Arnold Kling  

Explaining the Direction of Health Care Refrom

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The most important political fact affecting health care reform is the sizable Democratic majority. There are too many Democrats in the House and Senate for a bipartisan bill to make sense.

Given that we are going to have a partisan bill, we are not going to see a bill that tries to address the issue of cost. Any measure that restrains health care spending is going to go against the interests of constituents. This sort of painful step will only be taken when both political parties are involved, with each one providing cover for the other.

At some point, the Democrats will invite Republicans to join in a genuine, bipartisan effort to control the excessive use of high-cost, low-benefit medical procedures. For now, however, the goal of a partisan bill will be to offend as few people as possible.

As I have written before, with a partisan bill, we will get dessert, not spinach. That is, more government subsidies, not efforts to restrain spending.

Down the road a few years, the Republicans will be invited to join in a statesmanlike effort to control costs. For the spinach, they will be allowed to share credit. Not for the dessert.


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COMMENTS (12 to date)
mobile writes:

But don't feel too bad for the Republicans. They got to have some dessert when they passed Medicare Part D.

N. writes:

Typically, I find Kling's metaphors and allegories a little tough to get my mind around.

I think this one is dead on, though.

Les writes:

The dessert and spinach metaphors are excellent.

But elections for the House of Representatives take place every two years. So the spinach of year n may become dessert in year n+2. If enough voters wake up.

David C writes:

Assuming for the sake of argument that a few extra seats in the House and Senate is all the Republican Party needs to become sane again, is there any evidence that bipartisan bills are better than partisan ones? By comparison, Bush's 2003 health care expansion managed to acquire 11 Democrats for the final vote. Did bipartisanship back then really improve things? Somehow I get the impression that bills are going to be drenched in chocolate sauce no matter how partisan or bipartisan they are.

R. Richard Schweitzer writes:

To Repeat:

The proposals (one now a "Bill") have nothing to do with "reform." The are concerned only with arbitrarily redistributing costs and benefits.

The legislative processes employed so far are conducted to demonstrate power, not to achieve specific social or economic objectives.

This all meets the Panglossian Tests.

R. Richard Schweitzer

Dan Weber writes:

When the party of stupid and the party of evil get together and do something both stupid and evil, we celebrate it with the word "bipartisanship."

R. Richard Schweitzer writes:

Mobile -

Non-Republican here:

Aren't there studies and reports that show with some statistical accuracy that the availability of pharmaceuticals has actually lowered all other medical care costs in the MediCare system.

I don't have the one particularly striking citation before me, but as I recall, for each $1.00 in drug benefits cost there was a savings of up to $2.60 in other MediCare benefits outlays.

RRS

R. Richard Schweitzer writes:

It has been said (I know I have said it):

The political essence of Socialism is to take from some and give to others.

That result, as much as, if not more than, all the other features, is what makes these proposals Socialist.

R. Richard Schweitzer

Lord writes:

This one does have more cost control than Part D and would control them more than the Republican alternative which does next to nothing. Still weak to be sure. But as for inviting the Republicans for the spinach, who believes they have any appetite but for dessert? All they wish for is a greater say to extract larger desserts for themselves.

John Fast writes:

Okay, assuming that the Republican Party does "become sane" (in David C's excellent phrase), should they refuse to cooperate on the spinach end? What is the best tactic for them, and what would be best for the country?

For the record, I believe the best health-care reform would be as many of the following as possible, not necessarily in any particular order of preference:

1) universal Health Savings Accounts, with any unused money rolled over to the next year and/or available for withdrawal for general use;

2) eliminating the skewed, unfair, give-to-the-rich tax deduction for employer-provided health insurance, at least for anyone over the median income -- and I would happily and legitimately sell this by beating the drum of class warfare;

3) a voucher -- universal, NOT means-tested -- to give each individual enough money to pay for the equivalent of either Medicare or the health insurance plan that government employees get, or somewhere in between. They would then have the option of taking the government plan, or using the voucher to pay for any private insurance plan that met minimal standards.

If #3 passed, I'd want to include a provision completly eliminating the tax deduction for employer-provided insurance . . . or else to reduce the amount of the voucher by the cost of the employer-provided policy.

CJ Smith writes:

I am starting to have the impression that "bi-partisan" approaches to political issues in the United States are not only no longer possible, but have not been possible for a significant period of time. Items are campaigned and voted for, not upon the merits, but by who takes blame/responsibility for initiating the matter. Both Republicans and Democrats have become the "No" party when it comes to addressing issues identified with "the opposing party," regardless of whether the issue is political or non-political in nature. Unfortunately, I have not seen a study that confirms or denies this hypothesis.

Is anyone here aware of a study on whether bipartisanship and compromise still exists (ever existed) in modern US politics between Democrats and Republicans? I would appreciate a summary of the findings and a cite link.

Mike Rulle writes:

You sound like you accept Government directed health care as unchangeable---and you are trying to make the best of a bad thing. I don't think that is possible in quasi-monopolistic situations.

Government-centric systems, as has already been amply demonstrated in US and elsewhere, lead to either an "all you can eat" response by consumers (medicare, medicaid, employer provided health expenditures-----re: 2001 Milton F essay) or a "bureaucratic" rationing process.

Exhortations for "spinach" are pointless---unless, of course, we believe "what the hell, who cares if we are rationed?".

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