Posts Tagged 'health care reform'

Shifting definitions of ‘liberal’

Ross Douthat is the New York Times’ wunderkind conservative pundit. Like anyone with a forced, public writing schedule, he writes some very smart things, but then he goes and writes some not-so-smart things.

His column today mainly argues that only time will tell whether conservatives or liberals are right about the health care bill that just passed. He guesses that it’ll take 20 years before the data is in, but after that, someone is going to be able to say, “I told you so.” That’s true, and it’s useful to keep some perspective on these matters. Don’t believe anyone who says they know exactly how this bill is going to affect the US health care system, health outcomes, the budget, and the broader economy over the next quarter century.

Where I part from Ross is when he calls the bill itself ‘liberal’, designed by liberals, and resting on naive liberal assumptions. He says that liberals believe “a bill this costly, this complicated and this risky can be made to work, so long as the right people are in charge of implementing it.”  He concludes, “As a conservative, I suspect they’re wrong.”

First, a liberal bill is a single-payer bill, which would put the federal government in charge of insuring everyone in the country (kinda like how the federal government is in charge today of insuring all seniors, veterans, and lots of poor people in the country through Medicare, the VA, and Medicaid). It works for many current US programs (Medicare for seniors, Medicaid for poor people, and the VA for veterans), and it somehow magically works for a large number of wealthy, industrialized western nations — despite Ross’s pessimism to the contrary.

That’s what a liberal bill looks like. A slightly more moderate bill, but still on the liberal side, would have created a government insurance program with a large price advantage that would compete head on with private insurers (ie, the public option). Clearly that’s not in the bill that passed last night.

A truly moderate, evenconservative, bill would probably retain our private, employer-based insurance system while creating new and deeper markets for private insurance in the individual market. Funny enough, that’s exactly what this bill does. It is by far a more moderate, even conservative bill, than that offered by Republican President Richard Nixon. In fact, the bill that passed last night looks most like the compromise bills Republicans were offering to President Clinton in the early ’90s, or the proposals of Bob Dole and other aging Republican luminaries from 2009. And it particularly resembles Republican Governor Mitt Romney’s plan in Massachusetts.

This cannot be repeated enough: the bill passed last night is a piece of moderate legislation, not a radical, liberal attempt at social engineering. Yes, it was backed by liberals and attacked by conservatives, but its a moderate, even conservative policy approach to start fixing the health care system. I don’t know when it became normal for conservative pundits to call increased competition, reliance on private enterprise, and creating new markets “liberal”.

My second point has little to do with the first, but it’s important nonetheless.

Ross’s pessimism about our ability to do anything, ever, with government is just plain weird. I wonder if Ross’s well-intentioned doubts about the ability of government to implement large, complicated bills apply equally to big things that Republicans like? What about the Bush tax cuts (much higher price tag than health care reform, with dire budgetary consequences)? Bush’s 2005 attempt to privatize social security (certainly a much more radical, sweeping change to social policy than anything in the health care bill)? The attempt to engineer a vibrant democracy in Iraq? What about  Rep. Paul Ryan’s budget proposal, which Ross seems to like (it envisions ending Medicare as we know it)?  Are any of these proposals just too big, costly, and complicated to actually work?

Or is Ross’s pessimism about government action less about philosophy and more about which party is making the proposal?

David Brooks: *still* an alien

Brooks is back, and so is his misunderstanding (unintentional or otherwise) of American politics. In today’s column, David Brooks’ main argument is that Democrats are too emotional on the issue of health care reform and are therefore insufficiently committed to deficit and debt reduction. Here’s Brooks:

For the Democrats, expanding health care coverage is an emotional hot spot. … There is something morally impressive in the Democrats’ passion on this issue. At the same time, it’s interesting to compare it to their behavior on other issues in which they have no emotional investment.

Now I’d like to go point-by-point through the rest of Brooks’ argument and evaluate his claims. Quotations from the column will be indented block quotes. My responses will be normal text. It’s longer than my usual post, but Brooks’ argument is just that bad.

