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"Big Government" and the Health Care Crazies

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Politics in this country is routinely described as a battle between liberals who want a larger role for government and conservatives who favor a smaller role. This framing is completely wrong, but the conservatives insist on using it because it helps advance their agenda. Liberals tend to accept it because they like to lose.

In reality, there is no direct relationship between the extent of government intervention in the economy that one prefers and whether they are liberal or conservative. There are numerous examples of cases where the conservatives have supported large amounts of government intervention in the economy, most notably in supporting strong patent and copyright protection. These are government-imposed monopolies that have the effect of redistributing close to $1 trillion a year from consumers to patent and copyright holders.

Another example is the "too big to fail" doctrine that says that we have to hand hundreds of billions of dollars to Wall Street bankers who can't keep their banks from collapsing. The conservatives who support these handouts cannot claim to be opposed to big government.

There are many other instances that can be cited in which the view that is conventionally labeled as "conservative" involves a larger role for government than the liberal position. Conservatives certainly don't like big government social programs, but that's because they don't like to see income flow from the top to the middle and bottom, not because they are inherently opposed to big government.

In the current debate over health care reform, most commentators are anxious to plug it into a big government versus the market framework. This is bizarre because the debate clearly does not fit this framework as the townhallers have tried to make clear.

The townhallers' efforts to fend off Obama's "death panels," while having nothing to do with anything in the health care reform proposals, are clearly not the complaints of someone opposed to big government. If it is possible to make any sense of the townhallers' concern, it is that Medicare and other public health care programs will not pay for medical procedures that currently would be covered by these programs.

In other words, the townhallers are worried about less government involvement in providing health care, not more. And they are yelling this fact as loudly as they possibly can. Yet, the media insist on ignoring what the townhallers are saying and instead tell us that the townhallers are coming out to "protest a bigger government role in health care."

Health care is already a sector with massive government involvement. Nearly half of all spending is covered by the government (more than 60 percent counting revenue lost through the tax deductions related to employer paid insurance premiums and other health care expenditures). Many items in health care are expensive simply because of government intervention, most notably prescription drugs and medical equipment, which are expensive because of patent monopolies.

No one in this debate is arguing for ending the enormous role that the government plays in the provision of health care. They are talking about restructuring this role. In this context, the big government story makes no sense. The question, pure and simple, is who is the government serving by its intervention? Is it ensuring that everyone gets the best coverage at the lowest possible cost or is it acting to guarantee high profits for the insurance industry, the pharmaceutical industry and other big actors in the health care industry.

What is at issue in the health care debate is who gets the money. It has nothing to do with bigger or smaller government. It is understandable that the industry groups and Republican opponents of the plan would like to discredit serious reform by labeling it "big government." It is less understandable that independent news outlets would mindlessly repeat this nonsense. It is even less understandable that liberals who support health reform would adopt this framing as well. Losing can be a tough habit to break.