TuTu Monroe
A Realist
Damn, this author hit the nail right on the head. KA-BOOM
By ROSS DOUTHAT-NY Times OP ED
Published: June 21, 2009
There was one small consolation for Republicans amid last November’s shellacking. For at least four years, their opponents would enjoy the dubious pleasure of trying to govern the United States of America. Late on election night, while the confetti swirled in Blue America, more than a few veterans of the Bush years no doubt hoisted a toast to the exuberant liberals: Good luck with that.
Oh, it seems easy at first. The press is kind; the Congress is pliant; the country loves you. You’re a breath of fresh air after the previous administration’s excesses. Your first attempts at big-ticket legislation shoulder their way into law. The opposition party looks easily divided, easily co-opted and deeply out of touch.
But eventually the hard part arrives. For Barack Obama, it may have started last week, courtesy of the abacus-wielding wonks at the Congressional Budget Office.
First, the C.B.O. slapped a $1 trillion price tag on Chris Dodd and Ted Kennedy’s version of health care reform — a figure, it noted, that would buy coverage for only a third of America’s uninsured. A day later, the C.B.O. priced the Senate Finance Committee’s more self-consciously centrist draft of health care legislation. The good news: The bill would cover more than two-thirds of the uninsured. The bad news: It would cost $1.6 trillion across 10 years.
These are scary numbers, for a country headed for a fiscal cliff — scary enough to send the Finance Committee scrambling to craft a cheaper version of its bill, and scary enough to give liberals flashbacks to the collapse of Clintoncare.
But they aren’t actually surprising numbers. The current U.S. health care system is, by general agreement, overpriced, bloated and hugely inefficient. And if you expand a bloated, inefficient system, it stands to reason that you’ll end up with billions or even trillions more in bloat and inefficiency.
In a world without political constraints, it wouldn’t be hard to create a fiscally responsible alternative. Conservatives would encourage people to self-ration, by putting a certain number of health care dollars directly in their hands and leaving the rest to market forces. Liberals would ration more directly, by slow-walking Americans into a public health care system, whose cost-conscious, evidence-weighing bureaucracy would pay for procedure X but not procedure Y, surgery P but not prescription drug Q.
But of course Americans want their health care system to bankroll the entire alphabet — and they definitely don’t want to think about “market forces” when they’re going to the doctor. They might be willing to pay slightly higher taxes to bankroll a reform, but their ideas about what “reform” should mean are far more expensive than what health care experts have in mind. Indeed, as William Galston noted recently, the best way to satisfy the public’s health care preferences would be to start with whatever the experts — right and left alike — say is required to keep the system solvent and do exactly the opposite.
This dynamic is particularly pronounced in health care, but it holds true across almost every domestic policy debate. Voters demand low taxes and generous services, and neither party has found a way to say no and stay politically viable while saying it.
Eventually, it’s assumed, either a liberal or a conservative majority will find a way to square this circle. But you just have to look west to California — polarized, and essentially bankrupt and ungovernable — to see that there are darker possibilities.
In recent years, liberalism has profited from the impasse. Liberals torpedoed the Bush administration’s attempt to trim Social Security benefits. They demagogued John McCain in 2008, when he proposed a market-based health care plan and hinted at means-testing Medicare.
But now it’s their turn to actually run the country. And just as Bush-era conservatives couldn’t really make tax cuts pay for themselves, Obama-era Democrats aren’t really going to be able to finance universal health care without substantial middle-class tax increases, or substantial spending cuts.
They’re looking for both, and maybe they can pull it off. The Bush administration saved its hard choices — on health care, entitlements and taxes — for the second term, and then ran out of political capital. The Obama administration is trying to tackle the hard stuff early, while it still has that first-term glow, and the power that comes with it.
But it’s just as likely that the Democrats will be forced into a choice like the one the C.B.O. presented them with last week — a fiscally reckless health care bill that falls far short of universal coverage, or no health care bill at all.
To govern is to choose. But with choices like these, liberals may find themselves pining for the days when somebody else was the decider.
