The insightful refrain of conservative populists goes something like this: The once-prosperous American middle class was built on nuclear families, well-paying jobs, and broad economic prosperity. Today, this simple dream is out of reach for millions of Americans. Conservative populists have done an excellent job articulating potential policy reforms around support for families raising children, bringing back the manufacturing key to our national security, and opposing monopolistic behavior from big tech companies that contributes to the economic bifurcation of the United States.
Yet one prominent field of public policy has gone largely unmentioned: health care. Is this because health policy innovation is the exclusive domain of Democrats? Is it because Democrats say that they care more about health care than Republicans? Or is it because, as Paul Krugman snipes, conservatives just don’t care about health care?
The answer to all three questions is obviously no. The reasons for conservative populism’s seeming neglect of health care likely has more to do with the newness of the movement than any prejudice against health policy itself. But conservative populists should talk about health care. Health care in the United States is exorbitantly expensive without delivering comparable outcomes to peer countries. Moreover, the chief liberal health care proposal is an unwieldy Medicare For All plan that is a policy disaster and a political impossibility. In this vacuum, there is a real opportunity for conservatives to generate health policy reforms that actually benefit American patients.
A conservative populist health care platform should acknowledge that the American health care system too often financially victimizes its most vulnerable patients. The evidence for this is staggering: medical bills are the most common reason for bankruptcy in the U.S. Patients who unwittingly go to an emergency room that is out of their insurance network can be saddled with tens of thousands of dollars of expenses—and you can be sure that even the most social-justice minded hospital will come knocking to collect. Meanwhile, drug prices are higher in the United States than they are in any of our peer countries, despite the fact that we drive the world’s drug development. More evidence, perhaps, that the rotten fruits of globalization have been left on America’s doorstep.
The costliness of American health care does not have a single culprit. Yes, drug prices have increased faster than the rate of inflation—but pharmaceutical research paved the way for our miracle COVID vaccines. Yes, hospitals have a disturbing tendency to raise prices when they merge—but our major medical centers touch the lives of practically every American by tending to us when we are sick. Even insurance companies—a common political punching bag for their administrative bloat and high premiums—have been drivers of some of the most substantial efforts to lower health care costs, and they tend to have high approval ratings from their beneficiaries.
While there is no single cause of exorbitant health care costs, there is a single victim: the American patient. Conservatives can align themselves with vulnerable American patients by pushing for incremental reforms that protect patients in their moments of suffering. For instance, Congress could pass legislation restricting pharmaceutical companies from increasing drug prices faster than inflation. Congress could also approve increases in funding for the Federal Trade Commission to heighten oversight of hospital mergers, ensuring that such mergers don’t lead to regional monopolies. And conservatives could also support legislation that removes nonprofit status from hospitals that have significant regional market share yet refuse to accept forms of public insurance.
This incremental approach to health care reform eschews the jarring reforms proposed by liberal Democrats in favor a pragmatism aimed at ensuring that American patients aren’t left holding the bag as health care’s big players—the insurers, hospitals, and pharmaceutical companies—go to war over the spoils. In the long run, a conservative populist platform might seek to improve an American hospital landscape that mirrors the American economic landscape: urban behemoths expand and prosper while their rural counterparts flounder and dissolve. And, of course, the ultimate conundrum in U.S. health policy remains parsing out the connection between health insurance and employment, something that makes little sense given that the median employee tenure in the United States is less than 5 years.
A conservative populist movement ought to protect American patients in their most vulnerable moments. An incremental approach that seeks to lower costs for patients and their families would be an excellent first step.
In a feature on our What Happened: The Trump Presidency in Review collection, Eric Levitz notes that “American Compass represents the most intellectually honest tendency within the anti-Establishment right.”
Responding to the Coin-Flip Capitalism project, University of Chicago Professors M. Todd Henderson and Steven Kaplan say to leave investors out of it: the fees to fund managers prove the social value.
In an extended New York Times interview, Oren Cass discusses the importance of labor to conservative economics.