David Frum is worried that politicians might learn the wrong lessons if the GOP "wins" health care. He's specifically worried that Medicare will never again be touched. At the American Scene, Conor argues that a better lesson for politicians to learn would be to "keep it simple":
If health care reform is defeated, one lesson should be that it is easier to scare people in misleading ways when your legislative reform package is so ambitious, ill-defined, complicated and all-encompassing that confusion [becomes] inevitable. Politicians should conclude that their time is better spent taking smaller, discrete steps to reform the health care system[.]
I'm sympathetic to this argument. Generally speaking, one of conservatism's most compelling aspects (among the non-Palins) is its embrace of doubt and intellectual humility in the face of planning. This is Burke's challenge to all planners, from Rousseau to Marx to Dewey.
And agency capture and interest group legislation are real concerns. I've been researching the history of spectrum regulation lately, and it's not exactly regulation's finest hour. But of course, that's why virtually no American liberals are "planners" in the strawman sense. Regulation is needed sometimes, and sometimes it's not.
But all that said, I disagree with Conor in the context of health care. Incremental legislation in this particular context won't work because it would create a Whack-a-Mole problem. That is, fixing one discrete issue would only reallocate problems elsewhere.
Think about how an incremental bill would look. I assume there's a wide consensus to ban pre-existing conditions. But the ban becomes pointless if insurers can just jack up the prices for, say, Down Syndrome. That, in turn, leads you to some sort of community rating.
But even if you solve that problem, then you create a wicked bad adverse selection problem, as high-cost individuals come rushing to get coverage. The answer to that, in turn, is some sort of individual mandate (or some device to get healthy people in). But the mandate will only be fair if you subsidize coverage for poorer people. And that brings up revenues issues, which brings up the ever-so-sexy, Orszag-chicy "curve" problems.
The point here is that pretty much any incremental bill would trigger this sort of a "Because A Little Bug Went Ka-Choo"-type chain reaction of additional legislation for it to be effective. Starting down one path will inevitably lead us down other, bigger ones.
Of course, I suppose a bill could be so incremental that it doesn't accomplish much of anything. But then what's the point?
(By the way, one reason to read TAS is that you get wonky health care posts followed immediately by posts like this.)