The estimable Jonathan Cohn is remarkably unconvincing  in arguing that long term health care cost-curve-bending is politically essential, right now, for the Democratic Party --as opposed to essential for some Blue Dog Dems who want to posture as non-big-spenders. If Congress passes a bill that basically produced universal, secure coverage and was deficit neutral over 10 years, are Dems really going to be punished at the polls because it doesn't also reduce the rise in medical expenses that's expected in years 11-30? 

It seems particularly unlikely that, as Cohn argues, long term curve-bending is essential for its political appeal to moderate income voters: 

If Democrats don't make the difficult decisions on raising revenue and controlling costs, then the reform they pass won't do much to help middle class Americans.  

a) Huh? Isn't the reform offering health security to middle class? Cohn should read Drum . b) Cohn suggests that lower subsidies will hurt the near-poor, who are middle class. But that's an argument for higher short term subsidies, which would have to be paid for by short term cuts or revenues. Long term curve bending doesn't affect those subsidies, at least not for a long time; c) In the long run, I suppose, Cohn's argument would be that the expected rise in medical costs will make health care less affordable to those in the middle, taking a bigger bite of their paychecks. True enough. Against this, though, you have to balance understandable middle class fears that Orszag's untested cost-bending solutions, involving empowering bureacrats to deny reimbursement for treatments on grounds that--well, who knows what the grounds will end up being --would bend the curve by undermining the very health security reform promises . That seems, at best, a wash.

I mean, do you really think the middle class Americans will oppose (or not care about) a historic, 10-year-deficit-neutral universal care bill that doesn't bend the curve, but suddenly burn up the Capitol Hill phone lines to demand that the package be passed when they learn that it contains an "Independent Medicare Advisory Commission"?   That's red meat out in the suburbs!**

I share the Obamist consensus that failure to pass a health bill would be politically disastrous for Dems, including the very moderates in swing districts who are currently making demands . Democrats need a victory. But a  historic coverage-securing bill that isn't a "curve bender" would be more than victory enough. ... And if Republican candidates then really started making a fuss about the perils of rising costs in 2024--as opposed to making a fuss about, say, government-mandated cost-control rationing near the end of life--the stage would be set for the Orszagists to push their curve-bending plans.  (Or is it because Cohn et al know this won't happen that they're desperately trying to portray curve-bending as politically essential this year?) ...

**--Isn't it more likely that empowering this cost-cutting commission will open up the reform to a Dick Morris-style they're-destroying-Medicare attack ? ...  4:11 A.M.

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