The Los Angeles Times is running a feature headlined “Conserva-care” in which four conservatives are asked what they would do to fix the nation’s health care crisis. Here is the short version.

First up is former Senator William “hide the cat!” Frist. Frist is an MD whose family fortune rests largely on the medical-industrial complex. I will come back to the Frist family business in a minute, but first let’s hear what Dr. Frist has to say.

The Frist plan for health care reform: Don’t get sick. Seriously. Live a more healthful lifestyle, and especially don’t get fat. It will lower the cost of everyone’s health care if we don’t need it so much.

Really, that’s it. That’s the entire plan.

Next is Mickey Edwards, former Republican congressman from Oklahoma. Edwards suggests a two-step approach:

Step one: Authorize creation of an alternative, non-government source of insurance — a “pool” that would allow the uninsured, self-insured, etc., to join in a private plan that would not be tied to any particular employer or association. This plan already has a great deal of bipartisan support and could easily be brought to life.

In other words, the public option without the “public.” I assume it would be left to the administration of the private insurance industry, which of course is eager to establish a less-expensive alternative that would complete with its own products. (/snark)

The second step is to regulate the insurance industry so that private companies no longer refuse to sell policies to people with pre-existing conditions. That’s a great idea! And it’s in the Obama plan already!

You’ve heard of David Frum. Frum, at least, is willing to admit the idea about selling insurance across state lines is a crock —

New Jersey health policies cost more in large part because New Jersey hospitals and doctors charge more. If I buy a cheaper Kentucky policy that reimburses my providers at Kentucky rates, leaving me to pay the balance, how much good does that do me? And if the Kentucky policy is made to pay New Jersey rates, there vanishes my low Kentucky price.

This has always seemed obvious to me, but I despaired of every seeing anyone on the Right understand this point. Anyway, Frum is thinking boldly. He wants to strip the states of their insurance regulatory policy to create one big national market instead of 50 state markets.

What we need instead is to assert federal regulatory authority over the whole marketplace and get the states out of healthcare altogether. Let the insurers do business as national entities; let the market contract to four or eight major insurers; and then let them do unto their suppliers as Wal-Mart does unto its suppliers: squeeze them.

Hmm, Wal-Mart. This reminds me of something.

You remember Rick Scott, the guy who organized Conservatives for Patients’ Rights and ran a bunch of inane ads against health care reform? Way back when Scott was the CEO of Columbia Hospital Corporation/Hospital Corporation of America (the latter being the old Frist family business, which Columbia purchased in 1994.

Anyway, while he was running Columbia/HCA, Scott preached loudly about the superiority of his efficient, for-profit business model over the sloppy practices of not-for-profit hospitals. His partner, Richard Rainwater (if that name sounds familiar — Rainwater had extensive business ties with George W. Bush) actually called Columbia/HCA “the Wal-Mart of healthcare.” Like Wal-Mart, he said, Columbia/HCA was a big chain that used volume buying and strict cost controls to provide services a low cost.

At the time, many not-for-profit administrators believed Columbia/HCA’s claims were hyperbole. In an article about Columbia/HCA by Joe Flower in Healthcare Forum Journal (March-April 1995), the senior vice-president of a prominent not-for-profit hospital group pointed out that healthcare managers all went to the same business schools, and that volume buying and cost controls were hardly revolutionary. “Price cuts from volume buying will not represent a sustainable competitive advantage for Columbia/HCA,” the senior vice-president predicted.

It turns out that Columbia/HCA’s real competitive advantage was not found in squeezing the suppliers, but in defrauding Medicare. Although he was never indicted, Scott was golden-parachuted out the door of Columbia/HCA in 1997, and the Frists swooped in and began running Columbia/HCA.

Anyway, however much money we might save from obtaining cheap medical equipment from China — slave labor and no quality control will lower costs — the Wal Mart approach already has been tried. Big hospital corporations and major medical centers already have been doing the volume buying thing for some time.

Well, Frum is a wuss, anyway. We finally get to Richard A. Viguerie, a true hairy-chested manly kind of conservative. He’s on Medicare, yes, but conservative nonetheless. Viguerie has a four-part approach.

One. Expect people to pay for much of their own health care out of health savings accounts. “When people spend their own money, they spend it more wisely,” Viguerie said. Patients need to have “skin in the game,” after which they may need to see a dermatologist.

The rightie idea is that Americans are getting too much health care. They demand health care they really don’t need because they aren’t the ones paying for it. If patients had to pay more of the costs themselves, they use better judgment about what health care they try to buy.

One problem I have with this theory is that in all those “socialist” (righties: I’m using the ironic sense) countries in which patients aren’t paying for their own health care, we’re not seeing costs go up as dramatically as in the U.S. Overuse of the system may be a problem in some countries, but other countries seem to be able to control it.

