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FiveThirtyEight

Politics

When the modern Democratic Party reached its nadir—by either the late 1980s and early 1990s or at some point earlier this decade, take your pick—one of the major criticisms leveled by Republicans, conservatives and self-critical centrist Democrats was that the party was held hostage by its own identity politics.

The argument against identity politics is that a party’s policy and platform choices are made with mostly electoral inputs in mind, even if said policies are not only detrimental to the country as a whole but often to the very identity groups whose votes are generated by such positions. The party is captured, paralyzed. So, for example, conservatives crowed for years (some still do) that affirmative action is a naked ploy to attract and keep minority votes, even if it creates perverse incentives and rewards mediocrity; George W. Bush’s “soft bigotry of low expectations” epitomized this critique.

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Although the GOP’s coalition is still the more monochromatic of the two parties, is it possible that they, rather than the Democrats, are now the party paralyzed by identity politics? A recent 60 Minutes segment about the costs of end-of-life care suggests that maybe they are. I would encourage people to read/watch the report in full, but if you don’t have time let me explain what I mean.

The segment is about the needless financial costs of end-of-life care. The US government spends about $50B each year on patients at the very end of their lives, much of it to little or no health or quality-of-life benefit. Because a lot of the procedures and medicines are authorized by doctors and hospitals worried about possible liability—pay attention now, tort-reform advocates—a lot of this money is being spent in medically-needless ways and thus ineffective because the treatments are unnecessary. Worse, because a lot of these procedures and medicines are administered by hospitals, where costs are higher–as NPR’s fantastic Planet Money team recently explained–these ineffective actions are also procured inefficiently. In short, it’s wasteful, which is bad enough, but expensively wasteful to boot. But because Medicare is there to pick up the tab, the disincentives against ordering irrelevant, expensive treatments are few.

Now, given that conservatives keep complaining about tort reform as if that were some miracle cure to our health care costs; given that they are also up in arms about rising government socialism (“one-sixth of the economy!”); and given their broader worries about government growth and spending more generally, we might reasonably conclude that Medicare—one the largest and fastest-growing programs in the entire budget—would sit atop their target list. Instead, Republicans point at Democrats in Congress and the White House and charge that they and they health care reform plans must be stopped because (a) they are going to cut seniors’ Medicare; and (b) they are going to institute “death panels” to pull the plug on seniors.

In other words, although the end-of-life use of Medicare is a government problem that violates almost every philosophy they espouse about the proper role of government—public sector over private; easily exploited by, rather than protected from, trial lawyers; a moral hazard, consequence-free billing system as opposed to rational, need-based spending; a program with rising outlays as opposed to slow or zero growth outlays—Medicare is instead the very program they are rallying behind.

And why? For votes—specifically the votes of those angry, mostly-white seniors upon whom they are betting their electoral fortunes in 2010 and beyond. In short, the GOP has now become so wedded to its dying, white majority that it is willing to sacrifice not only good public policy and smart long-term budgeting, but its very own core principles. Their politically-motivated, 180-degree defense of Medicare and their inflammatory rhetoric about death panels proves that the GOP is now the party paralyzed by identity politics.

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