Friday, April 17, 2009  

Democratic blogger Ezra Klein appears to be positioning Dem health care reforms as a way to cut costs,  on the grounds that a reformed system will be able to make "hard choices" and "rational" coverage decisions, by which Klein seems to mean "not providing" treatments that are unproven or too expensive--when "a person's life, or health, is not worth the price." Matthew Yglesias' recent post   seems to be saying the same thing , though clarity isn't its strong suit. (He must have left it on Journolist.)  

Isn't it an epic mistake to try to sell Democratic health care reform on this basis? Possible sales pitch: "Our plan will deny you unnecessary treatments!" Or maybe just  " Republicans say 'yes.' Democrats say 'no'!" Is that really why the middle class will sign on to a revolutionary multi-trillion dollar shift in spending--so the government can decide their life or health "is not worth the price"?  I mean, how could it lose?

The "rational," cost-cutting, "hard-choices" pitch isn't just awful marketing --I don't even think it's accurate. Put it this way: I'm for universal health care in large part precisely because I think the government will be less tough-minded and cost-conscious when it comes to the inevitable rationing of care than for-profit insurance companies will be. Take Arnold Kling's example of a young patient with cancer, where "the best hope is a treatment that costs $100,000 and offers a chance of success of 1 in 200." No "rational bureaucracy" would spend $20 million to save a life, Kling argues. I doubt any private insurance company is going to write a policy that spends $20 million to save a life.  But I think the government--faced with demands from patient groups and disease lobbies and treatment providers and Oprah and run, ultimately, by politicians as terrified of being held responsible for denying treatment as they are quick to pander to the public's sentimental bias toward life--is less likely to be "rational" than the private sector.

That is to say, the government's more likely to pay for the treatment (assuming a doctor recommends it). So it's government for me.  

Now, I understand that President Obama has chosen to sell his health care plan in the current budget as a way to control costs. How else to even colorably bill it as a policy response to the immediate economic crisis?  That it won't control costs seemed, initially, to be merely disingenuous--and what's a little deception if that's what it takes to get a good universal health care law passed? But on second thought, Obama's strategy isn't just disingenuous. In the not-so-long run it's ineffective, a political loser.  

Didn't universal health coverage gain traction during the anti-HMO era, when voters began to see private-sector cost-cutting bureaucrats override the decisions of doctors to provide drugs and treatments to their patients? The evil HMOs tried to kick new mothers out of the hospital after a day! Politicians responded with laws  mandating treatment, with a " patients' bill of rights ," etc. But now, through a heroic, concerted effort at self-congratulatory Obamaist groupthink , the Dems are about to cast the g overnment in the cost-cutting, treatment denying role and put themselves on the side of the heartless bureaucratic bean counters.  

More broadly, haven't liberals historically prospered when they promised and delivered more for the average American (more Social Security, health security, prosperity, clean air) in exchange for increased spending? Why not try the same with health care? Give pandering a chance. ...  2:49 A.M.

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