Monday, October 05, 2009

And You May Ask Yourself: Who Am I?

Paul Krugman:
In 2005, when Democrats campaigned against Social Security privatization, their arguments were consistent with their underlying ideology: they argued that replacing guaranteed benefits with private accounts would expose retirees to too much risk.

The Republican campaign against health care reform, by contrast, has shown no such consistency. For the main G.O.P. line of attack is the claim — based mainly on lies about death panels and so on — that reform will undermine Medicare. And this line of attack is utterly at odds both with the party’s traditions and with what conservatives claim to believe.

Think about just how bizarre it is for Republicans to position themselves as the defenders of unrestricted Medicare spending. First of all, the modern G.O.P. considers itself the party of Ronald Reagan — and Reagan was a fierce opponent of Medicare’s creation, warning that it would destroy American freedom. (Honest.) In the 1990s, Newt Gingrich tried to force drastic cuts in Medicare financing. And in recent years, Republicans have repeatedly decried the growth in entitlement spending — growth that is largely driven by rising health care costs.

But the Obama administration’s plan to expand coverage relies in part on savings from Medicare. And since the G.O.P. opposes anything that might be good for Mr. Obama, it has become the passionate defender of ineffective medical procedures and overpayments to insurance companies.


Andy said...

Yes, ironies abound. Another example are Democrats who want single-payer arguing that competition is necessary to bring down prices.

helmut said...

I'm sure we could find plenty of ways in which certain Democrats take on inconsistent positions. But your particular example only makes sense if you assume that Democrats are anti-market and anti-competition, which they are pretty much universally not.

The big difference, I think, is that Republicans have made an explicit political platform of being oppositional to the Obama administration. So, any time Obama discusses an idea that might normally be perceived across the political spectrum as a good idea, Republicans thus place themselves in the position of choosing a worse or just plain bad idea in response. It's a self-defeating platform Repubs need to find their way out of. That most don't seem to want to or maybe can't suggests that opposition is pretty much all they have substantively as well as rhetorically.

If I were a Repub concerned about the future of the party and substantive philosophical differences, I'd try to shift the party's focus to serious discussions about real, concrete policy options in the face of various concrete problems.

An analogy is science - if a scientist continues to propose results of an experiment that others cannot replicate, those other scientists will ultimately conclude that the first scientist's results do not accurately represent physical reality. That conclusion eventuates out over time precisely because reality resists false representations. The Repubs seem to be pinning their hopes on convincing people of a reality that's favorable to themselves, true or false. There may be some short-term gains by doing so, but this will also play out in the longer term. Just like the scientist, you can't force such a subjectivist, relativist view of policy on others over time.

Or something like that....

Andy said...

Single-payer is inherently anti-competition, so I think my example stands. Are the Democrats universally anti-competition? Of course not, but the GoP isn't universally anti-government, despite some of the rhetoric.

What the GoP is doing is called politics. It may turn out to be a self-destructive strategy and we'll find out soon enough.

It's also important to keep in mind that compromise is not easy for policies that cross ideological red lines like the public option. For another example, see the GoP social security reform plans that had private accounts as a voluntary option. That crossed a red line for the Democrats.

There is actually a lot of agreement on several health reforms across party lines and even among the insurance and drug industry that progressives are demonizing. The fault-line is actually in the democratic party, specifically the progressive wing which sees a public option as a necessary step to get to what they really want, which is single payer.

helmut said...

I don't think it stands. The market is not devoid of policy intervention. There is no such free market. The question involves where we think market forces produce unsatisfactory outcomes. Defense, education, large parts of national infrastructure, etc. are basic government services, public goods, that we don't wish to leave solely up to the market. They are essentially single-payer. If a person or group wants to boost government spending on defense, for example, does that mean that the person or group is anti-market? Yes, but in a pretty banal sense that recognizes that not all things should be left to the whims of market forces and so pretty much all of us are anti-market. Some public goods are simply worth supporting, regardless.

