Posted by: Jeff | January 8, 2010

Statesmen, Not Politicians

Ezra Klein suggests that we’re beginning to get a clearer picture as to what aspects of health care reform the White House is willing to put up a real fight over.

The only ideas they’ve introduced into the debate, and the only ideas they’ve really stood and fought for against serious opposition, are cost-control ideas. Namely, the excise tax, the Medicare Commission, the insistence on deficit neutrality and the $900 billion price tag, none of which have a natural majority on the Hill, and all of which the Obama administration has kept in the game through direct advocacy.

Maybe that’s to be expected, given that the administration is functionally run by economists. Either way, there’s nothing comparable on the coverage side: The White House has not shown a preference for the improved subsidies or expanded coverage or employer mandate preferred by the House.

Now, arguably there are complications to this picture. The public-option-on-steroids  originally proposed by Jacob Hacker – favored by the subsidies, attached to Medicare’s rates, and subsuming Medicare and Medicaid – probably could have brought serious cost control. But it was almost certainly a political non-starter, and had long been bargained away by the time the public option became a serious political flash point. Operating the exchanges on the national level rather than the state level could also help with cost control, and securing that will require siding with the House against the Senate, which the Obama Administration seems loathe to do. But for the most part, I think Klein’s observation holds. And I think it reflects admirably on Obama and his team.

Things on the coverage side – expanded benefits, more generous subsidies and regulation preventing insurers from kicking off people with pre-existing conditions – all have natural constituencies amongst voters and thus natural constituencies in the legislature. Because those policies have benefits which directly affect large groups of people, who in turn are willing to fight for those benefits. Meaning the Administration doesn’t necessarily have to. Meanwhile, the costs of those policies, in terms of our long-term systemic financial health, are more abstract.

On the other hand, things like the Medicare Commission and the excise tax have no natural constituencies, because there are no groups of voters who see any direct benefit from those policies. The good those policies do by controlling systemic costs is abstract and only visible from 30,000 feet, while the pain of those policies falls directly on certain groups. (In these instances, the elderly and the unions, respectively.) So there’s no natural support for cost-control, but there is natural opposition. Which makes fighting for cost-control a thankless task. But fighting for cost-control is crucial, because without it our health care system is going to run the country off the financial cliff.

The Obama Administration has been getting a lot of flack for not putting up more of a fight for the favored policies of liberals and progressives. The Administration’s supporters have expected it to place its political capital on the line alongside that of its constituencies. But in not doing so, the Obama team has actually behaved like what Americans so often claim they want in theory but always reject in practice: Politicians who are truly willing, at least in some circumstances, to place wise policy ahead of popularity.


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