Yuval Levin: I’m actually always struck by the way in which our left-right divide encompasses a broad array of not only political but also cultural, social, and economic differences. On the face of it, the division of our politics into two camps seems peculiar and paradoxical—we’ve got one party that combines social conservatives with economic libertarians and another that combines social libertarians with economic statists. The tension between libertarian and communitarian impulses clearly divides each party internally. So why shouldn’t we have a party of social and economic communitarians and another of social and economic libertarians? But I actually think the coalitions we have make a lot of sense—both philosophically and (more importantly) as a response to the circumstances of American history and American life.
At the level of ideas, Western politics has long been divided (in very general terms of course) along the axis created by the response to the radicalism of the French Revolution, and then sharpened and clarified by the response to the radicalism of communism. The radicalism of the French took the form of an assault on what they perceived to be irrational traditional mediating institutions like the family, religion, and local ties in pursuit of a pseudo-scientific technocratic mastery of human affairs that was thought to offer the promise of more rational, just, and effective administration. The radicalism of the communists accepted that aim and added to it an assault on what they perceived to be irrational and unjust market economics in pursuit of a pseudo-scientific technocratic command economy that was thought to offer the prospect of greater economic efficiency, justice, and equality. The left wing of modern Western politics emerged to advance these two sets of views, with varying degrees of radicalism in various countries at various times. The right wing of modern Western politics emerged to oppose these views, and so to defend first traditional mediating institutions and practices, and second the market economy.
Americans, in this regard as in most regards, have been less extreme than our European cousins. Our left wing, therefore, has for the most part not consisted of communists or radical anti-family atheists (though we have had our share, to be sure) but of more mundane technocratic reformers and social activists who view traditional institutions (sometimes rightly, sometimes wrongly) as oppressive and unjust. And certainly in our time, with the left all over the world reeling from the collapse of communism and the growing decay of the welfare state, the left is on its heels a bit. But our political debates are still, to a great degree, defined by the debate between organic or traditional mediating institutions on the one hand and technocratic expert management on the other. That distinction is at the heart of the health-care debate, for instance. It is at the core of many of what we call the social issues in our politics. It is the essence of our economic policy arguments. And it is still what divides left and right.
Our parties today actually embody this division better or more clearly than they used to. There have always been conservatives and liberals (or progressives) in American politics. But until fairly recently, there were some of each in each party, so the parties didn’t so much embody as contain our deepest ideological divisions. Today, the parties come much closer to embodying those divisions, so that we really have a conservative and a liberal party. In the course of the second half of the 20th century, the conservatives were made to feel unwelcome in the Democratic Party, as it grew more culturally liberal and more aggressively technocratic. Friends of the market and friends of the family, threatened by a common enemy, found common cause in the conservative camp. This in turn made the Republican Party more decidedly conservative, and therefore made many liberal Republicans feel unwelcome, and turn to the Democrats.
So we find that the various social, cultural, demographic, and economic distinctions that fall along the axis of ideas that has given shape to Western politics for more than two centuries now fall pretty neatly along our partisan axis as well. Our parties are increasingly divided between adherents of expert management and pseudo-scientific rationalism in politics on the one hand and defenders of traditional mediating institutions and self-organizing markets on the other. Obviously tensions remain within each camp: the family and the market are not always natural allies, and neither are technocracy and equality. But there is both a historical and a philosophical logic to this division, it speaks to the debate at the heart of modern life, and so it persists. It has made our conservative party increasingly populist and our liberal party increasingly elitist, and it has made our politics increasingly sharp and clear (or, if you like, polarized and divided).
All of that is both good and bad, like everything else in life. But, to return to your question, it means that our partisan divisions today actually capture quite a lot of underlying social, cultural, and historical divisions. I think left and right mean more in American life today than they ever have before....
RS: Let's say Obamacare were repealed tomorrow and conservative voters wanted to pick up their phones and tell their Representatives what they want instead - but didn't know exactly what to say. If you were advising them, what would tell them?
Yuval Levin: Two plain and boring words: defined contribution. That is the key to the conservative approach to reforming American health care.
The problem with our health-care system is that costs are rising too quickly, and therefore both bankrupting government and preventing too many people from being able to afford insurance. How do we keep costs down in our kind of economy? The left and the right each has its answer. The left’s answer is you force them down by government policy—put government in charge of purchasing coverage for everyone and let it set price controls that then shape the market. The right’s answer is you create a consumer market in which providers have an incentive to offer a better product at a lower price....
Conservatives would transform each of these from an open-ended benefit to a defined contribution: in each case, the government would provide consumers with a pre-defined amount of money to spend on health insurance (in addition to any of their own money they want to spend), and those consumers would then choose among an array of insurance options—options which would be regulated by the states, as insurance is now, but not micromanaged by the federal government. The purposes of today’s policies—to make sure that the elderly and poor can get insurance and to help the middle class afford it—would still be served, and indeed would be served more efficiently at lower cost. And market incentives would be aligned to promote lower costs more generally, rather than higher ones. The cost of the most basic or minimal coverage for catastrophic care would be likely to drop precipitously, to the point that just about everyone could afford it (if the exclusion for employer-based coverage were transformed into a tax credit and every family got $5,000 they could only use to pay for insurance, you can bet that $5,000 minimal insurance policies would emerge, neither consumers nor providers would leave that money lying on the table), and more expansive coverage would be within the reach of more families.
There is much more to be said about the details, of course (here is one very good paper to read). But moving from open-ended benefits to defined contributions is key.