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Siding with cost control

Wise words from Paul Krugman:

[T]here’s another reason failure to pass reform would be devastating — namely, the nature of the opposition.

The Republican campaign against health care reform has rested in part on the traditional arguments, arguments that go back to the days when Ronald Reagan was trying to scare Americans into opposing Medicare — denunciations of “socialized medicine,” claims that universal health coverage is the road to tyranny, etc.

But in the closing rounds of the health care fight, the G.O.P. has focused more and more on an effort to demonize cost-control efforts. The Senate bill would impose “draconian cuts” on Medicare, says Senator John McCain, who proposed much deeper cuts just last year as part of his presidential campaign. “If you’re a senior and you’re on Medicare, you better be afraid of this bill,” says Senator Tom Coburn.

If these tactics work, and health reform fails, think of the message this would convey: It would signal that any effort to deal with the biggest budget problem we face will be successfully played by political opponents as an attack on older Americans. It would be a long time before anyone was willing to take on the challenge again; remember that after the failure of the Clinton effort, it was 16 years before the next try at health reform.

In other words, enough with the deficit nihilism, already. If you believe in cutting the deficit, you have to support bills that cut the deficit. If you believe in controlling health-care costs, you have to support bills that begin controlling health-care costs. The Republicans want to win some seats in 2010, so they've gotta do what they've gotta do. But anyone who cares about the deficit should not be allied with the people trying to make deficit reduction untouchably toxic.

By Ezra Klein  |  December 4, 2009; 3:23 PM ET
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So let me get this straight - I'm supposed to support this sell-out bill that will gladden the hearts of health industry hacks everywhere (hello, captive mandate market with no government or non-profit alternative) because other people oppose the bill for other reasons? Some twisted logic you got there, dude. Is this the Journolist talking point of the day? Guilt by association? Jeez, try again.

Posted by: redscott | December 4, 2009 3:38 PM | Report abuse

"If you believe in cutting the deficit, you have to support bills that cut the deficit. If you believe in controlling health-care costs, you have to support bills that begin controlling health-care costs."

How about if you believe in cutting the deficit and controlling health care costs, but don't believe that the proposals on the table will actually do that?

Posted by: ab13 | December 4, 2009 3:43 PM | Report abuse

Ezra- I think that its just inevitable that if the republicans were in control and tried to pass cost control measures that Democrats would be doing the EXACT same thing. Which is why I don't at all support making the problem WORSE by greatly expanding the problem with this bill. Cost control in government provided healthcare is already politically toxic when just 15% of the public is covered yet you think it will be easier once that coverage is expanded? Ridiculous.

Posted by: spotatl | December 4, 2009 3:53 PM | Report abuse

(Incidentally, up until the summer, Krugman was one of those you deride for "convincing liberals that this bill was worthless in the absence of the public option.")

But anyways... now he's "wise" for pushing reform that doesn't control health spending, and reduces the deficit mostly through a 40% tax on worker benefits.

I wonder what would have happened to George W. Bush if he tried to reduce the deficit this way.

Posted by: bmull | December 4, 2009 4:02 PM | Report abuse

Deficit reduction should not be a priority in the middle of the biggest recession in 80 years.

Posted by: NS12345 | December 4, 2009 5:02 PM | Report abuse

The Commentariat is making the same mistake. Yes, the bill isn't very good on cost control. But it's better than nothing. And nothing is the alternative. We can all come up with theoretical ways to control costs, but none of them will mean anything because they'll never actually make it into law. You have to start somewhere. So it's either pass a bill with limited, but real, cost control now and build momentum for more later. Or do nothing and let things get worse for another dozen years. That's the reality of the situation

Posted by: etdean1 | December 4, 2009 5:16 PM | Report abuse

Comments by 'redscott' and 'ab13' are right. Ezra is not honest here.

There is not much credibility left with Krugman in all these issues and it is not 'enough' with deficit nihilism.

Ezra - you do not get to publish President's lucid explanation about deficit and how medical costs are at the root of that in one case and then just divert the attention about how GOP is bad in this regard. Well, you can (and you have) publish these things but then you are not consistent and useful.

Why are you, quintessentially the policy guy, getting involved in the Politics of GOP? Why again the policy guru Krugman, disingenuously getting involved in politics and GOP when both of you need to bother about policy details and still unsolved issues of 'cost control' in the current bills? We do not need you to tell us how foolish GOP is in this regard. (That old man Sen. McCain thinks we Americans are all as intelligent / dumb as like Palin. With what straight face he talks about stopping Medicare cuts and at the same time deficit reduction...)

