Policy or Judgment?

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Rep. Steve LaTourette (R-​​Bainbridge Town­ship, OH), a casu­alty of vot­ers’ shift to a pol­icy focus

I’ve been intrigued by what seems to me to be an evo­lu­tion in the way we choose our elected offi­cials. From my under­stand­ing of his­tory, the pur­pose of a rep­re­sen­ta­tive form of gov­ern­ment is to have the peo­ple col­lec­tively choose a sub­set whom they trust to make deci­sions that would reflect, as closely as pos­si­ble, the desires that they would have, were they to be informed of the rel­e­vant infor­ma­tion. That is, they are sup­posed to choose some­one in whose judg­ment they trust.

When an elected offi­cial uses judg­ment, it’s not unrea­son­able to expect a shift in pol­icy as new infor­ma­tion becomes avail­able or the fun­da­men­tals change. In fact, not only is it not unrea­son­able, it should be expected.

But increas­ingly our gov­ern­ment offi­cials are being pil­lo­ried for using judgment.

A con­ser­v­a­tive website’s reac­tion to John Roberts’s opin­ion on the indi­vid­ual mandate

Look at Chief Jus­tice John Roberts, whose job as a judge is, by def­i­n­i­tion, to use judg­ment. When he found the health insur­ance indi­vid­ual man­date to be con­sti­tu­tional, he went overnight from being the hero of con­ser­v­a­tives to a trai­tor. He wasn’t expected to use judg­ment; he was expected to toe the line on con­ser­v­a­tive pol­icy. And, when he failed to do so, he was vil­i­fied for it.

We have been hear­ing an ever-​​growing cho­rus of mem­bers of Con­gress who are retir­ing because they can no longer stay in Con­gress in good con­science, because they are increas­ingly unable to use their judg­ment, and are instead expected to hold fast to an overly sim­plis­tic set of immutable policies.

They read his lips, and later read him the riot act.

And so, over time, vot­ers have shifted from choos­ing elected offi­cials based on judg­ment to choos­ing them based on pol­icy. Those who were unwill­ing to acknowl­edge the shift paid for it with their jobs. Remem­ber “read my lips”? Pres­i­dent George H. W. Bush made the right judg­ment call in rais­ing taxes when he did, but it vio­lated the pol­icy under which vot­ers chose him.

The prob­lem with choos­ing our rep­re­sen­ta­tives based on poli­cies is that they are immutable and ever­green. Until taxes are elim­i­nated alto­gether, they can always be lower. Until our gov­ern­ment is lit­er­ally bank­rupt, we can always spend more on police offi­cers, fire­fight­ers, teach­ers, roads, mil­i­tary, and health­care. Pol­icy of this sort doesn’t leave room for acknowl­edg­ment of trade­offs or prioritization.

Repub­li­can Pres­i­den­tial can­di­date Mitt Rom­ney hasn’t had a career of pol­icy, which has resulted in par­tic­u­larly unen­thu­si­as­tic sup­port from the Repub­li­can base. But nei­ther has he had a career of judg­ment. How can we tell? Because a rep­re­sen­ta­tive using judg­ment can explain why his con­clu­sions have changed over time. Rom­ney could have explained why he thought Rom­n­ey­care was good when he sup­ported it, but that his opin­ion had changed because of lessons learned. Instead, he has tried to explain why the PPACA is com­pletely dif­fer­ent from the vir­tu­ally iden­ti­cal pro­gram he sup­ported in Mass­a­chu­setts. That’s not show­ing judg­ment; that’s pre­tend­ing he has been fol­low­ing a con­sis­tent pol­icy all along.

Com­pare this to Rep­re­sen­ta­tive Paul Ryan (R-​​Janesville, WI), who is Romney’s run­ning mate. Ryan has long run on a pol­icy plat­form. While his votes in Con­gress haven’t always hewn to the pol­icy, he has nonethe­less man­aged to build a rep­u­ta­tion for being a con­ser­v­a­tive pol­icy man, with none of that pesky judg­ment to get in the way. It is this rep­u­ta­tion that gar­ners the sup­port of the Tea Party.

What we’re left with is a ticket that has nei­ther judg­ment nor pol­icy at the top, and solely pol­icy in the #2 slot.

Things are dif­fer­ent on the Democ­rats’ side, with a can­di­date at the top who is focused on judg­ment. As you might imag­ine, I pre­fer this model. That said, while I think the pol­icy that is derived from Pres­i­dent Obama’s judg­ment aligns pretty closely with my own, it is also clear that his judg­ment in get­ting the resul­tant poli­cies enacted has not deliv­ered the desired results. Per­haps nobody could have; it’s hard to tell in absence of a con­trol. I am more inclined to believe that judg­ment at the top sim­ply can­not be effec­tive against coun­ter­vail­ing policy.

