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Chickens-For-Checkups and Conservative Hostility to Health Insurance

I suspect lots of you who have never heard of Nevada senatorial candidate Sue Lowden have heard of the "Chickens For Checkups" brouhaha, which has already swept through the late-night comedy circuit and is now endangering Lowden's front-running campaign to beat Senate Majority Leader Harry Reid.

Long story somewhat shorter: at a candidate forum Lowden got to talking about individual negotiations between patients and health care providers as a tool to hold down health costs, and suggested that people without insurance barter with their doctors.

Asked about it on a Nevada TV station, Lowden defended the validity and relevance of bartering for health services, and mentioned the "olden days" when people would pay their doctors with chickens. And then, for reasons that defy imagination, she kept defending her gaffe, and getting other Republicans to defend her gaffe, turning what should have been a one-day story into a major political disaster.

Worse yet, her main rival for the Republican nomination, Danny Tarkanian, is now using her clueless handling of the controversy as a good reason to vote against her. Tark's campaign is encouraging people to watch a video of Lowden's latest interview on the subject, which is pretty devastating. She has finally stopped defending poultry-bartering as a good idea, but instead engages in a stammering effort to change the subject while accusing Harry Reid of "trying to change the subject."

It's unclear exactly how much damage Lowden has done to herself (a DKos/R2k poll released just yesterday showed her remaining well ahead of Tarkanian and maintaining a small lead over Reid) , but it is clear the gaffe-aganza will haunt her campaign til the primary, and, if she survives it, all the way to November.

Sue Lowden is a casino owner and a former state party chair; she wasn't born yesterday. It's entirely possible that some of the hilarity at her expense is based on sexist gender stereotypes, particularly since she is, after all, a former Miss New Jersey and a self-proclaimed advocate for the Miss America Pageant. But in any event, I suspect something else is going on here that has largely escaped notice: poultry metaphors aside, Lowden believes what she says about bartering, reflecting the bedrock conservative conviction that reliance on health insurance, private or public, is what's driving up health care costs. According to this theory, when people in the "olden days" had to pay for health services out-of-pocket, they were more responsible for taking care of themselves and had a strong incentive to obtain the lowest possible prices. With "third parties" (i.e. insurance providers) handling health care provider payments, these incentives have largely disappeared.

This implicit hostility to the very idea of insurance and risk-spreading is what accounts for the perpetual Republican support for Health Savings Accounts, which provide tax incentives for purchasing health services with saved cash, theoretically limiting the need for insurance to catastrophic ailments. (Indeed, Lowden talked up HSAs in her original "bartering" comments). And it's also why virtually every major GOP health "reform" proposal (notably those advanced by George W. Bush and John McCain) in recent years has focused on driving people into the individual market for both insurance and health services. They never come out and say it like Lowden did, but the idea is to go back to the "olden days" of the 1950s or earlier when Americans were basically left to their own resources to deal with health problems.

So give Sue Lowden some credit for candor, and more importantly, be prepared to hang the "Chickens-For-Checkups" label on any Republican who talks vaguely about the need for greater "individual responsibility" in health care.

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I suggest that anyone thinking of using this argument first read "How American Health Care Killed My Father" in the Sept. 2009 Atlantic. One reason American Health Care is so costly is "nobody" pays for it. ???

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