In 1997, Princeton economist Alan Blinder asked a classic public policy question: "Would the country be better off if more public policy decisions were removed from the political thicket and placed in the hands of unelected technocrats?" Believing the answer to be the affirmative, he revived the argument earlier this year in objecting to calls for enhanced oversight of the Federal Reserve. Similarly, the Columbia economics professor Jeff Sachs recently advised increased reliance on expertise, in his case to make up lost ground in the fight against climate change. Indeed, much discussion of the overhaul of the financial regulatory system has focused on the technocratic acumen - or lack thereof - of the overseers of the financial services industry.
The debate about health care reform is currently about this very question. In the last two weeks, from a short-term policy perspective very little has changed. Yes, the public option, which would have covered several million Americans, was dropped. But the very best argument for the public option as constructed was about its potential as a structure on which future cost savings might be built - remember, the CBO predicted higher premiums in the House's public option - and whose eligibility requirements could be loosened down the road to make public insurance more widely available. The public option has long since been abandoned as a means of expanding insurance coverage.
The public option's immediate power as a bargaining chip, however, was real and significant. Thus, with its death, the astute Jonathan Cohn reminded people "What Public Option Supporters Won." What they won, I take him to argue, is a bill that they can support: a bill with subsidies, an insurance exchange, and tens of millions fewer uninsured.
On the other hand, skitterish progressives considered the cashing in of this most important of chips as the last straw. Look at the stock market, Dylan Ratigan screamed at Rep. Debbie Wasserman Schultz on Friday morning. Insurance industry stocks are skyrocketing! Yet, when Congress last looked to the stock market for legislative advice we ended up with the $700 billion TARP bailout without thinking twice about our order of operations (bankers first, homeowners last).
Obviously, nonpoliticians - technocrats, doctors, academics, and the like - would have designed a much better, more effective, more efficient framework for health care reform. Cost-savings, for example, would not have to rely on a million little experiments, which might all fail against the money and influence of the insurance industry.
But the question for those who actually want health care reform is now not about politics - it is not about falling in line behind a Democratic Party or in step with a progressive movement that was duped by its own leaders into supporting something, albeit worthy, that was in some important ways always a pipe dream. The question for supporters is: how well equipped is the public, especially the informed public, to support reform based on its merits, rather than its politics?
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