Washington Post Crashed-and-Burned Watch
Henry Farrell Has a Nice Piece on How Clive Crook Is part of Our Problem

Health Care Reform and Institutional Dysfunction

Steve Pearlstein has, as usual, smart things to say:

It's Time for Obama to Rise Above the Partisan Health-Care Debate: What makes reform such a difficult puzzle is that the fundamental policy goals of universal coverage and cost containment are inconsistent with the political instincts to assure Americans who already have health insurance that they will be able to keep everything they already have, to assure that nobody will get a tax or cost increase and to assure those in the health-care industry that there will be no reduction in their income....

Deals negotiated with doctors, hospitals, health insurers and drug companies represented a good running start on the path of shared sacrifice, but the president failed to follow through with other key players. From a business community that wants to preserve the employer-based system, he failed to get a commitment that all employers should participate. He kowtowed to organized labor by backing away from a reasonable cap on the favorable tax treatment of health benefits. And he folded like a cheap suit when right-wing attack dogs scared the elderly with talk of euthanasia and death panels rather than aggressively defending the logic of living wills and evidence-based medicine.

By signaling that he was willing to stand up to some interests but not others, Obama gave up the moral and political high ground that would have made the opponents of reform look "small" by contrast.

The president's approach needs to be simple and direct: The health-care system we now have is wasteful and expensive and leaves the United States... the only rich country to ration medical care on the basis of income. Runaway health spending is the main reason the average American worker hasn't gotten a real pay raise in a decade. And it is the big reason the government is looking at huge budget deficits for years to come....

If reform doesn't "bend the cost curve," as the budgeteers like to say, then it's not worth doing. And if it does, then there is no need to scale back the program and compromise on universal coverage just so the annual subsidies can be reduced from $110 billion a year to $70 billion.

An equally silly compromise comes from the Senate's "Gang of Six."... Aside from creating an administrative nightmare, this provision would have the perverse effect of encouraging employers to fire, or not to hire, low-wage workers with children or spouses who are unemployed. Republican Olympia Snowe is said to be particularly enamored of this idea. I'd bet a two-pound lobster and bowl of Maine's best chowder that she can't find a labor economist back home who thinks this is a good policy....

What the president needs from Congress is succinct legislation that guarantees that every American will have a basic health insurance policy and sets reasonable caps on the growth of government health-care spending. The details should be left to the regional exchanges and a new board of independent health experts.... Their recommendations could be subject to an up-or-down vote from Congress, as advocates of entitlement reform have long suggested...

Steve Pearlstein is essentially calling for a Federal Reserve for health care reform, and claiming that congress as we know it is irremediably broken--broken by partisans and by lobbyists. I have a different perspective: in my view it is the Senate that is broken--the House of Representatives is running like a normal legislature.

Comments