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Mitch Rofsky Headshot

Universal Health Insurance and the Failure of Liberal Framing

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To the right wing, the legal dispute over just one aspect of Obamacare isn't about the optimal strategy for health care delivery in the United States.

No, it's about the very nature of the U.S. economy, about whether America will remain America. The Wall Street Journal's Daniel Henninger put it precisely: If the Supreme Court upholds the individual mandate, the U.S. becomes France.

That's right. According to Sean Hannity, Michele Bachmann and countless others, although designed by the conservative Heritage Foundation and first implemented by the likely Republican Presidential nominee, the individual mandate is pure evil. With its adoption, America's socialist future is inevitable.

Obama's health care program, with its private doctors, hospitals and insurance companies, isn't close to socialism, of course.

But is it close enough to liberalism?

Conservatives frame economics as if there were only two legitimate philosophies: conservatism on the right and socialism on the left. Conservatives believe the marketplace maximizes human welfare. Socialists believe that government does. There's no room in between, so liberals are proto-socialists.

But liberalism is distinctive. Liberals believe that it's the interaction between the marketplace and the government that maximizes human welfare.

Why can't liberals frame this? True, framing is harder for liberals than conservatives. Conservatives plug into the "libertarian" frame of the Founders: Government "bad." Individualism "good."

Liberals too often respond in kind: Government "good." Individualism "bad."

But liberalism isn't socialism. Given how self-actualized Americans are, does anyone truly believe that individualism, self-reliance, hard work, etc., are "bad"?

All too often, the liberal frame appears limited to "morality": the unfortunate deserve our help, so government must be expanded.

This is just too narrow an argument. Conservatives have their own morality: the marketplace rewards "virtue." The poor didn't work as hard. They made bad decisions.

Liberals need a broader frame. When it comes to the economy, it is not "the government versus the individual." It's "the government versus the marketplace." The marketplace is essential but not perfect. And only government can mitigate its imperfections, which affect more than just the poor.

Liberals understand that the last 60 years have established the value of the marketplace and its superiority to government as the primary vehicle for organizing an economy. Yet, the same history has reinforced the wisdom that, unregulated, the marketplace can devastate unknowing investors, rip off consumers and destroy the environment, while leaving unskilled workers impoverished and unemployed workers hopeless.

These all reflect marketplace imperfections: the marketplace doesn't force businesses to internalize "external" costs (such as pollution); depends on perfect information (sorry, parents who bought toys manufactured with lead) and rational behavior (as, say, reflected by mortgage ratings agencies prior to the latest financial crisis); treats individuals as marginal numbers with no context (a positive when it forces everyone to meet an objective standard of productivity, but if your financially unstable family can't send you to college, not so much); and doesn't create sufficient living-wage jobs at all times for everyone who needs one.

Imperfect. As a result, much more liberal than conservative policy has become law, even though conservatives have generally controlled Congress since World War II.

Fortunately, there is a vehicle to manage the riskiness of the marketplace -- insurance. Most Americans recognize that certain forms of insurance must be universal so that the most unfortunate -- even those who don't have the money to pay for it or would make the mistake of not acquiring it -- can be protected from the greatest marketplace risks.

Private insurance is certainly useful to cover discretionary risks -- insure your jewelry or don't. But when we want universal coverage, it makes more sense for the government, to manage it.

This is true for unemployment insurance, retirement insurance (Social Security), worker's compensation, fire, flood and food insurance (food stamps). It should be true for health insurance as well (as it already does for seniors through Medicare).

In a discussion with the insurance rep of my company, Better World Club, I asked how much an insurance underwriter charges to manage a large company that is self-insuring: "6 to 9 percent, depending on the bells and whistles," was his response.

"And when you're moving risk around, the administrative costs and profits are closer to 30 percent, right?" I asked.

"Right," he responded.

"Then why shouldn't the U.S. declare that it is self-insuring, hire one of the insurance companies to administer it, and save the 20 percent or so cost of risk management that we don't need as we want everyone to be covered, which could then cover the uninsured?" He responded that it could. (If the government can administer it more efficiently, then fine. If it makes more economic sense to hire an insurance company(s), that's fine, too. Either way, billions are saved.)

Much of what we think of as economic liberalism is really about insurance. We have food stamps, but are not trying to nationalize farmers. We can have universal health insurance, without nationalizing doctors.

All of these insurance programs ameliorate the greatest risks of the imperfect marketplace while permitting it to function effectively. And people still get rich. (The stock market has done better under Democratic presidents than Republican.)

They are among the most popular -- and effective -- government programs as well. The Tea Party shout, "Keep Government's Hands Off My Medicare," is testament to this -- and to the ineptness of liberal framing.

Sean Hannity and Michelle Bachman may not want to admit it, but even if Obamacare went well beyond the individual mandate to government managed, universal insurance -- aka "single payer" -- it still wouldn't be socialism.

It's liberalism. Why can't Democrats say so?