Bryan Caplan  

How I Would Have Sold Obamacare

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Ayn Rand's Niche... Too Small to Succeed?...
Russ Roberts and Will Wilkinson are baffled by Krugman's understanding of how the U.S. government works.  I think Krugman might actually be right.  Yes, there is division of powers.  But leadership, rhetoric, agenda setting, and commitment all work to some extent - especially during political honeymoons and economic crises.  If I were Obama and believed in socialized medicine, here's the speech I would have given ten months ago.
My proposal is simple: Medicare for all who want it, paid for with higher taxes on the wealthiest Americans.  I think it's the right thing to do.  I hope Congress feels the same way.

I reject politics as usual.  Here is my offer to our Representatives and Senators: If you think this is better than what we have, if you recognize Medicare as the great success that almost all Americans do, vote for it. 

I'm not going to bribe anyone in Congress to support my bill.  It should pass on its merits, or not at all.  If Congress passes another health care bill that contains bribes, I will veto it.  Why?  Because I want the American public to know that if I sign a bill, they can be as proud of it as they are of Medicare.

We have before us a great opportunity to fulfill the promise of this great nation.  But we won't get there by dishonesty and backroom dealing.  I think that many members of Congress are as sick of this hypocrisy as I am.  In fact, I am willing to stake my presidency on it.  Let's show the American people that we deserve their trust and act now.
I admit this would have been a high-risk strategy.  But look at how easily Bush pushed through TARP!  In the midst of recession hysteria and Obama worship, I say there's a 40% a more polished version of my speech could have worked.   Am I crazy to think so?

P.S. Whenever I write things like this, I slightly worry that it will fall into the wrong hands and be misused.  But on net, better understanding political manipulation probably makes it less likely to happen in practice.


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COMMENTS (16 to date)
ThomasL writes:

A bit tricksy... as a congressman I might, if I wanted the bill to be vetoed, introduce some popular pork amendment.

sean writes:

LOL LOL Bryan, that is essentially the exact rhetoric that has been applied over several (hundred) speeches. I am not for HCR so I dont lament its slow traction, but this is politics as you well know.
you get up and say that speech, after it goes through punditry filters and criticism and voters short attention span, it wont have close to the lasting effect that you might have of predicted.

Recall Obama made people cry (!) regularly by "shooting straight" and telling them his plans would succeed on merit alone. He also mentioned how they would always be open to transparency. Clearly, for whatever reason, American politics just never really seem to work in practice as they would some climatic plot point within an inspiration political movie.

Ow@ll writes:

This assumes that republicans actually want health care reform. Not to mention that not a single senator will vote for a bill without getting something in return... for their own PRSONAL political gain. This can be interprited as:
Money
Money
Money
and ...
Maybe some votes if they're on the right side of the cash position.

Matt writes:

Be sure to mention all those people dying in the street everywhere in the US. When I go jogging I must trip over at least 8 every time.

Sam writes:

But Ow@ll, it didn't actually matter what the Republicans wanted until a few days ago. The whole HCR effort to date has been various individuals and factions of the Democratic Party negotiating with each other.

Reader writes:

I was a bit disappointed by the lack of Obama-style rhetoric in that faux-Obama speech. Very unpolished, this is.

Blackadder writes:

If it were really that easy, don't you think it would have been done by now?

chipotle writes:

Yeah, Bryan, your approach lacks the politician's veneer.

However, I think you do hit on a point that is more broadly correct.

Simple + Leftist = Better formula than Complicated + Corporatist + Evasive.

Whether you're a libertarian or a "progressive," sometimes you just have to confront your enemies head-on.

(Obama's idea that he was going to cover +50 million uninsured at no additional cost was too big whopper to swallow at once)

Yancey Ward writes:

And when the analysis of what "richest Americans" means in the context of figuring out just how much it would cost to give Medicare to all, the plan dies an ignoble death.

This was always the problem- at the end of the day, these wonderful "free" medical care programs have to be paid for by real people paying taxes or increased premiums, or paying the same premiums for less in return. Politicians always want to sell their programs as more for less- this is Politics 101. Your plan only works better if you can still somehow hide the costs- honesty doesn't work that way.

Manuel Nunez writes:

You are clearly not a politician!.

From a foreigneer point of view, your have the most expensive and inequal system in the world, and more and more americans will be incapable to pay for it in the next years!. Don´t forget this point.

