Let's start with Who Really Cares: The Surprising Truth About Compassionate Conservatism: America's Charity Divide; Who Gives, Who Doesn't, and Why It Matters, by Arthur Brooks of Syracuse University's Maxwell School. Brooks, a political scientist who grew up in Seattle in what he says was a liberal home, examined the data and came up with a conclusion that he found unlikely enough that he went back and checked the data again: Conservatives give more to charity than liberals. As he explains, it's a little more complicated than that. Fact 1 is that Americans give a lot to charity:
A large majority of U.S. citizens give money away: Approximately three out of four families make charitable donations each year. The average amount given by these families is $1,800, or about 3.5 percent of household income. And contrary to what one might think, it is not true that American giving goes allor even mostlyto churches. About a third of individual gifts go toward religious activities, such as support for houses of worship. The rest goes to secular activities, such as education, health, and social welfare. All together, private charitable donations in the United States add up to a quarter trillion dollars a year.
That's $250,000,000,000, folks. Not chump change.
Here are some other interesting findings:
Although 225 million Americans give away money each year, the other 75 million never give to any causes, charities, or churches. . . . [A] very bright line exists between people who give and people who don't give. People who do give time and money tend to give a lot of it.
Givers are also more sympathetic and tolerant than nongivers. Consider the ways in which donors and nondonors differ in the feelings they express for certain groups in the population. Data from 2002 tell us that givers express less negative prejudice than nongivers toward African-Americans, whites, Latinos, and Asians. But it doesn't stop therethey are more sympathetic to Protestants, Jews, Christian fundamentalists, and Catholics. They like labor unions more, but big business more, too; also environmentalists, feminists, welfare recipients, and political conservatives. They like the Supreme Court, Congress, the U.S. military, and the federal government more. Givers are more favorably disposed to everybody than nongivers. (Everybody, that is, except for two groups: Nongivers like political liberals and the news media slightly more than givers do.)
Givers seem to have more of what sociologist Robert Putnam in Bowling Alone (which, amazingly enough, is not currently available), calls social connectedness than nongivers. The fact that givers outnumber nongivers by 3-to-1 suggests there is more social connectedness in our Tocquevillian republic than Putnam suggested.
What makes people charitable? Brooks writes that the data on giving demonstrate to him that "four forces in modern American life are primarily responsible for making people charitable. These forces are religion, skepticism about government in economic life, strong families, and personal entrepreneurialism." In an opinion article on the editorial page of yesterday's Wall Street Journal, he notes that religious people give nearly four times as much a year as secularists, and more than 50 percent more each year to nonchurch organizations than secularists. Also, "people who oppose government income redistribution donate four times as much money each year as do redistribution supporters." Married couples give more than singles, and entrepreneurs give more than nonentrepreneurs. Conclusion: "So while there may be nothing more inherently charitable about political conservatism, today's conservatives do outperform liberals on most measures of private giving."
Brooks is at some pains to insist that he does not mean to denigrate liberal beliefs and to note that many political liberals do contribute generously to charity. But his facts speak for themselves. If charitable giving is a test of compassion, conservatives are more compassionate than liberals. I suppose that liberals could argue that charitable giving is not the test. Along the lines of the old dodge, "I gave at the office," they could say, "I gave at the ballot box."
When I was growing up in the 1950s, when most adults had vivid recollections of the Depression of the 1930s, it was widely thought that deep economic downturns were a natural consequence of capitalism and that government aid to the economically disadvantaged was necessary because private charity could never cope adequately with a downturn like that of the 1930s. Those assumptions seem weaker today. As the obituaries of Milton Friedman reminded us, Friedman proved that the Depression of the 1930s was the result of serious public policy mistakes, mistakes we have learned to avoid; it was not the necessary result of capitalism. And private charity, to the tune of $250 billion a year, doesn't seem like such a weak forceand seems to do a lot more good than the welfare system that was reformed in the states starting in the late 1980s and at the federal level in 1996.