Also, in the real world, we’ve got these creatures called “doctors” who are the ones making the decisions about what tests, procedures, etc. their patients will receive, assuming the insurance companies approve it. And there are some aspects of some physicians’ practices that could use some reforming, Id say. I’m sure there are patients who do demand unnecessary MRIs because people are always getting MRI’d on House, but surely there are ways to control that beside expecting people to pay for their tests so they are not overused.

Also, in the real world, the health savings plan idea would work fairly well for upper-income people with no serious health problems, or for the fabulously wealthy. For everyone else, it would pretty much bite.

Two. Don’t allow government to control health care, Viguerie says. No one is calling for government to “control” health care.

Three. Allow consumers to purchase insurance across state lines, which is a really bad idea.

Four. Don’t discourage profits. I believe that’s from the Ferengi Rules of Acquisition.

Not much of a plan, but Viguerie isn’t done yet. Remember how uninsured patients are driving up everyone’s health care costs? Viguerie’s got the answer to that:

Obama claims that health insurance is a moral imperative. By law, hospitals can’t deny emergency treatment for patients who aren’t insured, leaving an unpaid care gap estimated at more than $50 billion annually, according to the American Enterprise Institute. Conservatives and independents at the tea parties, town halls and beyond believe it is a moral imperative to stop burdening the next generations with trillion-dollar deficits and to stop government’s stealing from the Medicare trust fund, which now has unfunded liabilities of $36.3 trillion, according to the Heritage Foundation.

OK, wait a minute — is he saying we should just not provide health care for people who can’t pay for it, period? Let ’em die in the streets? And this is somehow tied to saving Medicare, which is a single-payer health care system run by the government?

Well, yeah, that’s the end of Viguerie’s little essay. I guess that’s what he’s saying.

So, in a nutshell, the conservative plan is … don’t get sick.

Missile Defense.
Righties are dense.
Baucus booed.
Workers screwed.
Discuss.

At The New Republic, Jonathan Chait reviews two new books about Ayn Rand — Goddess of the Market: Ayn Rand and the American Right by Jennifer Burns and Ayn Rand and the World She Made by Anne C. Heller. Via Burns and Heller, Chait’s review nails Randism and the Randbots who still worship at her altar. Just a snip:

When Rand condemned a piece of literature, art, or music (she favored Romantic Russian melodies from her youth and detested Bach, Mozart, Beethoven, and Brahms), her followers adopted the judgment. Since Rand disliked facial hair, her admirers went clean-shaven. When she bought a new dining room table, several of them rushed to find the same model for themselves.

Chait calls Rand’s ideas “inverted Marxism.” He notes the degree to which her novels “oddly mirrored the Socialist Realist style, with two-dimensional characters serving as ideological props.” Like Marxism, Rand’s Objectivism “failed for the same reason that communism failed: it tried to make its people live by the dictates of a totalizing ideology that failed to honor the realities of human existence.”

Yes, Rand hated Marxism, and her ideas were relentlessly reactionary to Marxism. But because Rand’s life and work were shaped entirely by reaction, she was never really free from the things she opposed. Marxism still ruled and defined her, even as she imagined herself liberated from it. Hers was an utter failure to find equanimity.

Anyway, the larger point of both books is the degree to which Rand’s unbalanced ideas still haunt our political discourse. In particular, we are hobbled by the idea “that the United States is divided into two classes–the hard-working productive elite, and the indolent masses leeching off their labor by means of confiscatory taxes and transfer programs.”

(An aside: Culturally, IMO there is something profoundly un-American about Randism. Although we’ve always had our Calvinistic undercurrents, through most of American popular culture since the age of Andrew Jackson our national mythos was about the triumph of common men — yes, usually men — over the inbred, indolent elite. Americans may have admired George Washington, but we identified with Davey Crockett, Daniel Boone, and Huckleberry Finn. Our ur-myth was about the savvy, weather-beaten cowpoke who proves to be a better man than the wealthy, educated city slicker. Now our ur-myth is about winning American Idol.

But notice how the once-admired cowpoke has been replaced by the likes of Joe the Plumber, a man plucked from obscurity not because of his weather-beaten independence but for his usefulness to the elite cause. Wurzelbacher became a pet of the elite because he embodies their sterotypes of a working man while parroting their worldview. In truth, he is close to being a white Step’n Fetchit.)

Chait’s review goes on to demolish most of the assumptions on which Randism is based, particularly the myth of the “self-made man” and the belief that wealthy people are wealthy because they work harder than poor people and therefore are more deserving.

Now, the part that intrigues me is the way so many obviously ordinary, poorly educated and un-affluent Americans have somehow bought into this nonsense. Think of the people presented in the video in the previous post. There is nothing “elite” about this crew. In large part, the rank-and-file of the tea partiers are from the “indolent masses” so devalued by Randbots. IMO what we’re seeing here are two different social-political pathologies finding common ground in opposing progressivism.

