Yesterday’s David Brooks column featured an interesting, but factually inaccurate, critique of health reform legislation:
Rather than pushing all of the new costs onto future generations, as past governments have done, the Democrats have admirably agreed to raise taxes. Over the next generation, the tax increases in the various bills could funnel trillions of dollars from the general economy into the medical system.
I suppose his out here is the use of the word “could funnel” but you’re clearly supposed to understand that as will funnel. This is, however, a major difference between the House and Senate bills. The House bill, financed overwhelmingly by income taxes on high earners, will represent a large aggregate shift of national resources from the wealthy to the poor and near-poor. It will also represent a large shift of resources from things that are not health care services to things that are health care services. The Senate bill is not like that at all. It is much more mildly redistributive, but its redistribution is overwhelmingly contained within the health care system via taxes on “cadillac” health plans, medical devices, plastic surgery, etc.
It’s a big, big difference that I think hasn’t gotten enough attention. And I’m not sure how the difference will be resolved. But it should be noted that one major consequence of the Republican Party’s decision to enforce unanimous opposition to health reform is that they’ve deprived themselves of the ability to influence the choice. One reason legislative fights used to be less polarized is that members seem to have been more inclined to say to themselves things like “some kind of health care bill will probably pass one way or another, I should see if I can shape it more to my liking in exchange for my vote.” One thing you see the more you hang around the health care debate, after all, is that there are sort of two different cross-cutting debates.
One is a left-right debate about how equitably national health expenditures should be and another is a basically unrelated debate about how high the level of national health expenditures should be. I would like to see NHE growth controlled, and I think Brooks would too. And I know some congressional Republicans agree with me. And the best way to make that happen would be if they would say “we’ll vote for a health care bill financed in the NHE-controlled Senate way, but not one financed in the House way.” That’s an offer the Democrats would have to take seriously. But they’ve taken themselves out of the process, so instead the choice will be made entirely by Democratic leaders bargaining amongst themselves.