https://www.nytimes.com/2017/06/27/opinion/health-care-london-fire-travel-ban.html?emc=edit_th_20170627&nl=todaysheadlines&nlid=59914923
What Do We Have a Government For?
The Conversation
By GAIL COLLINS and BRET STEPHENS JUNE 27, 2017
Gail Collins: Bret, let’s talk about rules. President Trump, like virtually all Republicans, thinks we have too many. Getting rid of government regulations is one of the cornerstones of his administration — if you can imagine anything as shaky as this administration having cornerstones.
The idea of streamlining government always sounds good. I live in Manhattan and half the buildings seem to be under construction sheds in order to comply with various regulations. When I was covering city government, the Department of Buildings was so inefficient people made entire careers out of standing in line for contractors.
But the ungodly fire in London put the whole thing in a different light. Officials were under pressure to be business-friendly, so they refrained from demanding that buildings be retrofitted with sprinklers. It also sure looks as if they went easy on building materials, although the investigation is still underway.
What are your thoughts?
Bret Stephens: My first thought is that every hot-blooded libertarian should read The Times’s cold-eyed investigation of the regulatory failures that led to the Grenfell Tower disaster.
My second thought is that we have to learn from the tragedy, but keep it in its right proportions. As the article notes, about 350 people die in fires in the U.K. each year, next to 3,000 in the U.S. — a favorable comparison for Britain even if you account for the fact that our population is about five times as large.
Third, I wish the debate about regulation was less ideological. There are good rules and there are dumb ones. Governments aren’t all-knowing and markets aren’t flawlessly self-regulating. Over- and under-regulation are both real problems. This is common sense to most of us and shouldn’t descend into a stereotyped left-right debate.
And another thing: Theresa May’s gotta go. My feelings about her are approaching yours about Joe Lieberman.
Gail: Wow, that’s very bad news for Theresa May.
We’re in agreement about good rules/bad rules. I have fond memories of the Clinton administration’s war on government inefficiency. Al Gore had his little hammer .… Ah, those were the days.
There are some things that will work out if you just let the free markets take care of themselves like, um, popular music. But there are others that won’t. And their number is legion, from building safety to … health care.
Bret: Building safety is a core responsibility of government, assuming it’s competently and honestly executed. I lived through a horrific earthquake in Mexico City in 1985, which at the time had some of the most stringent building codes in the world. They didn’t help because too many buildings, including dozens of public schools and hospitals, had been cheaply built in violation of the codes. Rules are good only if they are sensible, affordable — and enforced.
Gail: I would barge in here and point out that good enforcement requires government funding, but that’d just be cranky. Plus it’s your turn. Go on.
Bret: On health care, the libertarian conceit that health care is just another marketplace where consumers can make their own choices according to their own tastes and budgets, as they might at Whole Foods or Walmart, is silly. The real problem is that, as with buildings, it’s hard to define the upper limit of how much safety — or health — we want, especially when it comes at the expense of other goods: affordability, availability, experimentation, innovation and so on.
Notice I’m avoiding the elephant in this chamber, so to speak.
Gail: How did you feel about that government-efficiency order Trump signed calling for doing away with two regulations every time a new one was implemented? I’m stacking the deck here, given that it was based on a British model that could well have been one of the reasons there was no rule on retrofitting apartment sprinklers.
Bret: I liked that executive order — one of the very few things for which I’ve ever praised Trump. Maybe it’s Procrustean, but I’m hard-pressed to think there weren’t two outdated U.K. regulations that could have been retired for the sake of installing fire sprinklers in older housing projects. The license fee for the privilege of watching TV in black-and-white, for instance?
Gail: You may have more faith in bureaucracy than I do. I wouldn’t want to bet everything on officials having the energy to change the status quo and retract two rules that somebody somewhere probably has a stake in keeping on the books.
While we’re talking rules, I want to ask you about one in Obamacare. It requires most people to buy health insurance or face tax penalties, and it’s possibly the thing Republicans hate most in the entire program.
Can you explain that to me? I thought requiring people to take responsibility for themselves was a very conservative ideal. Mitt Romney used to say that all the time — at least back when he was governor.