Given that judg­ment con­tin­ues to wane as pol­icy waxes in the Dis­trict of Colum­bia, I’m afraid this does not bode well for our nation’s future.

But per­haps I’m too much of an ide­al­ist and not enough of an ide­o­logue. What do you think?

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  1. GROG,

    Here’s the prob­lem as I see it. The states now have, and have always had, the power to cre­ate state-​​level health care solu­tions for their citizens.

    With the excep­tion of a hand­ful of states (Mass­a­chu­setts, Ore­gon, Ver­mont), there haven’t been any state-​​level solutions.

    How would you reduce the num­ber of Amer­i­cans with­out insur­ance (about 50 mil­lion) absent Fed­eral action?

    In my view (and you’re wel­come to dis­agree), the state-​​level solu­tions didn’t arrive for over 100 years, the sit­u­a­tion got worse and worse, and finally Con­gress had to act. Absent Fed­eral action, unem­ployed or under­em­ployed Amer­i­cans were with­out health care, clog­ging up the sys­tem and mak­ing them even unhealth­ier, and we were spend­ing 18% of our GDP on health care. That’s a huge drag on the national econ­omy.

  2. GROG,

    He thought Mass­care was good for the nation in 2007. He thought Mass­care was good for the nation when Obama embraced it. He has never thought it should be fed­eral law.

    Then why, in his op-​​ed, which was clearly timed to match the ACA debate, did he say that those things should be done…but not once did he say the states should be doing it? Given the con­text, why on earth would some­one walk away from that arti­cle with the impres­sion that the advice was intended, not for Obama, but for 49 Governors?

  3. Michael,

    The advice was clearly intended for Obama — par­tic­u­larly two main points.  The first being to not rush the bill through a par­ti­san Con­gress.  It took two years to work out Mass­care.  The sec­ond, advis­ing against a pub­lic option.

    These are a sum­mar of the points he made.

    1) He encour­aged Obama to not rush a bill through a par­ti­san Con­gress like he did the stim­u­lus and cap and trade bills.

    He threw in every spe­cial favor imag­in­able, ground it up and crammed it through a par­ti­san Demo­c­ra­tic Con­gress. Health care is sim­ply too impor­tant to the econ­omy, to employ­ment and to America’s fam­i­lies to be larded up and rushed through on an arti­fi­cial dead­line. There’s a bet­ter way. And the lessons we learned in Mass­a­chu­setts could help Wash­ing­ton find it.

    2)  He advised the pres­i­dent against a pub­lic option.

    To find com­mon ground with skep­ti­cal Repub­li­cans and con­ser­v­a­tive Democ­rats, the pres­i­dent will have to jet­ti­son left-​​wing ide­ol­ogy for prac­ti­cal­ity and dump the pub­lic option.

    3) He men­tions how his state got 98% of its cit­i­zens insured.  In Mass­a­chu­setts, cit­i­zens do not pay a fine for not pur­chas­ing insur­ance.  They instead do not receive cer­tain tax cred­its they would have received if they did pur­chase insurance.  

    4)  He advised the that the fed­eral gov­ern­ment should stop send­ing bil­lions to hosp­tials and use those funds to help the poor buy pri­vate insurance. 

    Sec­ond, we helped pay for our new pro­gram by end­ing an old one — some­thing gov­ern­ment should do more often. The fed­eral gov­ern­ment sends an esti­mated $42 bil­lion to hos­pi­tals that care for the poor: Use those funds instead to help the poor buy pri­vate insur­ance, as we did.

    5) He advised that patients should pay a higher por­tion of their bill.

    We might do what some coun­tries have done: Require patients to pay a por­tion of their bill, except for cer­tain con­di­tions. And providers could be paid an annual fixed fee for the pri­mary care of an indi­vid­ual and a sep­a­rate fixed fee for the treat­ment of a spe­cific con­di­tion. These approaches have far more promise than the usual bro­mides of elec­tronic med­ical records, trans­parency and pay-​​for-​​performance, help­ful though they will be.


    Those rec­om­men­da­tions does not equal say­ing  — “fed­eral health­care law should be mod­eled after Mass­care”.  And noth­ing he has said or writ­ten prior to Obama becom­ing Pres­i­dent or after Obama becom­ing Pres­i­dent sug­gests otherwise.