Unit writes:

Is this Bryone speaking?

Mike writes:

Congress would refuse to pass it. All eyes would be on Obama. Obama would look like a spoiled child who refuses to play nice by working with Congress. Nothing gets done while Obama is in office - for his one and only term.

Chris Koresko writes:

What policy you would propose in the President's place?

John Fast writes:

I don’t understand Will Wilkinson's lack of understanding of Paul Krugman’s understanding of the American system of government.

For example, I've had abortive discussions with people who point out that, technically, the President can't submit a bill to Congress. However, it's trivially easy for the President to find a Congressman who would support such a bill and ask him to submit it.

Similarly, the President has enormous powers because of publicity (especially when the public supports him) and other forms of influence -- some statutory, some unofficial but legitimate, and some not-so-legitimate -- that he can use. (Remember "Martin, Barton and Fish"?)

The challenge, of course, is that to most of those in Congress the loads of pork added to the bill are not seen as a bad thing -- they're a feature, not a bug.

Chris Koresko wrote: What policy you would propose in the President's place?

A voucher program, although I might use a more appealing name. The voucher would be sufficient to pay for insurance covering hospitalization and catastrophic conditions, and preventive care; the amount would be based on what it would cost to do it via Medicare. If a private health insurance provider could do it more cheaply, the recipient could either pocket the savings or purchase additional coverage. Other than that, the program would include a high deductible and a Health Savings Account high enough to cover the deductible, and which could be "rolled over" each year. (One slogan might point out that "The government doesn't take your IRA savings every year, why should it take your health savings?")

As a "take-that" to any unions that refused to support my plan, I'd threaten to not merely reduce the tax deduction for employer-provided health care, but also provide that the vouchers would not be cumulative with such policies. And I'd use rhetoric to make *them* look like the bad guys.

KarneyII writes:

Manuel, your comment strikes me as interesting. As a foreigner, how is your healthcare system working? Do you know that the US Based Pharma companies produce 90% of the medical research available around the world? If someone didn't pay for healthcare or medicines, who will produce the research to develop new medicines? You see, the reality of the healthcare in the US is that we have become the healthcare welfare system for the rest of the world.
At first glance, it would appear that companies are taking advantage of us, however, when you really delve into the healthcare that is available compared to the rest of the world, we have the best ever. The problem from the government perspective is as long as healthcare isn't socialized, they can't control who lives and who doesn't. I will keep my higher insurance premium as long as the government is not ivolved. We make $130,000 a year and have a family of five. I will cut back on other expenses to keep the healthcare I have. It is the best in the world.

Dan Weber writes:

I think "Medicare for all" could have been sold to the honest conservatives. Something like this:

"Yes, you don't like the government being involved. But the government already is involved. Instead of growing government, I seek to make that government more responsible and efficient.

"Currently the Federal Government spends $600 Billion a year on Medicare and Medicaid. That's $2,000 for every man, woman, and child in the country, which many modern countries find entirely sufficient to cover everyone.

"My vision is that 20 years from now the Federal Government is still spending $600 Billion (inflation-adjusted) on health care, but instead of covering only portions of the population, it is an option for everybody.

"Here is the plan: like the Federal Reserve, make Medicare quasi-independent, where the government occasionally re-elects its chairman. It is freed from political influence so Senators cannot dictate what it will cover. It also has no political power so while it can bargain hard for lower prescription drug prices, it cannot threaten to kill patents like some other countries do.

"For conservatives, the take away is this: government spending is strictly limited. $600 Billion a year, no more. The people in charge decide the best way to spend it.

"Is this enough to give quality coverage to everyone? Like I said, many other countries do it just fine. But if you don't want in, that's perfectly fine. If you buy your own insurance, we will give you a $1000 tax credit. If half of Americans take that option, that pushes up the budget for the remainder to $3000 per patient, well over the median for other modern countries.

"This Medicare-for-all is available to every single person, no matter or rich or how poor. There are no cut-offs or marginal taxes. I expect that some people, perhaps even a lot, will buy out, and that's okay. It is even commendable, so we will give them the tax credit to help them along."

The biggest sticking point would probably be making sure that the money stays limited. Traditionally this has been a big conservative talking point so in theory they should like it. Hopefully the conservatives can be shamed to not use the "death panel" rhetoric.

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