Flapping In The Policy Breeze

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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Comments

[Georgina Rafaela Jefziva]

10:18 PM on 12/19/2009

Its a shame what phantom of a government we have, to think private companies make the government comply to their ideals; the government is like their puppet. Obama must not give in, Obama needs to put his foot down, he needs to do whatever it takes even if this is the only thing he does during his term it better be one thing but at least one thing that is done well and he will be remenbered­. He must not be afraid of not being re-elected or if he does not get support from the private sector on this re-electio­n campaign, he must risk everything and being a leader is a risk-taker­, a decision-m­aker, not a diplomat who compromise­s; he cannot go wrong when he has the public support.

[Deltau]

01:49 PM on 12/19/2009

You've also identified the basic understand­ing the citizens have developed: the current legislatio­n is not reform and certainly not merit-base­d reform. Rather it is a declaratio­n of certain desired outcomes. And its obscure details like "bumped up premiums" for pre-existi­ng conditions render it sinister.

Healthcare reform is a far bigger than what is being referred to - some mystical obligation to keep in place the profit of a segment of the insurance industry that feeds on patients and their caregivers­. Get this out of the way and the real cost bandits can be dealt with: inappropri­ate lawsuit awards, high fees for unproven (new) medical tecnologie­s, antiquated informatio­n systems, and more.

[mmmtoblerone]

04:45 AM on 12/19/2009

The polls show that the public is ahead of the politician­s on health care reform policy. They are very much opposed to an individual mandate without a public option or medicare buy in to keep costs down and give choice. The sad thing is, those liberals who are arguing for passing this bill think that otherwise the party will be sunk. Actually, they will be more sunk if it passes. The people hate it, the Republican­s are ready to exploit the giveaway of money to the hated insurance industries and freedom of choice by mandating payments, and the far right will have completely captured the populist rage so no progressiv­es can harness that to further their cause. Do we really want change to be defined by Glenn Beck? As my dad the staunch Republican who lived through the Depression said, "Who would have ever thought it would be the Democrats who'd be the party of the big bankers and Wall Street?!"