A few thoughts. As Mickey Kaus has been chronicling, Obama has made a tactical error in focusing on cutting costs. But why do it? If there is any time to focus on expanding coverage and making it more portable in the face of job loss, this is that time. But at the rate our current government has been spending, I guess it was necessary to include cost control. This is where it gets interesting.
Isn’t cutting costs on large public entitlement programs essentially a Republican, or perhaps better put, a conservative issue? It almost looks like the initial focus on cutting costs was a way to make the bill more bipartisan — entitlement reform is something Fred Thompson would tackle, not Nancy Pelosi. Was this a way for Obama to move to the center on a critical policy issue? Of course, the irony of these “cost-bending” strategies is that no one really has that much confidence in the ability of these reforms to actually lower costs, but “cost-bending” is certainly part of the design.
This is where the bait and switch is on the conservative end. On one hand, the argument is that the plan is too expensive, while on the other it is about what happens if care is “rationed.” I certainly understand rationing/innovation/incentive concerns in a single-payer system — note Megan McCardle’s great take — but I’m unsure the extent to which these concerns translate to the current proposals.
For once, it seems, Democrats are arguing on Republican turf — that the spending level in a public program is unsustainable. And the Republicans are arguing back against cuts by focusing on the potential for less care. A great way to kill a bill, but a lousy way to deal with the problem if you believe current spending trends are unsustainable. Now conservatives are arguing for more care, and liberals for less (long-term) spending? What is the world coming to?
If the public option is dropped — and it looks like it very well might be — then this bill starts to be an interesting tradeoff. It will include expanded coverage and punitive measures that make some conservatives queasy, but it also could be the first step to making coverage portable, dealing with preconditions, and introducing competition to the oligopoly of the insurance business — all while trying to make the programs sustainable in the long-term.
Not sure that looks terribly different than the conservative ideas that failed to see the light of day –with the exception of HSAs– when they were in control of the executive and legislative branches. Selling insurance across state lines? Decoupling employer tax breaks and insurance? Even tort reform? Republicans weren’t able to do these things when they were in power; but a watered down ObamaCare bill, potentially without a public option and with a focus on curtailing long-term costs, is almost a conservative fix for the current health care system. These are the types of tradeoffs a party makes when it’s out of power.
That appears to be the logic Obama used when he chose to emphasize the fiscal responsibility of health care reform. Conservatives have taken these ideas and turned them into political opposition, an understandable, if politically callous move. But then again, this wouldn’t be the first time conservatives have pulled a bait and switch on fiscal responsibility.