The tea-partiers also are locked inside an ideology that says some people are more deserving than others. But in their world “deserving” is not defined by wealth and status, but by race and culture. This is discussed by Michael Lind in “Uninsured Like Me.” See also, Glenn Greenwald’s “Who are the undeserving “others” benefiting from expanded government actions?”

What’s beneath wingnut hysteria is not just racial hatred but a sense of racial/nativist entitlement. They are obsessed with the idea that progressivism means taking something away from them and giving it to people who are undeserving (i.e., not white, especially not native-born white).

Having come from a working-class white background myself, I can’t tell you how many people I’ve met in my life who were neither wealthy nor especially industrious, and who were invested with the usual number of faults and moral weaknesses, but who saw themselves as being uncommonly hard-working and virtuous because they were white people with jobs. Such people deny their own vulnerabilities — economic catastrophe couldn’t happen to them — and somehow identify with the self-interests of people who are far more wealthy and insulated than they are. Hence, working people without health insurance somehow are persuaded to oppose health care reform.

(Sign at Saturday’s 9/12 demonstration: “I work hard so Obama voters don’t have to.”)

Odds are that some minority of Saturday’s 9/12 crowd have no health insurance themselves. They are, in effect, choosing to do without decent health care for themselves than to share a benefit with the Other. They are disproportionately and irrationally obsessed with the issue of illegal immigrants getting a taxpayer-funded benefit, and they would rather sacrifice cost-effectiveness than begrudge so much as an aspirin to a migrant worker. As I wrote recently, we Americans are spiting ourselves to death.

So the Randbots and the 9/12ers view the world in different ways, but they’ve come together in lunatic solidarity nonetheless.

This toxic compound is all the more dangerous because it is funded by powerful corporate and media elites. Hendrik Hertzberg writes,

This sort of lunatic paranoia—touched with populism, nativism, racism, and anti-intellectualism—has long been a feature of the fringe, especially during times of economic bewilderment. What is different now is the evolution of a new political organism, with paranoia as its animating principle. The town-meeting shouters may be the organism’s hands and feet, but its heart—also, Heaven help us, its brain—is a “conservative” media alliance built around talk radio and cable television, especially Fox News. The protesters do not look to politicians for leadership. They look to niche media figures like Rush Limbaugh, Sean Hannity, Glenn Beck, Michael Savage, and their scores of clones behind local and national microphones. Because these figures have no responsibilities, they cannot disappoint. Their sneers may be false and hateful—they all routinely liken the President and the “Democrat Party” to murderous totalitarians—but they are employed by large, nominally respectable corporations and supported by national advertisers, lending them a considerable measure of institutional prestige. The dominant wing of the Republican Party is increasingly an appendage of the organism—the tail, you might say, though it seems to wag more often from fear than from happiness. Many Republican officeholders, even some reputed moderates like Senator Chuck Grassley, of Iowa, have obediently echoed the foul nonsense.

Our national forefathers vowed to create “a more perfect Union,” but we have never really overcome the divisions of race and class that have plagued us from the beginning. I’d like to close by pointing out that Canada is at least as racially diverse as the U.S., yet Canadians seem able to govern themselves sanely. In the Washington Post, Jonathan Malloy argues that what makes the difference between the U.S. and Canada is that the two nations are operating under different national myths. “Canadians, who have a highly fragile and internationally ignored national identity, understand instinctively that health care says a lot about a country’s heart and its understanding of itself,” Malloy writes.

I fear our country’s heart is a cold one, and if it’s heart doesn’t warm up soon the U.S. is destined for a long and steep decline.

Via AllSpinZone (’cause I hardly ever read Maureen Dowd any more), today MoDo got to the roots of what’s motivating the tea partiers (emphasis added):

Surrounded by middle-aged white guys — a sepia snapshot of the days when such pols ran Washington like their own men’s club — Joe Wilson yelled “You lie!” at a president who didn’t.

But, fair or not, what I heard was an unspoken word in the air: You lie, boy!

Yesterday70,000 or so right-wingers “demonstrated” in Washington. If you believe their handlers, a segment of people who looked on complacently for eight years while the Bush Administration plundered the treasury suddenly are outraged about government spending. Some of them seemed to have other concerns, however.

Did any of yesterday’s protesters carry signs that had some connection to actual issues — “No Public Option” or “Ixnay on Exchanges” or something? Or was the entire exercise about the hobgoblins who live in their heads?

Like Dowd, I don’t forget that “Democratic presidents typically have provoked a frothing response from paranoids.” But as much as they hated Bill Clinton, the degree of frothing does seem to have been kicked up a notch.