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Judging from Charley’s reaction to my post the other day, I may not have been clear in my hypothesis on why the local business community was mobilized politically against any reasonable solution to the crisis in health care provision and its costs. In trying to answer his questions (why don’t they support health care reform? what do they want?) I saw four possibilities:

1. Stupidity. They’re too dumb to act in their own best interests or otherwise don’t understand the nature of the health care crisis.
2. Ideological reasons. People support things against their immediate self-interest frequently because they have strongly held beliefs. Entrepreneurs and corporate leaders are inclined to believe in the sanctity of the market more than others are.
3. Political maneuvering. They would support health care informs of the sort Blue Mass Group is talking about except that, because of other points of political/ideological/interest-group solidarity, they’re siding against Beacon Hill Democrats. 
4. Merits of the case. They’re right that the plans they support, even the status quo, would be better to their interests than the plans put forth by the Legislature.

As I read him, Charley seems inclined to #1, and in one way I sympathize (I agree with the case for state intervention in health care provision and see all sorts of practical grounds for the business community to go along), but as an explanation of their political behavior, I’m not really buying it. The business elite is too well-versed in its problems to chalk up them to ignorance.

Explanation #2 is definitely at play, though as a secondary cause. So I’m left with combination of #3 and #4. That sounds abstruse. Fortunately, Mark Thomas of Economist’s View quotes a Financial Times analysis piece that strikes me as getting to the heart of what’s going on locally with health care politics:

One side of the Atlantic clings to the notion of a welfare state - if not the cradle-to-grave version beloved of postwar socialists, then at least one where governments mandate some form of universal healthcare and pension provision. In the US, meanwhile, the more basic social security and medical safety net provided by the government is dwarfed by generous health and retirement benefits offered by large employers - a voluntary paternalism long ago dubbed "welfare capitalism".

Both models lend themselves to easy caricature. … Yet in truth, the challenges facing rich economies are remarkably similar. Ageing populations and rising medical costs are straining twentieth-century welfare systems to their limit. Just as Europe’s social model is creaking under the weight of German unemployment or the runaway budget of Britain’s National Health Service, so the US model is being tested to destruction in industries such as carmaking and airlines…

If welfare capitalism is dying away, what will replace it - a more self-reliant individualism or creeping state intervention? The irony of the second scenario is not lost on those who study the history of US corporate benefits. Since American Express launched the first employer-provided retirement plan in 1875, through the Great Depression and the postwar boom, part of the reason the business community has been willing to provide such benefits was to guard against the dread accretion of big government.

This is the crossroads we face: outside of a few stalwarts from our golden industrial age, employer-subsidized health care is the last major pillar of welfare capitalism. The crisis of rising costs will pretty like force some correction, but it’s unclear whether that response will be self-reliant individualism or creeping state intervention. Smart money may be on the latter (witness the political defeat of social security degutting), but the former’s not out of the question. Given GOP control of the federal government and an impending gubernatorial election here, the business community has every reason to wait out the storm of rising costs another year or so in hopes that political winds will blow their way when a true crisis forces reform.

Like I say, this is sheer hypothesis, because I don’t know anyone in the business elite to ask if this is true. But it’s an explanation that makes ex post sense of the facts.

ADDENDUM: Charley strikes a similar note in his post on the "bad health care policy, but good health care politics" of Maryland’s health-care assessment. Mutatis mutandis, what the local business leaders seem to be doing is supporting bad health care policy as (in their mind) good health care politics.