Speaking of Milton Friedman, he wrote the foreword to The Cure: How Capitalism Can Save American Health Care, by David Gratzer of the Manhattan Institute. Gratzer is a physician and a Canadian whose first book was on Canada's dysfunctional government health system. Like Who Really Cares, The Cure is not a long book, but it manages to provide some useful historic background on how America's healthcare and healthcare-finance systems came to be what they are. Looking back to the introduction of penicillin in 1941, he shows how medicine can do so much more than it could back when my father was a premed student in college. He notes that the 1943 decision to make employer-provided health insurance exempt from employees' income taxes has tied health insurance to employmenta decision many on the left as well as the right wish we could revisit today. That means that patients aren't faced with the costs of treatment and have no reason to make choices they would make as consumers who had to bear some of the cost (as we do when we make claims on the auto insurance we purchase with after-tax income).
He moves ahead to the problems caused by two men of undoubted high intellect and political skill, House Ways and Means Chairman (1958-74) Wilbur Mills and President Richard Nixon. In other writings I've attacked them for the hugely generous Social Security benefit increases they pushed through in 1972 (the first checks went out on October 3 of that year, just a month before the presidential election), which were premised on the idea that the children of the post-World War II baby boom would produce another baby boom of their own. We didn't, and Social Security has been in trouble ever since. Gratzer hits Mills for his design of Medicare and Medicaid, passed in 1965, and Nixon for his support of "cost control through HMOs":
While both men retired amid scandal in 1974, their competing visions are still doing damage, like the opposing blades of a scissors. Because of the need to constrain rising costs, government programs have led to rationing and price controls. Because of its restrictions on patient choice, managed care has outraged American sensibilities. Consequently, both visions have lost their luster. America's healthcare policy predicament is now akin to Eastern Europe's political terra incognita after the collapse of the Berlin Wall: Everyone knows what doesn't work, but no one knows how to proceed. The crisis will only deepen until we find a third way between the Scylla of big government and the Charybdis of bureaucratic HMOs.
Gratzer argues that the third way is to increase consumer choice. We take cost increases in healthcare as a natural consequence of technological innovation, yet in other fields technological innovation lowers prices: The pocket calculator I paid $110 for in 1970, in 1970 dollars, I can buy now for $2.95, in 2006 dollars. Cosmetic surgery and Lasik procedures, which are never covered by health insurance policies, have become cheaper, not more expensive: Competition works, even in healthcare. What about the uninsured? Gratzer argues that the problem is overstated and says that 93 percent of Americans are insured or have ready access to insurance. He calls for reducing the cost of health insurance by allowing interstate purchases of health insurance policies (which gets you around state mandates requiring you in some places to pay for coverage for everything short of Wiccan therapy) and to convert federal programs to block grants to the states so they can experiment with vouchers for private insurance. Medicaid, too, should be devolved to the states, which can experiment with insurance that includes the copayments that are almost entirely absent from current Medicaid coverage. As for Medicare, which threatens to use up one third of tax revenue by 2030, it should be replaced by something like the Federal Employees Health Benefits Program, which allows a choice from a wide array of insurance policies. On prescription drugs, Gratzer wants to decrease the time and expense it takes the pharmaceutical companies to get FDA approval and to increase the monitoring of drugs once they are approved.
Finally, Gratzer has a three-part "vision for revolutionary change" in health insurance. The tax code should be changed to make health insurance individual and portable, rather than tied to employment. This could be done by making employer-provided health insurance taxable or (much more palatable politically) making nonemployer health insurance premiums tax deductible. He would limit the FDA to ascertaining a drug's safety, not its efficacy. And he would provide tax-sheltered health savings accounts to allow workers to save for the healthcare costs they will incur in retirement.
The prospects for advancing anything like what Gratzer is proposing would seem to be dim with Democrats now in control of the House and with a majority of seats in the Senate. Some Democrats, of course, would like to impose a Canadian-style single-payer system here in the United States. But they seem unlikely to prevail. Others would like to chip away at Health Savings Accounts, which have been expanding rapidly since they were authorized in the 2003 Medicare prescription drug act. But they seem to have generated a lot of satisfaction with many employers and employees, and so now may have an active constituency in their favor. Some Democrats have talked about making premiums for nonemployer-provided health insurance tax deductible. It's not clear that this Congress will address healthcare in any major way. But our healthcare finance system is not one system but many systems that are changing rapidly in response to the actions and decisions of many, many players, public and private.