David Brooks and The New Anti-Anti-Orszagism. It's Wrong!

A mostly political weblog.
Sept. 1 2009 1:11 PM

David Brooks and The New Anti-Anti-Orszagism. It's Wrong!

Politico conveys the latest White House staff boasts about health care strategy:

Top officials privately concede the past six weeks have taken their toll on Obama's popularity . But the officials also see the new diminished expectations as an opportunity to prove their critics wrong ...

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Anti-anti-anti-Orszagism : David Brooks mounts the conventional defense against anti-Orszagism:

The second liberal response has been to attack the budget director, Peter Orszag. It was a mistake to put cost control at the center of the health reform sales job, many now argue. The president shouldn’t worry about the deficit. Just pass the spending parts.

But fiscal restraint is now the animating issue for moderate Americans. To take the looming $9 trillion in debt and balloon it further would be to enrage a giant part of the electorate.

Brooks is being disingenous, I think. The complaint against Orszag isn't that he's worried about the deficit. You could easily have a substantial health reform effort that was deficit-neutral--that didn't add to the $9 trillion , which is the estimated deficit for 10 years.  Where Obama and Orszag went wrong was in ostentatiously blabbering about long-term health cost "game changers" beyond that 10 year period, involving a "very difficult democratic conversation" on whether to put limits on treatments toward the end of life. It's the "game changers" that rightly scare people who worry about moving toward Brit-style rationing or other sorts of restrictions ..

This discussion of long-term "game changers" was almost entirely gratuitous, policy-wise. 1) They're unproven. Maybe they'll work--i.e. cut costs without affecting care . Maybe they won't. It's irresponsible to make speculative efforts to control long term health costs, something that hasn't been done in this country, the centerpiece of an attempt to extend care; 2) They're long term! There's plenty of time to institute whatever curve-bending changes in medical practice between now and 2019, as eminently respectable policy person Uwe Reinhardt notes ; 3) Cutting health care costs isn't the only responsible way to control the deficit. You could also cut other costs (e.g., Social Security) or raise taxes; 4) It was intellectually misleading to argue that spending a trillion dollars to extend health care coverage (and add demand to the system) was somehow the way to control long term costs, which was the essence of Obama's appeal in his address to Congress. Maybe expanded coverage would give the government more monopsony leverage--a not-unscary prospect in iitself, especially if you are "suspicious of centralized government," as Brooks says we Americans are--but basically the two issues seem separable. If you want to control long term costs and shift to a different treatment model you could start doing that independent of efforts to broaden coverage (which, indeed,  Orszag proposes doing). There's no clear policy reason--certainly no reason we've been given--that the two have to be linked. 

Brooks has it backwards, then, when he suggests Orszag's critics are saying Obama should have put good policy common sense aside for cheap political reasons. The policy groundwork for insisting on legislating "game-changers" now is weak. The only reason to include them was political --the calculation that even a speculative, possibly Potemkin-like effort to address long term costs would appeal to Blue Dog legislators and independent voters.  It's this political calculation that appears to have been the big mistake--the curve-bending, treatment-denying talk has scared seniors so much that popular support for the whole package (including among independents)  has sunk to dangerous and possibly fatal levels.

P.S.: I've learned the hard way not to question the judgment of John Harwood, but his Obama's-in-good-shape analysis seems a little ... well ... Ambinderish. ... Same goes for Norman Ornstein, who focuses on the inside game (for Senate votes)  and ignores the outside game (for public opinion). Is he ...rearranging reconciliation votes on the Titanic ! ... And didn't Ezra Klein tell us a couple of weeks ago  that the inside game had failed, and now Obama was going to move the argument "to the country" where he'd "marshal public support"? What happened with that? ...

P.P.S: According to Atlantic , Obama is going to seize on his moment of seeming weakness to ... draw lines in the sand! Auspiciously, none of the lines (as reported by Ambinder) is an insistence on Orszag's long-term rule benders. But the night is young. ... 2:46 P.M.

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The New Republic explores new revenue models , Atlantic -style. ... And they're going to viciously attack Christina Romer after she's helped them charge $250 a seat? ... 2:45 P.M.

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"Hot Blue on Blue Action": Joe Klein vs. Glenn Greenwald: Tom Maguire buries his real lede --Is it possible that Glenn Greenwald is not  a member of the secretive Journolist? ... P.S.: On the question of whether "Klein pretends to position himself as an observer rather than a rooter at TIME," I would say the answer is no.. It would be futile to do otherwise at this point, anyway--as Maguire notes. ..."Rooter" is too passive, though. More like "player." ... You got a problem with that? ... 2:44 P.M..

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