Dr. Yuval Levin is the founding editor of National Affairs and contributing editor to National Review and The Weekly Standard. The Hertog Fellow and Director of the Bioethics and American Democracy program at the Ethics and Public Policy Center, Dr. Levin is a leading figure in the health care policy debate.
We invite you to read our interview with Dr. Levin:
What sparked your interest in Healthcare Policy
Health care is an usually clear instance of what we often think about of as the left-right divide in public policy debates. On its face, it seems a technical question – how do we provide these goods and services in health care in a way that controls costs but gives us high quality. But once you dig in to that question, it ends up being about the role of government and the nature of our society; what we owe one another and how we might go about meeting those obligations. It’s a significant practical question for our society. How we, as a society, can meet the challenges posed by that kind of modern good makes politics interesting.
As a leading voice in the health policy world, what is it you see that needs to be resolved?
How to provide people with access to the benefits of modern medicine in our very wealthy society without undermining those benefits, individuals’ freedom, or their basic rights. On one hand, our government is going bankrupt paying for health insurance. On the other hand, a lot of people don’t have access to coverage or to care. Should we spend more to provide people with access or spend less to keep the country from going bankrupt? The underlying problem that drives both of those is that costs in health care are too high and grow too quickly. It’s an enormously complicated but interesting and important policy question.
To what extent is it the responsibility of a government based in the preservation of natural rights for its citizens, as ours is, to address or resolve these issues?
In a lot of ways, the way the idea of rights is introduced into the health care debate is very counter productive. When people talk about a “right to health care” as a positive right, that has relatively little to do with what our government exists for. To me, the health care debate is not ultimately about whether there is or is not a “right to health care.” I don’t think there’s a coherent way to really think about that question in a way that makes sense.. Natural rights, and the ways they shape our understanding of what our government is about, run much deeper than these kinds of more practical everyday policy questions.
What role do you see Natural Rights having in current US Health Care Policy?
It’s important for those of us who understand our government as defined by a certain ideal of natural rights in the sense that that gives us a broad ideal of what government ought to be in our society. In a lot of ways that role is about opening and securing a space in which a free society can live and thrive. Health care is one of things we can do in that protected space. It’s one of the things the free economy can provide for us. It’s one of the things modern science and medicine can provide for us.
What kinds of considerations need to be made for private choices in medicine – those of the doctors and patients.
The kinds of complicated choices and difficult moral judgments that people have to make when it comes to health care are going to be made much better by people involved in the situation – by the patient and the family of the patient – than by a centralized bureaucracy that tries to treat everything as an economic question. These are life and death choices, we don’t assign those to the government if we can help it. We have to make sure we understand the ways in which our healthcare system has to answer to a vision that allows us to maximize peoples’ freedom and dignity and control over their circumstances.
It’s clear every individual needs some level of health care. How do you distinguish a basic level of health care – especially when every individuals’ needs are different?
The role that government and public policy ought to play should be something like enabling people to enter health care markets as consumers with meaningful consumer power. The idea should be for government to make sure there is at least a floor – a minimal level of access and resources – that people have to access health car. Beyond that, people should have choice and control. And that’s not because choice is the highest good. It’s because this is the most plausible way to arrive at a system that finds the best balance between giving people control over intimate choices and judgements and making sure we are not leaving behind the poorest people in our society.
What advice do you have on balancing private and public sector?
Ask ourselves what role should government be playing: the provider, the insurer, or providing a safety net. I think the latter is the most plausible role for our system of government that’s informed by a sense of what works rooted in our experience with the market system. That means government, to the extent possible, ought to provide a set benefit that’s available to everyone and sets a floor. So people have at least access protection against catastrophic costs in health care and people with greater needs have access to some more protection than that. I think that’s what a lot of conservative approaches to health reform look like. I think “single payer” would be a huge step in the wrong direction as an economic matter and also a moral matter and we have to make that case.
Looking forward, what do you see as politically viable alternative policy that would fit this description. Are there any policy proposals or bills that you favor? If not what would you recommend?
I think that something that follows the logic of Graham-Cassidy – that the role of government as a provider of a safety net underneath the individual market in health care ought to flow through the states. Overall, I think we ought to think in terms of defined benefit support. To make available a set amount that helps people enter the health insurance market as consumers. That’s how a lot of employer provided coverage works, it’s how the Medicare advantage system works. I think it’s a more plausible way to think about the role of government.
What would you recommend for anyone interested in getting involved in health care policy?
Begin from first principles. Think about the nature of our system of government, what it’s rooted in, the idea of natural rights, and think about what those principles/ideals might have to say about how we think about public policy questions. We have to resist the tendency to treat our society like a machine where you just turn dials and get it working. Understanding ourselves as living in a moral order has a lot to say about what the role of government is in health care both in terms of means and especially in terms of ends. I think people inclined to think that way are badly needed in the health care debate.