• Health reform: Beyond the numbers

    The Atlantic‘s Derek Thompson put it beautifully (via Jon Cohn):

    One side doesn’t want to spend more money to insure more Americans, and the other side wants to pay for their insurance with tax increases and spending cuts. The numbers are beside the point now. This isn’t a math problem, and it’s not even really a debate anymore, it’s a calcified difference of ideology.

    I want to be very clear about this: in principle, there is nothing wrong with either side’s position. I share the priorities of one side and not the other, but that doesn’t mean I’m correct and others are incorrect.

    Ultimately, I suspect nearly every American would want everyone to have access to affordable coverage without bankrupting the country. If that were all we had to agree on, we’d be done. Unfortunately, the means to that end matter.

    We’ve spent over a century trying and failing to reform our health system. The signature of that failure is written in the confusing, dysfunctional patchwork that has evolved. With each successive law and innovation, the system changed, sometimes for the better, but not always in a broadly bipartisan fashion. In 2003, Republicans had the majority and will to reform Medicare. It was their watch and it was their law. Consequently, the Medicare prescription drug benefit is their legacy, as are its costs.

    Almost a year ago we took a major step, though only the first step, at more comprehensive health system reform. The chosen course more closely resembles the preferences of today’s Democrats (though yesteryear’s Republicans). Whether through good fortune or skill, Democrats amassed the will and means to push something through. The window of time was brief and the range of the politically possible narrow, but something passed. It was their watch and it is their law, their legacy, benefits, costs, and all.

    In principle we could  and go the other way, repeal the Affordable Care Act. It won’t happen soon. It likely won’t happen ever. But the law will be amended, as it should be. We’re not done with health reform. I hope we can compromise on enough elements of future enhancements to health reform so that everyone feels invested, everyone feels part of the solution. I don’t know if that is possible.

    One thing is certain, we can’t have it both ways. Coverage expansion and minimizing costs can’t both be top priorities. One comes first. Now that we know which one, let’s start to work on the next priority. Political leaders of both parties have expressed concerns about health care costs. Are they concerned enough to put old arguments to rest and get to work on doing something? I’m not naive. I know it’s not likely, not soon anyway.

    Paradoxically, I also know that it’s inevitable. Health care costs can keep gobbling a larger share of the economy for many years, but not forever. Some Congress will do something about it, though perhaps not in our time. The health reform debate may have gone way beyond the numbers today, but at its heart there is still a math problem we don’t know how to solve.

    • The neglected part here, at least by some, is that everyone is slowly being priced out of health care. This is much more than just a problem for the poor. So, carrying out Chait’s opening dichotomy, I think that we have one side which recognizes this as a problem, and another side which ignores it. We need to get to the point where both sides are willing to spend significant political capital on this issue.


    • Costs are the problem.
      Every other industrialized country has solved this problem and provides near universal access at less than half the cost of the US. They have adopted similar approaches which all focus on strong government regulation of prices. Unfortunately, the US has a corrupt government controlled by corporate kleptocrats. It is possible for the US to reduce costs and expand coverage but our political leaders are captive to the medical industrial complex.

    • “I want to be very clear about this: in principle, there is nothing wrong with either side’s position. I share the priorities of one side and not the other, but that doesn’t mean I’m correct and others are incorrect.”

      I’m curious about what lies behind this statement. Is this akin to saying that “in principle” chocolate and vanilla are on a par, despite the fact that you may prefer chocolate while I prefer vanilla? It’s hard to believe you’d spend so much time defending one side if you really believed views on health reform were merely just matters of taste.

      • @Paul – What’s the objective basis for my preference for coverage to come before cost control? I do believe that it can’t occur the other way, but that has nothing to do with my preference. That’s why I used the words “In principle.” In practice, I think there is a big problem with one position. That’s why it happened one way and not the other. Again, this does not explain the entirety of my preference.

        In fact, I spend far more time citing evidence that informs everyone about the nature of our health system and how individuals and institutions respond to incentives in it.

    • @Paul – What’s the objective basis for my preference for coverage to come before cost control?

      Sorry. I didn’t realize you were referring to the debate between those who wish to expand coverage by paying more and those who are willing to spend as much as we are spending now, but no more. I thought you referring to the debate between those who wish to spend as much or more to cover everyone and those of a libertarian ilk who don’t want to pay at all (including what we are paying now).

      Given my mistake, I hope it’s clear why I thought it curious that you’d treat your rejection of libertarianism as something like a matter of taste.

    • Sorry Austin, but Mr. Thompson over-simplifies so much that his quoted statement becomes a falsehood. I am a conservative and (naturally) know lots of other conservatives. And I don’t know a single person who unequivocally believes that we shouldn’t “spend more money to insure more Americans.” On the contrary, almost everyone I know acknowledges that lack of insurance is a problem, and that it is prudent to spend some amount of money to address that problem. Our issue is with all of the stuff in the 1000+ page bill and all of the spending in the $1T+ that does not do these things.