Ross Douthat’s column appears on Mondays.
By ROSS DOUTHAT-NY Times OP ED
Published: June 21, 2009
There was one small consolation for Republicans amid last November’s shellacking. For at least four years, their opponents would enjoy the dubious pleasure of trying to govern the United States of America. Late on election night, while the confetti swirled in Blue America, more than a few veterans of the Bush years no doubt hoisted a toast to the exuberant liberals: Good luck with that.
Oh, it seems easy at first. The press is kind; the Congress is pliant; the country loves you. You’re a breath of fresh air after the previous administration’s excesses. Your first attempts at big-ticket legislation shoulder their way into law. The opposition party looks easily divided, easily co-opted and deeply out of touch.
But eventually the hard part arrives. For Barack Obama, it may have started last week, courtesy of the abacus-wielding wonks at the Congressional Budget Office.
First, the C.B.O. slapped a $1 trillion price tag on Chris Dodd and Ted Kennedy’s version of health care reform — a figure, it noted, that would buy coverage for only a third of America’s uninsured. A day later, the C.B.O. priced the Senate Finance Committee’s more self-consciously centrist draft of health care legislation. The good news: The bill would cover more than two-thirds of the uninsured. The bad news: It would cost $1.6 trillion across 10 years.
These are scary numbers, for a country headed for a fiscal cliff — scary enough to send the Finance Committee scrambling to craft a cheaper version of its bill, and scary enough to give liberals flashbacks to the collapse of Clintoncare.
But they aren’t actually surprising numbers. The current U.S. health care system is, by general agreement, overpriced, bloated and hugely inefficient. And if you expand a bloated, inefficient system, it stands to reason that you’ll end up with billions or even trillions more in bloat and inefficiency.
In a world without political constraints, it wouldn’t be hard to create a fiscally responsible alternative. Conservatives would encourage people to self-ration, by putting a certain number of health care dollars directly in their hands and leaving the rest to market forces. Liberals would ration more directly, by slow-walking Americans into a public health care system, whose cost-conscious, evidence-weighing bureaucracy would pay for procedure X but not procedure Y, surgery P but not prescription drug Q.
But of course Americans want their health care system to bankroll the entire alphabet — and they definitely don’t want to think about “market forces” when they’re going to the doctor. They might be willing to pay slightly higher taxes to bankroll a reform, but their ideas about what “reform” should mean are far more expensive than what health care experts have in mind. Indeed, as William Galston noted recently, the best way to satisfy the public’s health care preferences would be to start with whatever the experts — right and left alike — say is required to keep the system solvent and do exactly the opposite.
This dynamic is particularly pronounced in health care, but it holds true across almost every domestic policy debate. Voters demand low taxes and generous services, and neither party has found a way to say no and stay politically viable while saying it.
Eventually, it’s assumed, either a liberal or a conservative majority will find a way to square this circle. But you just have to look west to California — polarized, and essentially bankrupt and ungovernable — to see that there are darker possibilities.
In recent years, liberalism has profited from the impasse. Liberals torpedoed the Bush administration’s attempt to trim Social Security benefits. They demagogued John McCain in 2008, when he proposed a market-based health care plan and hinted at means-testing Medicare.
But now it’s their turn to actually run the country. And just as Bush-era conservatives couldn’t really make tax cuts pay for themselves, Obama-era Democrats aren’t really going to be able to finance universal health care without substantial middle-class tax increases, or substantial spending cuts.
They’re looking for both, and maybe they can pull it off. The Bush administration saved its hard choices — on health care, entitlements and taxes — for the second term, and then ran out of political capital. The Obama administration is trying to tackle the hard stuff early, while it still has that first-term glow, and the power that comes with it.
But it’s just as likely that the Democrats will be forced into a choice like the one the C.B.O. presented them with last week — a fiscally reckless health care bill that falls far short of universal coverage, or no health care bill at all.
To govern is to choose. But with choices like these, liberals may find themselves pining for the days when somebody else was the decider.
Ross Douthat’s column appears on Mondays.