Bret: The conservative answer would be that it’s an infringement on liberty to require people to purchase a product they don’t want; and that it doesn’t work. I’m more persuaded by the second point than the first, since it’s also an infringement on my liberty to have to subsidize, through my tax dollars, the bad choices of others. In Massachusetts, what was once “Romneycare” has mainly amounted, as a good op-ed essay in The Boston Globe pointed out last year, to a near doubling of Medicaid enrollees, declines in the number of people with employer-provided insurance and more than a doubling of costs.
I know everyone wants to pile on when it comes to the G.O.P. health bills. But I haven’t really seen my liberal friends come to terms with the fact that Obamacare was leading private insurers to pull out of Obamacare exchanges in one state after another, while Medicare premiums kept going up.
Gail: This liberal friend would say that Obamacare could quickly be repaired if the two sides worked together on it. It would still be a deeply imperfect program, of course. (Listen and you will hear the trees whispering, “Single-payer option!”)
But about requiring everyone to have health insurance: It’s the only possible way you can have a plan that allows people with pre-existing conditions to buy coverage. Otherwise they can just coast while they’re healthy and opt in when they’re looking at large bills.
Also, we’re committed as a nation to providing emergency health care to all — I believe our current president came out very strongly against letting people “die in the streets.” And it’s a crushing burden for hospitals when the people come into ER.s uninsured.
The most sensible answer is to have national health care for all. But if that isn’t going to fly I think part of being an adult citizen should be having at least adequate health insurance to pay for a crisis. Otherwise, we’re … encouraging spongers.
Bret: For those of us on the conservative side of politics, the chief problem of the Senate bill is that it is basically an Obamacare rescue package, as Philip Klein pointed out in The Washington Examiner. The Senate bill promises a lot of spending in the next three or four years to sustain Medicaid’s current expansion. The spending is pared only after that, which is to say, sometime during the Warren-Booker administration (or is that Harris-Sanders?). Which is all another way of saying, it’s never going to happen. That’s why I’ve been so skeptical of the whole G.O.P. exercise.
I suspect you’re going to get your wish for single payer, sooner or later. Even if the G.O.P. bill goes through, it won’t survive the eventual Democratic wave election, whenever it hits. And to me single payer sounds like a lousy outcome: a two-tier system in which middle-class Americans get lower-quality medicine while the fortunate few maintain access to expensive private clinics.
By the way, what’s your read on Supreme Court ruling in the travel ban case?
Gail: I don’t know that it’s a big deal in terms of the actual consequences, but this whole thing was born out of a clear, specific attempt to discriminate against one religion, and as far as I’m concerned, any piece of it is still tainted.
Bret: Uh-oh, we’re back to agreeing about something. The whole thing stinks. The stated purpose of the travel ban was to give the government three or four months to deal with supposed gaps in vetting procedures. On those grounds alone the executive order is moot. Then the court split the baby, upholding the ban only with respect to foreigners with no “bona fide relationship” with someone in the United States. But who’s going to figure out what’s a “bona fide relationship”? And then there’s the larger point that this is unmistakably a Muslim ban, awkwardly tailored to pass constitutional muster.
I hope Justices John Roberts and Anthony Kennedy consider what will happen when they rule in the administration’s favor — only to see Trump gloat over his “Muslim ban” in a tweet the morning after the ruling.
Gail: Speaking of tweets, you wrote a great column last week announcing that you were giving up twittering, except for occasions when you wanted to say something nice.
Welcome to the non-tweeting tribe! I have to admit my two reasons for pretty much avoiding Twitter are 1) fear of saying something really stupid and 2) fear of having it turn into another occupation. Yours seem much more elevated. How’s it been going?
Bret: I gave one last parting glance at the Twitter reaction, much of it obscene, to the column, and it made me feel that much better about the decision. Twitter is supposed to be just another communications tool, and in theory it has its uses. In practice, it has a way of turning its users into jerks. And yes, God save you (or me), from tweeting something impulsively and then regretting it for the rest of the week.
At the risk of being self-congratulatory, let me just say that part of what we’re trying to do with these conversations is model a certain kind of discourse — disagreement minus nastiness — that we could all use a little more of. Now, did I mention that your readers are demented morons if they think Betsy DeVos is the worst member of the cabinet?
Gail: Ah, the beat goes on. See you after our Independence Day vacation next week, Bret. And meanwhile, if you can’t tweet something nice about somebody, don’t tweet anything at all.
