Posted by: Jeff | September 18, 2009

The Larger Picture

Andrew Sullivan has a great post up on the health care debate.

The major resistance to healthcare reform at this point is, understandably, fiscal. If healthcare reform actually lowers the deficit over the long run according to the CBO, then resistance on that score should crumble. That’s why this bill may have more legs than it first appeared. It will appeal to fiscal worry-warts like yours truly. It will be manna for Independents. And if the GOP opposes a bill that both removes some of the current injustices and reduces the long-term deficit, then the joke in the end is on them.

I think that’s right, and it’s why, in spite of everything, I tend to be pretty positive on the Baucus bill. A lot of the bill’s critics are still comparing it to what they’d ideally like to achieve, rather than comparing it to the status quo. But the second comparison is really what matters.

Also, as far as I understand, there’s no inherent reason why the affordability issues in the bill – the subsidies and so on – couldn’t be improved while still preserving the budget-friendly structure Baucus put together. The key there would be finding new tax revenue. That’s no easy feat, certainly, but I wouldn’t think its impossible. The House’s surtax on Americans making over $350,000 seems like an obvious place to start. I realize several Senators have declared it a no-go, but we’re getting into crunch-time here and the political realities, and thus the political incentives, are starting to shift.

But even better is Sullivan’s take on the health care debate as a whole, which I’ve included “after the fold.” I agree with every word. (Even the bit about the tea-partiers, I suppose.)

Most of us who are not Ezra Klein are not versed up to the gills in healthcare terminology and policy wonkery. The debate back and forth has been clarifying to me in a very complicated area which once bored me to death but has become increasingly interesting the more I’ve learned about it. Allowing the Congress to present different options, from several committees, letting the debate unfold as it has, allowing legitimate fears to be expressed (along with nutty Palin-style lies), bobbing and weaving between parties and senators … this is the system working. The system in America is not supposed to create massive sudden change. Maybe if the TARP and bank bailouts had been subject to this kind of to and fro, more errors would have been avoided.

To those who say the president has been too passive, may I suggest making that judgment once this process ends? I find Obama’s style to be more constitutionally appropriate than the president-as-decider model. I think that beneath the tea-party loopiness, we’ve made strides toward grappling with one of the biggest and most complex policy challenges there is. Even the tea-parties serve a purpose: they channel unease with the vast changes we have absorbed in the last year, and vents it. A democracy that cannot vent is less stable in the long run.

And there’s scope for more manuevring. Why not add Wyden’s more competition-friendly ideas into the final bill, as he suggests in the NYT this morning? Maybe there’s something I’m missing, but it seems to me that the Baucus plan may be fiscally solid but doesn’t do enough to enable patient and consumer power to bring down costs. Is Wyden’s proposal a helpful fix? Or a step too far at this point?

It seems to me Wyden’s op-ed gives Baucus’ bill too little credit for the way it extends the reach of the exchanges after 2017, but that’s certainly no argument for not adopting the changes Wyden suggests. I’m not aware of any downsides to expanding the scope of the exchanges even faster. Is anyone else?


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