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Matt Yglesias and Ezra Klein have a request
They ask that I direct more messages to Republican Congressmen (here and here); Kevin Drum discusses related issues. They have a point and I'll state it more clearly: Republicans should support and indeed applaud Obama's attempt to cut some Medicare costs. Republican Congressmen also should stand ready to make a "grand bargain" on health care, again provided that it puts Medicare on a sustainable cost basis.
If I don't write more "for Republican politicians," it is for two reasons. First, I view their incentive as to make Obama fail, not to find an acceptable compromise that will move the nation forward. Second, I view the future of Medicare as the President vs. Congress, not one party vs. another. Democratic Congressmen will, ultimately, require persuasion as much as the Republicans or maybe more so. I still think the real danger is not recalcitrant Republicans but rather that we will get a health care plan without plausible mechanisms for fiscal responsibility.
Posted by Tyler Cowen on June 16, 2009 at 07:18 AM in Medicine | Permalink
Comments
I hate their obsequious attitudes. Fundamentally, they as progressives believe that the reason that Republican Senators don't enact their policies is because they are obtuse and/or ignorant, because anyone who really listened would be totally enamored with the new Medicare plan. It's just another false consciousness argument, and it sucks.
Posted by: Billare at Jun 16, 2009 7:51:36 AM
Rather, *supercilious* attitudes. Wrong adjective.
Posted by: Billare at Jun 16, 2009 7:52:05 AM
LOL, so I assume you're busy typing up letters this morning, Tyler?
Posted by: MikeDC at Jun 16, 2009 8:13:29 AM
Please talk to health care providers, medicare costs are being cut, but total expenditures are increasing. Why?
But please convince the American public that those expenditures to save husband/wife or mom/dad are often wasteful. Convince an American public that they should just be willing to slip into the darkness of eternal sleep not because we lack treatment options but because government regulators, on their charts, say it is your time to go.
The Obama plan will quickly become about rationing and price controls. His empty promises, like attacking McCain for wanting to tax health care benefits but now flipping on the issue, are just political theatre to gain initial control.
Obama claims that he doesn't want to control the auto industry, but he wants to control what they produce and how they compensate. Each passing day sees a government taking greater control of the economy.
What is happening in this country? Will we become a secular Iran, controlled by an elite council of government regulators devoted to the belief that the private sector can never be trusted?
Posted by: DanC at Jun 16, 2009 8:20:03 AM
What is your fascination with these twits?
Posted by: josh at Jun 16, 2009 8:36:59 AM
There is no moving the nation forward! And if it is it doesn't come from politicians.
And the Democrats incentive isn't to get credit for success? Politics IS zero sum. Who's ox? Why should Republicans offer any cooperation in screwing doctors? They aren't saying we will reduce overall Medicare spending, so what's the point in acknowledging them.
Like your neighbors dog do on your property line, ignore politicians utterly, until you absolutely can't. Then shoot them...rhetorically speaking. That will make YOU happiest.
Yglesias: "Basically, the administration is saying that while providing health insurance to the currently uninsured will cost money up front, that systematic reform has the potential to slow the rate of health care cost growth and reap large benefits. Importantly, this is the only way to prevent Medicare from bankrupting the entire country."
He finds your critique odd because he didn't understand it. Government spending up front to save later is NOT like other people's spending to save later. Because it is government, it doesn't work. The country won't be bankrupted, but the government will be, god willing. And, they don't want to insure the uninsured, they want to bill them. They could do this at the counter, but they have enacted laws requiring emergency rooms, which are now misnamed, to treat non-paying customers.
Posted by: Andrew at Jun 16, 2009 8:40:05 AM
"What is your fascination with these twits?
Posted by: josh at Jun 16, 2009 8:36:59 AM"
Second.
Posted by: Tom at Jun 16, 2009 9:15:12 AM
They have a point and I'll state it more clearly: Republicans should support and indeed applaud Obama's attempt to cut some Medicare costs.
I believe that their point is that Republicans should let the Democrats write and take credit for all the popular "expanding coverage" part of the bill, but that the unpopular "cutting coverage to cut costs" part of the bill should be bipartisan. Either that or they've just realized that health care reform isn't a free lunch, because the cost controlling reforms that Ezekiel Emanuel and Peter Orszag want to do to pay for it (and to control costs long-term) aren't really popular, being as popular as HMOs controlling costs in the early '90s.
But Obama's most common ads and speeches were criticizing McCain for suggesting that employer benefits should be taxable and replaced with a universal tax credit, or for suggesting and voting for somewhat more modest cuts in Medicare spending than being proposed now.
Candidate Obama poisoned the well on bipartisanship on this issue. He got his filibuster-proof majority in Congress; they can write the bill themselves, including the unpopular parts.
Posted by: John Thacker at Jun 16, 2009 9:18:58 AM
"...we will get a health care plan without plausible mechanisms for fiscal responsibility."
Don't we already have one?
Posted by: Milena Thomas at Jun 16, 2009 9:20:55 AM
This blog post leads me to suggest another, one that provides your take on why left-wing writers still focus so much attention on Republicans. It really doesn't matter what Republicans in Congress think or how they vote right now. They're a tiny minority. (Yes, they can filibuster but only on one or two issues, not everything.) The Dems control everything so it seems to me that writers from every side of the political spectrum should focus on making arguments to them.
