By Kevin D. Williamson
Wednesday, March 08, 2017
To a visitor from the late 19th century, a modern
passenger train would be familiar enough. Even the wi-fi on Amtrak would be
within the realm of his imagination, at least if he was already familiar with
Mr. Marconi’s radiotelegraphy experiments. But even if he was familiar with
Karl Benz’s petrol-powered automobile (the first of them was built in 1886),
much of what is on the road in 2017 would have to seem to him like magic.
Imagine trying to explain to him how the self-driving features in a Tesla or
Mercedes sedan work, or even how the sensors that make such technology possible
work. “Well, Mr. Wells, in the front bumper of the car are eight cameras that
understand what they’re seeing, with electronic brains that solve math problems
at the speed of light . . . ”
Progressives love trains and despise cars — remember
Arianna Huffington’s daffy campaign against the SUV? — along with “car culture.”
This is a consequence of the fact that our politics are rooted in our
aesthetics, that “politics is downstream from culture,” as Andrew Breitbart
memorably put it. Progressives prefer urban life to suburban or rural life (if
you dislike car culture, chances are you’ll truly hate truck culture and gun
culture) and desire to live in communities that are scaled to pedestrians
rather than scaled to the Santa Monica Freeway. Lots of people who are not
politically on the left prefer that sort of life, too: TriBeCa really is a more
interesting and pleasant place to foot around in on a Saturday afternoon than
is Houston, if that’s your thing.
Trains are the preferred mode of transit if your ideal is
central planning. Automobiles are the preferred mode of transit if your ideal
is spontaneous order. It is in the nature of trains that they tell you where to
go; it is in the nature of automobiles (for the time being, at least!) that you
tell them where to go. If you have ever lived in New York and relied on the
trains to get around, then you understand both the virtues and defects of the
planning model: If everything goes according to plan, the system works pretty
well. When the plan breaks down — which it always does — it is a mess, often a
mess that leaves you with no choice but to go outside the system for an
alternative. (That fellow from the 19th century would probably think Uber is
pretty nifty.)
Likewise, if you’ve spent much time in Houston, Atlanta,
Los Angeles, or any American city that got most of its growth in the post–World
War II era, then you appreciate the virtues and defects of the
spontaneous-order life: The price of gasoline is unpredictable, traffic is
terrible in some places (although here there is a bit of central planning to
blame, too, in the form of Dwight Eisenhower’s ill-considered federal highway
system), the cost of owning and maintaining a car is very burdensome for some people
and introduces an unwelcome degree of financial uncertainty into their lives,
some people insist on driving their F-350 Super Duty trucks 87 mph while
swerving from lane to lane, suburban sprawl, etc.
Transit, like most everything else in life, is about
trade-offs. There are many roads that lead to home and subways that will take
you to the office, but there is no train to Utopia.
Question: Do we want our health-care system to be more
like the spontaneous order that produces both awesome cars and terrible
traffic, or do we want it to be more like the New York City train system, a
system that works well enough when it is working — which isn’t often enough?
The passage of the Affordable Care Act was a vote for
trains, and the House Republicans’ recently unveiled and remarkably modest
attempt at reforming it is a vote for a train system with a slightly different
fare structure and schedule.
We should think a little bit about why cars — and not
just cars for the rich — are so much better than they used to be.
The short answer, of course, is competition. Competition
is a spur to innovation, and it is a spur to — more important — investment.
What transformed Karl Benz’s first primitive automobile into the wondrous
machines we see before us on the road every day was the massive deployment of
capital. If you think not only of all the machinery, financial assets, and
human ingenuity that are at work making automobiles today but also of all the
machinery, financial assets, and human ingenuity that have gone into the
incremental development of the modern automobile over the centuries (many of
the technologies that make a modern car run far precede the first automobiles)
— it is beyond comprehending.
Of course that has happened with trains, too — modern
trains really are superior to their 19th-century counterparts — but in a very
different economic context, one with markets driven not by individual consumers
but by governments and large enterprises working not from changing individual
preferences but from various kinds of central plans, a market in which new
equipment is purchased not every few years but every few decades. At the high
end of the automobile market are buyers who get a new car every other year —
and who want something new and better every other year.
That part is key. There is something egalitarian about
trains and other forms of mass transit, but it is in the individualistic
automobile market that we really see a massive transfer of wealth that no one
ever notices. In cars as in mobile phones and many other consumer goods, new
technologies, new materials, and new concepts are developed most often at the
high end of the market, with the associated costs borne — enthusiastically — by
early adopters and high-end purchasers. Things like cruise control and
automatic windows begin as luxuries for Rolls-Royce owners and Cadillac
drivers, but end up as everyday conveniences for working stiffs with Hyundais,
who enjoy an invisible subsidy from the high end of the market.
But that model implies that there will be periods of time
during which some nifty and useful things will be available to Mercedes owners
but not to Chevy owners. We understand that situation and endure it without
complaint when it comes to automobiles, but not when it comes to health care. For
reasons that are by no means irrational or less than humane, we want health
care to be an all-Lamborghini market rather than a market with Lamborghinis and
Fords and Hondas (and bicycles and eccentric guys who walk everywhere and the
government-subsidized bus for those who cannot afford a car of their own). The
coverage mandates in Obamacare are essentially a set of rules that makes that
outlook a matter of federal law.
As long as government remains the central player in
health care (acting largely through the instrument of health insurance) and
there is no truly robust, individual consumer market both for health-care
services per se and for health insurance (these are separate enterprises:
health care means medical services, while health insurance is a financial service), then the
competition, innovation, and massive investment that are necessary to put the
medical business on the same better-and-cheaper-every-year trajectory as the
mobile-phone business or the automobile business are simply not going to
happen.
But allowing a market to work means accepting some
realities that we wish we could ignore: There will be inequality in access and
inequality of outcomes; there will be uncertainty; some people will make bad
decisions with results that we will not like; there will remain a need for
government-funded services for those who cannot provide for themselves.
Americans will eventually have to get used to the fact that they cannot enjoy X
level of health-care consumption while paying < X, no matter how many shells
we have in the shell game.
A better first step than what has been offered would be
working to jailbreak Americans out of their employer-based plans and letting
them loose in a market in which they can choose plans not only across state
lines but across national borders, too. (Surely there are some firms in
Switzerland or Singapore that would like to be dealt into this
multi-trillion-dollar game.) It is all good and fine to say “Let markets work,”
but that requires a market — a market with real prices — which does not really
yet exist. Tweaking the ACA here and there, while needful, will not get that
done. If Republicans are in fact telling the truth that this is only the
opening round in an iterative process of health-care reform, that’s fine: Trying
to do everything at once is usually a recipe for failure or chaos. But
majorities aren’t forever, and if Republicans are going to get moving in the
right direction, they had better get moving quickly. Eventually, that train
will leave the station.
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