David Brooks is not wrong to recommend the Brookings Institution’s report “Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth”. He is, however, being completely absurd to suggest that what’s gone wrong with the health reform process in the United States could be fixed by “ask[ing] Obama to go to the Brookings Institution Web site and read a report called ‘Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth.’” As James Suroweicki says:
I could be wrong about this, but I suspect that Obama is more than familiar with Brookings’s work on health-care cost-containment, particularly since Peter Orszag, Obama’s budget director, was a fellow at the Brookings Institution, and has spent a good chunk of his recent years working on the problem of how to contain health-care costs. And it’s not as if the Administration hasn’t been talking — I would argue perhaps talking too much—about “bending the curve” when it comes to health-care costs. Brooks’s piece is written as if the real hurdle to change is that the Obama Administration doesn’t realize what’s wrong with the health-care system, so that if Obama just read the right texts, he would be willing to push for fundamental reform. But the Administration knows more than enough about the problems with health care. It’s just trying to figure out how to come up with a politically possible solution.
The fact that the Brookings report’s title is chosen to echo a phrase popularized by the Obama administration should perhaps have been a clue that the administration is aware of the basic shape of the problem. The fact that one of the authors of the report, David Cutler, was Obama’s chief health economics adviser during the campaign also seems relevant. Unless this is just pure low partisan politics, Brooks seems to be manifesting a weird form of the cult of the presidency problem, in which he suggests that sheer White House willpower could generate congressional support for controversial cost control measures.
But if you want to find villains in our failure to focus on controlling long-term costs, Obama is the last person you should point your finger at. The administration has done more than anyone else to focus attention on this issue. Second come moderate Democrats in congress who’ve also emphasized this. Third come congressional liberals, who don’t seem that interested in the subject but also seem perfectly willing to embrace it as a goal of reform as long as reform succeeds in expanding access. Then you’ve got the congressional Republicans who’ve given no sign of interests in bargaining in good faith. And then you’ve got the right-wing demagogues who now have every politicians in American convinced that any move toward cost control will get you denounced as eager to euthenize grandma. Insofar as respectable conservative like Brooks would like to see health care spending brought under control at some point, their failure to confront these voices is going to make that impossible.
As David Frum has written, the right is waging this war in a way that makes future conservatism impossible:
Even worse will be the way this fight is won: basically by convincing older Americans already covered by a government health program, Medicare, that Obama’s reform plans will reduce their coverage. In other words, we’ll have sent a powerful message to the entire political system to avoid at all hazards any tinkering with Medicare except to make it more generous for the already covered.
If we win, we’ll trumpet the success as a great triumph for liberty and individualism. Really though it will be a triumph for inertia. To the extent that anybody in the conservative world still aspires to any kind of future reform and improvement of America’s ossified government, that should be a very ashy victory indeed.
The perversity of winning this kind of pyrrhic victory is what convinced people that congressional Republicans might prefer to make a deal. But it seems that those who believed that were mistaken.