I'd guess that many folks think it's still important to get at least some bi-partisan support for major changes, just for political cover, but I find that an odd notion. If you're a left wing blogger who supports universal care, surly you believe that Obama's plan would prove so successful that there'd be no need for political cover. Indeed, you'd root for no Republican support so you could use that against them in the next election and further extend your majority.
Posted by: Scoop at Jun 16, 2009 9:39:21 AM
"The ginormous organization that has demonstrated an inability to control costs (and if it didn't we wouldn't be having this discussion, because all we really care about is COG, continuation of government) is going to control costs, and in a fair and rational way that doesn't screw politically disadvantaged individuals. You told us about regulatory capture, so we won't do that. Trust us! Now what is your freaking problem, Republicans? Its for the good of the country(=government), it's not like WE are doing this for political reasons."
The liberal promise of cost controls involves their wet dream of a cost czar akin to the scene at the beginning of the Bourne supremacy where Pam Landy gets a call from CIA headquarters.
CIA director/Med cost czar: "That's a lot of money Pam."
Pam/Doctor: "It's where we came out. All it does is narrow the list of suspects. A bargain at twice the price."
CIA director/Med cost czar: "What's the story?"
Pam/Doctor: "A mole. A biopsy, it could be cancer. The patient is on site and we are ready to go. There is nothing more to discuss."
CIA director/Med cost czar: "Okay, it's your call"
See, after reading this, the liberals just (http://www.youtube.com/watch?v=4pXfHLUlZf4), the conservatives chuckled, and the doctors got the willies. Insurance companies doing this is eeeveeeel, but government will be competent, with a soft touch, see. When we say everyone will spend the same, is it REALLY going to reduce costs to the lowest, or just raise them to the highest?
The liberal cost cutting idea rests on competent and knowing government experts. Conservatives don't believe in those type of angels. The libs, also think Tyler is an expert to conservatives in the same they view economic experts. The experts we believe in are doctors and customers, and we've given them the wrong incentive structure, so fix it. Are they talking about fixing the structure, or just adding another bureaucracy. They are claiming, we'll add the bureaucracy and then the structure will evolve to improve. Conservative skepticism ensues.
Posted by: Andrew at Jun 16, 2009 9:39:24 AM
"I still think the real danger is not recalcitrant Republicans but rather that we will get a health care plan without plausible mechanisms for fiscal responsibility."
The "rational politician" is just as much a myth as the rational voter. And that goes for the political process, too. When have we ever had a "plausible mechanism for fiscal responsibility?"
Posted by: Eric H at Jun 16, 2009 10:18:08 AM
If the GOP incentive is to make the Dems fail, then isn't the Dem incentive to make the GOP fail? There are a few pols whose goal seems to be "for the good of the country"--Flake, Coburn, and....um...--but mostly it seems to be "for the good of me."
Posted by: Laserlight at Jun 16, 2009 10:39:15 AM
I'd guess that many folks think it's still important to get at least some bi-partisan support for major changes, just for political cover, but I find that an odd notion. If you're a left wing blogger who supports universal care, surly you believe that Obama's plan would prove so successful that there'd be no need for political cover. Indeed, you'd root for no Republican support so you could use that against them in the next election and further extend your majority.
The idea is that Democrats want credit for the expanded coverage, but want Republicans to sign on for the painful cuts and tax increases to pay for it to prevent political attacks.
But if the painful cuts are so unpopular, won't they be repealed or eased over time? A compromise doesn't have to last forever.
Posted by: John Thacker at Jun 16, 2009 11:06:48 AM
Sigh, compromise in this case is another word for losing. Sorry, dude, I don't want to go down that road.
Posted by: Doc Merlin at Jun 16, 2009 12:30:18 PM
Here are two reasons for writing more about and for Republican politicians. First, the more that people direct their criticisms and concerns at Obama rather than at Republicans, the stronger the Republicans' incentives to make Obama fail. Second, in a 60-40 (or 59-40) Senate with regular filibuster attempts, a few Republican votes can go a long way towards getting something through Congress.
Posted by: Dan at Jun 16, 2009 2:26:11 PM
Love the Klein kiss-up: "Cowen, of course, is one of the nation's most respected conservative economists. He has agency here."
Ooh, "agency". Almost as exciting as fiat power. But if Congress actually expressed the agency of Tyler and other "respected" economists, we wouldn't have had all these problems over all these years, either.
Tyler, if you could make one request to Congress and know that it would be granted, what would it be?
Posted by: Gordon Mohr at Jun 16, 2009 4:05:42 PM
". The experts we believe in are doctors and customers, and we've given them the wrong incentive structure, so fix it."
Ok, I am a doctor. Tell me how you will do that. I have yet to see a conservative plan that will come close to working.
Steve
Posted by: steve at Jun 16, 2009 9:33:48 PM
I view their incentive as to make Obama fail, not to find an acceptable compromise that will move the nation forward.
But how will they have a chance to pursue that end, being a minority party without so much as a filibuster to stop the crazy train out of Chicago?
If Obama "succeeds", America fails. (Unless you want paternalistic, cult of personality fascism)
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