Thursday, July 23, 2009    

The Case for Delayed Orszagism:  One way to control health costs--at least according to the Congressional Budget Office --is to wean people away from employer-provided insurance, maybe by taxing it like other income. Once everyone's buying insurance with their own, unsubsidized dollars, the argument goes, people will be more sensitive to the price of care, more willing to shop around, and less willing to spend on unneeded treatments. 

Fair enough. But if you want to break the employer/untaxed insurance link,  won't that be easier to do if there's a public option in place with a good rep that people know they can rely on if they leave their employer's plan?   First you give everyone security. Then many of the changes necessary to control costs are that much easier to make. They will be less threatening, for one.  And even when they are still threatening--as some of the treatment-defunding plans of the Orszaggers arguably are--people will understand that the changes are needed to preserve their benefits, not to pay for extending insurance to someone else.

The two-step approach doesn't necessarily mean abandoning cost controls, in other words. It might be the only way to actually achieve reasonable controls (though put me down as doubting that the cost curve can or should actually be bent very much).

P.S.--The Case Against 'Comprehensivism':  This is the problem with a "comprehensive" plan--i.e. a plan that does everything at the same time. It's asking the public to trust that all the parts will work at once just as the experts say they will work. I don't understand why Dems seem to think it helps policy proposals like their health plan to call them "comprehensive." ... Look how that word helped sell "comprehensive immigration reform." It's just catnip for voters! (Even supporters of "comprehensive" immigration change have been gravitating toward a two-step, non -comprehensive approach: reassuring border security first, legalization later.) 

Every time a politician calls his reform "comprehensive" I look for the dangerous part that doesn't have to be there. ...  7:14 P.M.

___________________________