Obama’s Health Care Reforms are morally decent technocratic improvements


By Joe Campbell
March 9th, 2010

I hate to quote this much from anyone, but Jonathan Chait’s entire post is brilliant and you should read his entire piece. But for future reference, and so I can always find it, these three paragraphs are what I wish I had written:

The latest Republican gambit, put forward by John McCain (who has become a pure stalking horse for the party leadership) is to demand that no change to Medicare be permitted through budget reconciliation. This means that the very difficult task of getting a majority of both Houses to approve a Medicare cut would become the nearly-impossible task of getting a majority of the House plus a supermajority of the Senate to do the same. Of course, Republicans as well as Democrats have used reconciliation numerous times to wring savings out of Medicare. But this proposal is not just the usual staggering hypocrisy. The immediate purpose is to render Obama’s health care reform impossible. But the long term effect would be to render any Republican reform impossible. How do Republicans propose to fulfill their vision of government when any forty Senators can block a dime of Medicare cuts? Don’t they ever aspire to govern?

In the lonely center of this howling vortex stands the Obama administration, diligently pushing its morally decent technocratic improvements. For this, the salons of establishment thought have given the administration little but grief. Sunday’sWashington Post editorial offers a fair summary of the response from the center. The editorial does allow that Obama’s plan would be ever so slightly preferable to the status quo. The Post editorial page is disappointed that Obama agreed to delay a tax on high-cost health care plans, and to replace the lost short-term revenue with a tax on the rich: “We think that it is not asking too much,” demands the editorial, “given the dire fiscal straits, for Washington to show that it can swallow distasteful medicine while, and not after, it passes out the candy.” Centrist critics have habitually used terms like “candy” and “dessert” to describe the provision of medical care to those currently suffer physical or financial ruin by the lack thereof. It is one of the most morally decrepit metaphors I have ever come across.

As Harold Pollack notes, Obama has successfully fought, over the opposition of lobbyists and Congress, to include numerous delivery reforms, such as an Independent Medicare Advisory Commission, bundled payments, and numerous other cutting edge steps. Centrists give these reforms little or no credit — after all, because they are untried, they have no record and the Congressional Budget Office can’t calculate their potential savings. The CBO can credit things like the excise tax, but the centrists give that little weight as well — after all, Obama agreed to delay the tax in order to let labor contracts adjust. He replaced the lost revenue by extending the Medicare tax to capital income earned by the affluent. But tax revenue from the affluent somehow counts less, too. The Postdismissively calls this “the politically easier option of extending the Medicare tax to unearned income of the wealthy,” as if raising taxes on the most powerful and well-connected people in America, in an atmosphere where one party opposes any taxes on the rich with theological fervor, is the kind of solution that’s just sitting there for the taking.

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