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Two days ago, Matt Yglesias pulled the pin on a rofl grenade, and yesterday he basked in the lulzplosion. Yet I think it’s worth addressing exactly why it is conservatives have a deep, emotional attachment to doctors – and vice-versa. Indeed, 16 of the 19 doctors in Congress are Republicans.
First, they tend to be old, white, and male.
Second, they tend to be rich.
But even beyond that, there’s lots of strong, deeply-rooted reasons conservatives gravitate towards doctors as vectors for identity politics. They work extremely hard. They are often small business owners or independent proprietors. They are seen (and perpetuate the image of themselves) as beseiged by regulation and government intrusion. They spend many years working extremely hard for little immediate reward, only to be richly rewarded later, a sequencing that matches conservatives views about the virtue of patience, saving, and hard work. And they also do good while still getting rich from doing good and they’re extremely popular which makes them vastly better symbols than CEOs or financiers or even, in some ways, the military, since even though the military is general respected and popular it is also fairly-widely associated with aggression, violence, discriminatory practices, and other negative characteristics that many would avoid.
So suggesting that doctors are actually rent-seekers supping on government cheese served on government silver while drinking fine wine out of government crystal really touches a nerve.
To relate this to another hobby horse of both myself and Yglesias, it’s similar to the reasons conservatives tend to have a giant blind spot around urban land use issues. Essentially, all the identity politics orbit the image of a person in their own, large, private home, being in their own large, private vehicle, owning their own land, away from cities filled with miscreants and students and criminals and socialists and various sundry unwashed masses. That this lifestyle is supported by exactly the kinds of burdensome, costly, stifling regulation they claim to oppose sets off a surprisingly rabid reaction.
Of course, there’s also tremendous cognitive dissonance among conservatives around the very idea that conservatives practice any kind of identity politics, so even brushing that raw patch elicts yowls.
Of course, this could all be changing. Nothing persists but change.
Now that it’s been a few months, we can all calm down and stop arguing over power calculations in the Oregon Medicaid Study and acknowledge that the most important finding in the study was this one:
For all the talk about the state of American health, and whether Medicaid provides quality healthcare, people really neglected to discuss that health insurance is insurance, a fundamentally financial project in which customers exchange regular payments for a promise to be protected from the consequences of low-probability but high-cost events. It’s certainly an interesting question whether car insurance or homeowner insurance effect the rates of collisions or fires, but more importantly it is completely clear that these products eliminate people who have suffered those events from also being bankrupted. Similarly, health insurance is a way that people who contract cancer from not also contracting six-figure debts. Despite what is my very strong discomfort with conventional methods of statistical significance, it is clearly obvious from the above results that even the relatively-minimal insurance afforded by Medicaid succeeds somewhere between “substantially” and “wildly” in reducing the financial risk of illness.
Now, the health care market is a funny one, because of the weird ways we think about it and conceptualize, the expense of it, and the large hand the taxpayer has in it. But while we should definitely strive to increase the efficiency of health care, by encouraging good behavior and incentivizing preventative care and reducing wasteful care and introducing more cost-reduction pressure and reducing administrative costs and eliminating infections in hospitals, all that is separate from following the commitment our society has already made to guarantee at least some forms of medical care to those in need with a commitment to put a ceiling on the financial risk that individuals can incur when they elect to not simply wander off and die when catastrophic illness strikes.