We need you to respond what Karent Tumulty is pointing - how Sen. Reid is throwing the 'bomb' on Medicare Commission.

Don't hide behind the foolishness of GOP and meanwhile ignore still unfinished business of cost control.

Posted by: umesh409 | December 4, 2009 5:36 PM | Report abuse

This is not a cost control bill and should never have been allowed to become one. This bill is by name and intent a bill focused on access and affordability which go hand in hand. The demand that the bill even be budget neutral was bad enough that it also had to hit selected and arbitrary spending targets was from a progressive perspective a regrettable compromise.

You have 50 million people with only limited access to what is by all measures an expensive service. You decide that almost everyone should have equal access to that service. But decide that on net it can't actually cost any more than before, that all moneys need to come from within societal medical spending. Thank God we didn't take that approach when it came time to establishing public education and libraries, when Massachusetts introduced public higher education did they insist on a surtax on Harvard tuition to pay for it?

Of course cost control is important and in the medium term absolutely vital, but particularly the Senate has been a little too eager to trade away access and affordability to achieve short term cost savings apparently indifferent to the fact that every additional percentage of the non-elderly population NOT covered is another 2 million people or so priced out of insurance.

I start from the position of Social Democratic Utilitarianism, decide where social and economic justice lies and then strive for the greatest good for greatest number solution that you can achieve through democratic means. But at least start from the goal and concede only what you have to. I mean who exactly signed us up for the Pretty Darned Good Society? Or the Near the Frontier? or the Modified Deal?

We have a 2074 page bill that does lots of stuff including some measures that I think will produce more cost control than people think. But somebody needs to keep an eye on the prize which is to deliver what other developed countries treat as a right, that is universal health care. If that ticks up the percentage of GDP spent on health care we can start working on cost from the other side of the equation, after we get the access issue settled.

Posted by: BruceWebb | December 4, 2009 6:45 PM | Report abuse

"But somebody needs to keep an eye on the prize which is to deliver what other developed countries treat as a right, that is universal health care."

I agree... and that is exactly why I cannot support anything about this bill. A mandate to buy some sort of insurance does not equate to universal care and only someone with a comfortable, employer paid plan would think that what is now being discussed would constitute some sort of solution.

Universal health care means that everyone can get *treatment* when he needs it without bankrupting himself, his company, or the government. It also means that the financing is the same for *everyone* -- whether tax paid, payroll tax, or individually paid. It does not mean a patchwork that protects most citizens from the realitiy of the financing with subsidies to extend a broken model to more people.

Universal means that every citizen is due equal consideration for care. I don't see any of that in this bill. I'm still waiting for someone to explain how anything in there is going to help the single and childless adults who are excluded from most Medicaid programs. How exactly are the people we see on news reports from skid row going to get care under this insurance company boondoggle? What is the mechanism to ensure that they actually have coverage and get treatment as needed?

Posted by: Athena_news | December 5, 2009 8:12 AM | Report abuse

"I'm still waiting for someone to explain how anything in there is going to help the single and childless adults who are excluded from most Medicaid programs."

Under the bill single and childless adults under 133% of FPL are now eligible for Medicaid.

See how easy that was?

Posted by: BruceWebb | December 5, 2009 10:53 AM | Report abuse

"See how easy that was?"

It's easy enough to say that they are "eligible" for aid but where is it written that states will be funded to include them? State officials are apprehensive about the increased number of eligible families to be accommodated, how will these people actually be guaranteed coverage -- not eligibility but coverage.

Posted by: Athena_news | December 5, 2009 11:19 AM | Report abuse

Okay, I found it...and it says exactly what I thought: (starting in 2014) the funding for childless singles will be shared between the states and the federal government. IOW, those folks will get coverage if/when the states have enough to cover them after the traditional medicaid groups.

Do people call this "universal" coverage?

Posted by: Athena_news | December 5, 2009 12:01 PM | Report abuse

Common sense would say that we will never cut the deficit significantly. That will only happen when an outside force makes us do it. Given the option, the American people will always point fingers and avoid any tough sledding. Sad, but true. We won't cut our habit of borrow and spending until the World Bank or China or something else makes us. We are too cowardly and simple, and neither party has the stones to try to change that.

Posted by: steveboyington | December 5, 2009 3:22 PM | Report abuse

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