Public Choice and the Prospects for Reform

Glenn Greenwald unleashes some righteous outrage: “The insurance industry gets the biggest bonanza imaginable in the form of tens of millions of coerced new customers without any competition or other price controls […] negotiated and effectuated in complete secrecy, in the sleazy sewers populated by lobbyists, industry insiders, and their wholly-owned pawns in the Congress.”

As Kevin Drum indicates, the main flaw in this analysis is that it doesn’t go nearly far enough. You would think from reading some left-wing blogs that this bill is a sellout to the interests of the insurance industry. In reality it’s so much more than that! You start talking about comprehensive health reform and a swarm of interest groups are after it like piranhas swarming a juicy steak:

The individual mandate was a way of getting support from the insurance industry. The backroom deal with Big Pharma was a way of getting support from the drug industry. The change in Medicare reimbursement rates was a way of getting support from doctors. The gutting of the Medicare commission was a way of getting support from hospitals. Provisions related to biologics, home healthcare, and the prescription drug doughnut hole were a way of getting the support of AARP.

The question is where does this analysis lead you. The smarter brand of rightwinger I know believes — or at least professes to believe — that the corrupt nature of the political process means that any effort to seriously remediate social problems through public action is doomed. Therefore, the best thing one can do politically is nothing. Or perhaps cut the minimum wage.


Another place it can lead you is the place where Kevin and I are. You complain about this stuff. And complain and complain and complain. And fight and fight and fight. And at the end of the day when what emerges from the piranhas’ den is better than nothing, you say yes and live to fight another day. I think if you read Andy Stern’s letter you’ll see that’s what he’s saying too.

But the place where I think it can’t lead you is the place where I think a lot of the people on the left want to go. That’s a place where you’re so shocked and horrified by the corruption of the system that you think that if you can persuade two or three left-wing senators to say “no” that suddenly a better legislative product emerges. If you think that’s going to happen, you should spend some time reading Glenn Greenwald posts about how screwed up Washington is.