductible is less than the cost of preventive maintenance. Our health insurance system is the same way. It is not designed to be preventative. Reforming health care has to be broken up into manageable pieces. We need a catastrophic system, a major medical system and a preventive system.
Now the question of if any of this can be accomplished via free market or government is yet to be seen. Working on making preventative/minor medical more efficient would probably be the best place to start for the uninsured. However, it is also the least appealing to the marketplace. It has the highest overhead and the lowest return. This makes it the most difficult. It is actually a lot easier to deal with the other two segments in the marketplace. I am willing to admit that a hybrid public/private solution may be needed to fix the problems that exist with family practice medicine. It is overburdened and unattractive. There is a need for Walmart style medicine at this level. The days of Doctors hours don't work anymore. Last thing you want to do is get sick on a holiday or weekend or late at night. Sure, a lot of it can wait; but our culture has changed a long time ago. We can do everything else at 2:00am, why not be able to get a family practice doctor at that time. There are more of these starting to fill the market; but it is still the ER that ends up handling a lot of stuff it shouldn't.
Plus, it needs to be easier to use when not in town. I will use my own example. This summer I went on a road trip. Prior to the trip, I had a bad sinus infection. The doctor at my clinic that works with my student insurance gave me some meds including penicillin. I have never had an allergic reaction to it in my life. Something changed, a week into my trip, I started to have a bad reaction. Now, I was still three days from home. I had to press to get home because 1) I needed to be home on time to prepare for the new semester, 2) there was not a clinic that I could get into without less than a four hour wait along my way and 3) I did not want to have to pay $100 for an emergency room visit when I knew what it was but just needed to see a doctor for a prescription. Something they won't/can't do over the phone. My delay in treatment ended up costing me a couple of days because I couldn't really do anything. Oh, and I did find one clinic that could have gotten me in about two hours; but they had no agreement with my insurance company and the company was not going to cover for a non-emergency, as they determined it to be since I was not incapacitated. This is where the system is really broken.
It is too complex to deal with in a huge cover it all measure. The reforms have to be done in much smaller steps and all sides need to work on this.