John Podhoretz: I think that the release of the American Healthcare Act, the Republican effort to start taking on Obamacare showed the way Republicans talked about it both positively and negatively, showed that a Rubicon may have been crossed since the passage of Obamacare in 2010. And the Rubicon is, a kind of common unspoken, almost unspoken acceptance of the idea that there should be universal coverage for healthcare in the United States. That was never a conservative or Republican goal. It’s not the right goal but in conceding it, or in seeming to accept it implicitly, not necessarily in the drafting of this law but in the way congressman went on TV to talk about the law and to defend it or attack it. That concession means that in the largest picture, Obama might have won the larger argument about where healthcare is going in the United States. Which is to say if Republicans cannot defend the idea that what is important is the freedom of the individual to make choices about how to live his life as opposed to the notion that we are all in this together and must all participate in healthcare to ballast each other’s healthcare outcomes. Then we have accepted an essential social Democratic principle and that’s a huge concession.
This is the problem with the failure of imagination of conservatism. It’s that we’ve conflated a policy outcome, more people having health insurance, with the process by which we achieve that outcome. And the point I’m trying to make is that we conservatives, we have always known that less government leads to more abundance, more wealth, more prosperity. We would never say we need more government so that every American can have a smartphone. We would never say we need government so that every American can have a job and yet we’ve accepted the left wing narrative that the only way to make sure that more people have the economic security of health insurance is through more statism. Why do we accept that narrative in healthcare when we accept it nowhere else in the economy? And this has been the failure of imagination of conservatism.
Avik Roy: Let’s say in 2010, hypothetically, we passed a law that reduced federal spending by 10 trillion dollars over three decades. Reduce taxes by two trillion dollars over three decades. Had no individual mandate but ended up resulting in 20 million more people having health insurance because health insurance premiums went down by 25%. This is, admittedly, a hypothetical scenario. But if that combination reforms less spending, less taxes, fewer regulations, led to more people having health insurance, would that have been a defeat for conservatism?
Generally, that’s the difference between digital health apps and mobile apps in other industries. The line for minimum viable product (MVP) is a far brighter line in digital health. You have to clear a real threshold of quality and accuracy, which in turn has implications for how you structure the business, how much capital you raise, all of it.