  4. “The fed­eral gov­ern­ment sends an esti­mated $42 bil­lion to
    hos­pi­tals that care for the poor: Use those funds instead to help the
    poor buy pri­vate insur­ance, as we did.    ”

    How does that dif­fer from the cen­tral point of ACA, wherein the poor are given assis­tance to help buy pri­vate insur­ance? If Rom­ney sup­ports the idea of using fed­eral funds to help the poor buy pri­vate insur­ance, why does he oppose the idea of using fed­eral funds to help the poor buy pri­vate insur­ance?

    I under­stand that your ide­ol­ogy does not allow you to see the
    dif­fer­ence between some­thing being “good for the nation” and
    some­thing “should become fed­eral law”. 

    I don’t under­stand. Do you want fed­eral laws that are bad for the nation? Do you want to avoid pass­ing fed­eral laws that would be good for the nation? Is not the point of a fed­eral to do some­thing that would be good?

  6. How does that dif­fer from the cen­tral point of ACA, wherein the poor are given assis­tance to help buy pri­vate insurance?

    Because it didn’t end an old pro­gram — the one that sent 42 bil­lion fed­eral dol­lars to hospitals.

    I don’t understand.

    You don’t under­stand that state laws can be good for the nation?

  7. You don’t under­stand that state laws can be good for the nation?

    I do under­stand that. Since states weren’t address­ing the ques­tion of pro­vid­ing ade­quate health care, do you not under­stand that the absence of both state and fed­eral law was bad for the nation? (That is, there were no state laws for us to judge whether they were good or bad.)

    Do you not under­stand that fed­eral laws can be good for the nation? And that if fed­eral funds are going to be used to help poor peo­ple buy pri­vate insur­ance, that requires a fed­eral law?

  8. GROG,

    The advice was clearly intended for Obama — par­tic­u­larly two main points. The first being to not rush the bill through a par­ti­san Con­gress. It took two years to work out Mass­care. The sec­ond, advis­ing against a pub­lic option.

    Exactly. Is that the advice of a man who believes Obama should have scrapped the whole thing and pushed for the states to do it instead?

  9. It took two years to work out Masscare.

    Yes, it did. It took about twenty years to work out the ACA, which started in 1992 soon after Pres­i­dent Clinton’s election.

  10. DC,

    Do you not under­stand that fed­eral laws can be good for the nation? And that if fed­eral funds are going to be used to help poor peo­ple buy pri­vate insur­ance, that requires a fed­eral law?

    Yes of course.  (That’s what I was try­ing to explain to Max ear­lier.)  But that has noth­ing to do with the false alle­ga­tion that Rom­ney at one time favored Mass­care as being a model for fed­eral law.

  11.  Michael,

    Is that the advice of a man who believes Obama should have scrapped the whole thing and pushed for the states to do it instead?

    No it is not.  Rom­ney clearly favors fed­eral action regard­ing health­care.  But he has con­sis­tently opposed mod­el­ing fed­eral law after Masscare.

  13. the false alle­ga­tion that Rom­ney at one time favored Mass­care as being a model for fed­eral law.

    I con­fess I don’t under­stand this. Rom­ney said that Mass­care is good, and that it should be a model for the coun­try. He also encour­aged fed­eral action, after say­ing what he thought was a good idea (i.e., Mass­care). I’ll awat your answer to Michael’s question.

  14. What fed­eral action does he favor?

    These are in addi­tion to the things I’ve already mentioned:

    Restore State Lead­er­ship and Flexibility

    1. Block grant Med­ic­aid and other pay­ments to states
    2. Limit fed­eral stan­dards and require­ments on both pri­vate insur­ance and Med­ic­aid coverage
    3. Ensure flex­i­bil­ity to help the unin­sured, includ­ing public-​​private part­ner­ships, exchanges, and subsidies
    4. Ensure flex­i­bil­ity to help the chron­i­cally ill, includ­ing high-​​risk pools, rein­sur­ance, and risk adjustment
    5. Offer inno­va­tion grants to explore non-​​litigation alter­na­tives to dis­pute resolution

      Pro­mote Free Mar­kets and Fair Competition

    6. Cap non-​​economic dam­ages in med­ical mal­prac­tice lawsuits
    7. Empower indi­vid­u­als and small busi­nesses to form pur­chas­ing pools
    8. Pre­vent dis­crim­i­na­tion against indi­vid­u­als with pre-​​existing con­di­tions who main­tain con­tin­u­ous coverage
    9. Facil­i­tate IT inter­op­er­abil­ity

      Empower Con­sumer Choice

    10. End tax dis­crim­i­na­tion against the indi­vid­ual pur­chase of insurance
    11. Allow con­sumers to pur­chase insur­ance across state lines
    12. Unshackle HSAs by allow­ing funds to be used for insur­ance premiums
    13. Pro­mote “co-​​insurance” products
    14. Pro­mote alter­na­tives to “fee for service”
    15. Encour­age “Con­sumer Reports”-type rat­ings of alter­na­tive insur­ance plans



    Do this with­out a 2400 page doc­u­ment “that relies on a dense web of reg­u­la­tions, fees, sub­si­dies, excise taxes, exchanges, and rule-​​setting boards to give the fed­eral gov­ern­ment extra­or­di­nary con­trol over every cor­ner of the health care system.” 