The question is whether healthcare is one such area of public goods, especially since the status quo is such a drain in terms of financial and human costs. But that's at the heart of the philosophical difference here. Single-payer (or not) involves a philosophical argument that's worth having. So far, the alternative proposal seems to be simply maintaining the status quo because single-payer is bad. Why? Because it's anti-market. Back to the circle.

Is it possible to achieve the kind of healthcare policy outcomes that, on moral and economic grounds, we would like to secure as a public good, but without a single-payer option, that might also overcome the deep problems of the status quo arrangement? Maybe. But where is that policy proposal?

This is not some conspiracy. It's a serious policy issue. There will be progressives that demonize others, sure, and I think they're as guilty of unseriousness as anyone else. But, honestly, apart from the ridiculous Alan Grayson and a handful of bloggers, who's doing the real demonizing in the public discourse (to the point of overt death threats)?

Andy said...

The market is not devoid of policy intervention.

That's true and I would go further and say that almost every market is created, managed or influenced by government policy. The free market types don't, I think, want to completely get rid of government in markets, but they want to minimize it. Health care markets are actually very highly regulated.

Is it possible to achieve the kind of healthcare policy outcomes that, on moral and economic grounds, we would like to secure as a public good, but without a single-payer option, that might also overcome the deep problems of the status quo arrangement? Maybe. But where is that policy proposal?

The GoP has come out with a few proposals and I think this is the most prominent. The Democrats, just like the GoP, have little incentive to seriously consider or merge ideas from the minority that just got stomped in the election. But the idea that the GoP has come up with nothing is just false.

On your bigger question, I think it is possible, but it will require the kind of reform that neither the Democrats or GoP are willing to make. My problem with the entire health-care debate (and the plans from each side) is that the fundamental systemic problems are not addressed and the most important of those problems is cost growth. The current Democratic bill, for example, will run out of money in 8-10 years because costs will rise much faster than the revenue streams that fund them. That will be a problem with any proposal that doesn't have cost growth control as a core feature.

So I don't think the Democrats are completely wrong to look at the uninsured and uninsurable (everyone agrees that is a serious problem), I just think that their plan is unsustainable and doesn't address more fundamental problems. I think either the GoP or the Democratic plan would work to cover the uninsured, but neither are sustainable.

And frankly, I'm not sure single-payer will work either, even if that were politically possible. The reality is that any single-payer program that gets enacted will start from a very high cost basis. It may be better at reducing excess cost growth, but even the Europeans haven't kept health costs completely in line with GDP growth and inflation. So reducing costs is the second major problem after cost growth.

This is not some conspiracy. It's a serious policy issue. There will be progressives that demonize others, sure, and I think they're as guilty of unseriousness as anyone else.

I agree, and that's why I don't, at the end of the day, see much difference in the political tactics used by either party. On the Democratic side, "some progressives" include the Speaker and other prominent party leaders....

helmut said...

Good and fair points, Andy.

Can't respond much today, and Blogger just ate the comment I had going, but one point:

I don't think cost is THE most important problem. Cost runs alongside the moral imperative as a feasibility consideration connected to other issues (like deficit, etc.). Societies often make choices for non-economic reasons and then figure out how to deal with the economics. It worries me to put the relation between non-economic normative imperatives and economics the other way around.

helmut said...

Also, check out the new Human Development Report, one of the indexes that moves beyond simple GDP as a measure of a country's well-being (imperfect, nonetheless, as are all attempts to apply a comprehensive metric to human well-being). HDI combines GDP/PPP, education, and life expectancy. US is still doing well on GDP at 9th in the world, but falling quickly on life expectancy and education. At some point, that's also going to be a serious problem for GDP.


Andy said...

Thanks for the link, I'll take a look.

I agree to an extent with our point on the moral imperative. The problem is that we've been making non-economic choices for decades now and keep kicking the economics can down the road. We can't borrow against future GDP indefinitely, particularly since it looks like GDP growth is going to be a lot lower than what we've seen over the past couple of decades.

MT said...

The government funds nearly all basic research in science, it seems to me. If we eliminated private foundations to make science single-payer, would it become non-competitive? There's a Nobel Prize in medicine too.