Continue reading ‘David Brooks: *still* an alien’

David Brooks is an alien

I usually don’t spend too much time trying to figure David Brooks out. My quick and dirty read on Brooks is that he’s reflexively and unthinkingly moderate, or rather just to the right of center. Like social studies teachers of yore, Brooks thinks there’s something particularly magical about compromise, incrementalism, tradition, bipartisanship, and the happy medium. Don’t get me wrong, those things are all great in their own way, but some things just don’t lend themselves to such an analysis. Yet Brooks insists on jamming every little policy or political issue he comes across into that one analytical mold, like a three-year-old doing a jigsaw puzzle. I personally prefer a little more flexibility in my analytical toolbox.

That said, I’m not completely anti-Brooks. The man has written some nice columns, and it’s good to have a voice of reason talking to right-of-center folks. But today’s column really makes me wonder if Brooks isn’t actually human, but an alien trying to understand our political system and failing miserably.

Here’s Brooks’ opening sentences:

Going in, I was as cynical as everybody else about the Blair House health care forum. I was planning to watch for a half-hour and then write about something else.

But the event was more meaningful than that. Most of the credit goes to President Obama. The man really knows how to lead a discussion. He stuck to specifics and tried to rein in people who were flying off into generalities. He picked out the core point in any comment. He tried to keep things going in a coherent direction.

Moreover, he seemed to be trying to get a result.

The result, he goes on to argue, is a possible compromise between Democratic and Republican health care policies.

Because of an odd confluence of events (overabundance of leisure, and a rural residence with little to do beyond trudging in the woods and going for a run – which I had already done that day), I ended up watching 5 of the 7 hours of the health care summit yesterday. Now, I’m no expert on American government or political science, and neither is Brooks. But what I saw at the health care summit was a President putting on a show for a very small number of Democratic legislators, primarily in the House, in order to give them cover and convince them to pass the Senate bill and then patch it via reconciliation in the Senate. That fact that Brooks thinks the summit was actually aimed at forging a bipartisan compromise shows his complete lack of understanding of the American political system. Just look at the five key structural incentives at work in the current health care process:

  • Actual negotiations on something this important and contentious, touching core constituencies in each party, cannot be conducted in public. As Matt Yglesias astutely pointed out a couple weeks ago, imagine if you were to negotiate with your significant other about whose parents house to go to for the holidays this year. Maybe you could reach an accommodation by seriously discussing your real preferences and likes and dislikes on the subject — if you could talk in private. But what if the negotiations were televised on CSPAN and piped right into your in-laws’ homes? Privacy is an essential component when negotiating about a compromise that would inevitably throw a major constituency of each party under the bus.
  • Democrats have little incentive to further compromise the Senate bill (as amended by the President’s proposals for a reconciliation patch). First, it’s already a large, substantive compromise to conservative ideas. Of course, Democrats have won zero Republican support despite these very painful compromises from the liberal ideal. They’re getting tired of unilaterally compromising. Second, and most important, all the political incentives for the party as a whole point towards passing the bill as is, and leadership is working overtime to make sure the individual members understand that.
  • Republicans have zero incentive to compromise. As many observers like Ezra Klein have argued, in the US system of government and particularly in the Senate, “the minority has both the incentive and the power to make the majority fail” and “the minority has learned that they profit in the next election when the majority is judged a failure.” That pretty much sums up the incentives facing any minority party in the modern political climate, and last time I checked, Republicans were in the minority.
  • Health policy works best when comprehensive, and could be disastrous if done piecemeal. For more on this, do some reading on the ‘insurance death spiral’. Cost control, mandates, exchanges, subsidies, insurance reforms … these things all go together as essential pieces. Remove on, and it doesn’t work.

An educated, dispassionate observer of American politics should look at the summit and see it in light of these structural incentives. And we all know that Brooks is smart and dispassionate. But he watched the summit and saw a grand, substantive effort at bipartisan compromise. That makes Brooks either a wild-eyed, hopelessly-naive optimist, or an alien. I’m voting for the latter.

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This is a group blog. JSC5 currently writes from the US. JSC7 writes from behind the Great Firewall of China.

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