David Brooks Doing the David Brooks Thing

There are aspects of this David Brooks column in the New York Times with which I’d very much like to agree.  (I’m much more inclined toward moderation than folks ’round here seem to perceive me to be, except naturally those farther to the right.)  But a couple examples of… what? wishful thinking? the sloppiness that obsessive moderation begets?… demand highlighting.

Take, for prime example, Brooks’s phrasing of a popular statement voiced around the center-right Internet throughout the day:

Roberts and six colleagues also restrained the power of the federal government to sanction the states. And, perhaps most important, he restrained future Congressional power.

The Supreme Court did no such thing.  It drew a line for use of the Commerce Clause to expand federal power well beyond where it actually ought to be, and then it opened up a whole new vista of possibilities in the form of creeping taxation.  What is the ObamaCare tax?  Is it a “sin tax,” as with cigarettes, to be levied against bad behavior?

Is it some new double-negative tax, levied on activities that Americans cannot not do?  Or is it some sort of inverted sales or excise tax on that which is not purchased?  (In which case, it would seem that the Constitution must allow us to evade the tax if we explicitly choose not to purchase insurance from companies that don’t sell it in our own states.)

In actuality, it’s a fee or fine. Either of those should require a violation that Congress must have the power to write into law, regardless of the method of punishment.

A second point from Brooks that demands consideration is this passing false truism:

Obamacare or no Obamacare, American health care is still distorted by the fee-for-service system that rewards quantity over quality and creates a gigantic incentive for inefficiency and waste.

I’ve been hearing, even from some relatively conservative people, that healthcare is somehow different as a market — not the least because a shoddy product (an inadequate treatment) can be fatal.  If that is the case, and to some extent it most surely is, wouldn’t fees for service tend to create a premium for quality?  Put differently, consumers would be willing to pay more for a service that is more likely to ensure their health, even if it comes in smaller quantities.

Most people would prefer one adequate pill to a daily regime of coded capsules.  Likewise, I don’t suspect many people would rather pay for time in a fancy MRI catacomb than chatting with the friendly neighborhood doctor, if the choice came down to those two.  In economic terms, a doctor whose talents are such that his patients can avoid expensive specialists and tests could charge more for what he does while still saving his patients (and the system) money versus the high technology, and multiple personnel and processing costs involved in its use.  Even more, he’d have incentive to find cost-efficient means of gathering the information and providing the services that previously he’d farmed out.

Our health care system is distorted, alright, but it’s distorted by layers of meddlers for whom the individual patient’s health is not the core incentive of their transactions.  Insurance should be insurance, and not broad health-benefit provision.  Employment should be employment, and not a health insurance delivery channel.  Government should be government, and not an arbiter of health consumers’ choices.  And doctors should be able to provide their services as they deem best, at a price that their clients find reasonable.

As long as these distortions persist, the inflation of health care costs will continue.

  • Dan

    Justin, I am in agreement with your philosophy, but I don't think you grasp just how bad things had become regarding the Commerce Clause. Based on the past century or so of Supreme Court case law, a huge portion of the legal community had come to believe that the Commerce Clause was essentially a general police power. Even worse, many had come to believe that this was a totally fine thing under living constitutionalism ("The world didn't end, did it? The framers got it wrong.") This is the first decision that sets hard and explicit limits on that power. It also set hard limits on the tax power and the spending power. Nobody can now argue that Congress has a general police power based on Supreme Court case law. If you happened to remove this one peculiarly-written act from the set of acts that survive these newly established limits, then limited government advocates would all be celebrating now.