    And do it with­out adding $1 tril­lion dol­lars of new health care spend­ing that requires increas­ing taxes by $500 bil­lion and requires cut­ting $500 bil­lion from medicare.

  15. Speak­ing of rule set­ting boards, I must have missed where Rom­n­ey­care, which is sup­pos­edly “vir­tu­ally iden­ti­cal” to ACA, has an Inde­pen­dent Pay­ment Advi­sory Board which con­sists of 15 unelected bureau­crats who have more power over health­care than elected officials.

    Maybe some­one can point that out to me in Mass­care, being that the two are “vir­tu­ally inden­ti­cal” and all.

  16. #10

    Does that mean end the write-​​off to employ­ers and tax the employee (Ryan), or does it mean give the indi­vid­ual a tax write-​​off on H/​C premiums?

  17. It should mean giv­ing indi­vid­u­als a tax deduc­tion for pur­chas­ing their own insurance.

  18. @GROG

    Seman­tics, she­man­tics. A tax deduc­tion for pur­chas­ing is just the flip-​​side of the same coin that has a tax penalty for fail­ing to pur­chase, except the penalty prob­a­bly requires less paper­work, so less cost to the gov­ern­ment to imple­ment it…

  19. GROG,
    Yeah — in Mass­care, the deci­sions on what is proper insur­ance and the like are made, not by a dis­crete board, appointed pub­licly, but by bureau­crats in the state gov­ern­ment health depart­ment.  Mem­bers of the SEIU (Ser­vice Employ­ees Inter­na­tional Union).  So much bet­ter than some appointed med­ical experts.

  20. mclever,

    Under Oba­macare, there a penalty for pur­chas­ing pri­vate insur­ance rather than hav­ing it pro­vided by your employer.

    I was asked by Micheal what fed­eral action Rom­ney favors.  End­ing that dis­crim­i­na­tion is one of those things.

  21. GROG,
    The “penalty” you refer to is a his­tor­i­cal arti­fact, since for decades expenses for insur­ance your employer buys for you are deductible for the employer, while your indi­vid­ual cost is not deductible for you. 

    Although this is hardly fair to indi­vid­u­als, com­pa­nies seem to like it that way.  Still, call­ing it a penalty under Oba­macare isn’t what I would call honest.

  22. sc,

    If you make a salary of $50k per year and your employer pays $10k per year towards your health insur­ance ben­e­fits, you are not taxed on that $10k.  If you pur­chase health insur­ance on your own for $10k, you are taxed on that money when you earn it.  You may have to earn $12,500 in order to pur­chase $10,000 of insurance.

    That’s where the dis­crim­i­na­tion takes place.

  23. GROG,
    Absolutely cor­rect (I know this, because I have to buy insur­ance as an indi­vid­ual and don’t get a deduc­tion for it, even though I oper­ate my own business).

    And was that the case before the ACA, or is it newly made in the ACA?

  25. GROG,

    Could you please let us know how many Repub­li­cans who have taken stands on the issue of taxes and health insur­ance pre­mi­ums, stand with your posi­tion of giv­ing a deduc­tion to indi­vid­u­als, and how many, to make things “fair”, would sim­ply remove the exemp­tion and tax the indi­vid­ual for the com­pen­sa­tion paid in the form of health insur­ance pro­vided by the employer?

    Which camp has more support?

    Thanks 

  26. Max,
    What does that have to do with whether or not Rom­ney has ever sup­ported Mass­care as a model for fed­eral health­care law?

  27. GROG,

    That was not the ques­tion I posed to you. Have you dif­fi­culty with a related issue? The tax­a­tion or not of H/​C pre­mi­ums as you have just been dis­cussing doesn’t have any­thing to do with “Mass­care as a model” either!! I believe YOU raised that issue as a mat­ter of “fairness”? 

    The ques­tion to you remains on the table, with the adden­dum: What is Romney’s posi­tion on the mat­ter I have raised?

  28. Max,

    It was one of 15 things I listed in response to a ques­tion posed to me. I hardly “raised” the issue.