America’s health-care debate is like a grown-up version of the silly ’90’s-era “culture wars”: Today’s fights are exposing profound and serious differences between “progressive” and “conservative” worldviews.
There is some research to suggest that these differences are rooted in temperament (more on this in future posts, but for now, see this pdf of a new paper by John Jost and his colleagues on temperament and ideology in last year’s election). If that’s so, then the left-right divide probably has a genetic component, and the basic question of politics (how do people change their minds?) gets more interesting. Because if we’re temperamentally wired to go left or to go right, then it’s not rational argument alone that sways us.
It’s clear to many now that reason has its limits, as we follow the health-care debate and confront arguments that make no sense to us. In such moments, you don’t think “I disagree heartily.” You think: “How could anyone think like this?”
That is how I feel about conservatism as a philosophy. I want to say why — not to persuade anyone but because, in circumstances where reasoned arguments won’t move people, the best we can do is understand each other better.
So, here goes.
As a general principle, I think, conservatives believe (a) what we’ve inherited from the past should be protected from change (because it is inherited, no other justification necessary) and (b) attempts to change people and society will generally make life worse, not better.
Case in point: This explanation by the ever-lucid Megan McArdle about why conservatives prefer markets to governments when it comes to distributing goods and services. “Progressives are so fond of rules,” she writes, because
they don’t want to tell grandma to take morphine instead of getting a pacemaker. It’s much nicer if you create a mathematical formula that makes some doctor tell grandma to take morphine instead of getting a pacemaker. Then the doctor can disclaim responsibility too, because after all, no one really has any agency here–we’re all just in the grips of an impersonal force.
Two things leap out of this, like Thoreau’s trout in the milk, to a non-conservative mind. First, the assumption that Grandma should get her bypass (because grandmothers have in the past, because no one would tell her own granny to go off and die). Second, the assumption that an impersonal force must be worse for decision-making than personal feelings and habits. Both those notions seem essentially conservative to me, and I don’t understand either of them.
The fact is, we’re in a global political paroxysm over health care precisely because no nation can afford to give people all the medical care they want. Health care technology is ever more expensive, many more people are living long enough to suffer from “lifestyle” diseases that stem from obesity and smoking, and expectations for care are higher than they were 20 or 30 years ago. So all health-care systems have developed means of saying “no,” and most people realize that if Grandma gets her bypass, some other grandma doesn’t. Or all grandmothers get bypasses, but less is spent on immunizing children, or treating infertility, or some other need. Choices have to be made, by one means or another.
Now, if we make such choices the province of individuals, we know, they will be bad for society as a whole. The rules will be bent for especially beloved old ladies, or by especially pro-senior doctors. And people in the grip of love, guilt, fear and grief will throw aside fairness and balance, and fight like enraged wolverines to get the most they can for Grandma.
In a world run along those lines, in other words, we’re looking at national bankruptcy and widespread injustice: more bypasses than we can pay for, and a country in which rich grandmas get three bypasses and poor grandmas get aspirin.
In other words, medical spending is one area where abstract rules are better than nuanced personal relationships. Just as we require aggrieved people to file lawsuits (instead of burning down the offending party’s house) and insist that people pay taxes according to a formula (instead of just handing over what “feels right”) so in the realm of health care, we want some choices to be unconnected to individual emotions and individual beliefs.
Which is, yes, a way of saying we want a way for people to behave in ways that don’t feel “natural,” that aren’t in line with how they were raised, and which weren’t a part of their world 20 or 30 years ago.
Those are my intuitions, anyway. I think they arise from the two principles of nonconservatism: First, things change, all the time, inevitably, so the past is no guide to the future; and, Second, if you don’t try to manage change, it will happen to you anyway, but in a worse form than if you had faced up to it.
Change is natural. To me, then, conservatism — the fantasy that change can be prevented or ignored — feels desperately contrary to the natural order of the universe.
We “progressives” like rules because rules detach people from tradition, habit and personal emotions. Abstract rules make it easier for people 30 years from now to behave differently from people 30 years ago. McArdle seems to say that’s a damn shame. But it’s going to happen anyway, so we might as well get our heads out of the sand and engage.
As I said, it’s a fundamental, temperamental difference.