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Why David Brooks should support health-care reform

David Brooks is right to worry that the further the excise tax gets pushed into the future, the less likely it is to ever happen. But that's an argument for supporting the health-care reform bill, not opposing it.

"There is no reason to think that the Congress of 2018 will be any braver than the Congress of today," Brooks sighs. I agree that the Congress of 2018 isn't likely to be very brave. But I also agree that it's likely to remain gridlocked. Lifting or delaying the excise tax would require our Congress of the Future to find 60 votes or an offset equal to every dollar of the excise tax's revenue (in which case repealing the excise tax doesn't much matter). And if we've learned anything this year, it's that 60 ain't easy.

Conversely, if health-care reform doesn't pass, it requires ... zero votes to stop the excise tax from happening. If you want the excise tax to happen -- and Brooks does -- it's pretty clear that you want the Senate to have to round up 60 votes to stop it rather than force them to find 60 votes to pass it again in the future. Plus, at some point, we have to bet that Congress will be able to stick to cost controls. Otherwise, we're bankrupt one way or the other, and we may as well give people health-care coverage as the country rides out its final years of solvency.

By Ezra Klein  |  February 23, 2010; 12:01 PM ET
Categories:  Health Reform  
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What cost controls?

When you give generous, subsidized healthcare benefits to people, they will spend it on more health care. This is a boon to the drug companies and health insurers.

And who also benefits? The trial lawyers. They are paid too much, like the Wall Street executives.

Didn't Ezra say the tax on cadillac plans was a good idea? How come it's been watered down. Most health economists see tax distortions favoring more healthcare utilzation as one of the problems.

Posted by: RandomWalk1 | February 23, 2010 12:11 PM | Report abuse

"Plus, at some point, we have to bet that Congress will be able to stick to cost controls."

That's a fools bet Ezra. When has Congress EVER utilized cost controls. I agree that if its fragile for the public option its fragile for those of us that want more cost controls in the form of an excise tax but we also need to be realistic too and honestly agree that while this bill is better than the status quo, its not much better and that's a poor job done for the last year and we're squandering away the last true negotiating chip in our posession for almost nothing.

Posted by: visionbrkr | February 23, 2010 12:30 PM | Report abuse

It seems there are 2 basic models of cost control: the "voucher model" - cap government expenditures and let the health care and insurance industries adjust on their own - and the health care commission model, in which government puts downward pressure on expenditures and helps guide the adjustment of the health care and insurance industries. Republics obviously prefer the voucher model, as it means less government involvement, but it would likely mean a more wrenching, drawn-out, inefficient change process. The moderate path would seem to be a more accountable, government-led process of change, with some kind of health commission leading the way, but with allowing maximum flexibility for the health care system to experiment and maintain autonomy and judgment.

Posted by: jduptonma | February 23, 2010 12:31 PM | Report abuse

leaving aside the discussion over whether it's fine to accelerate our bankruptcy by expanding an entitlement that will be much harder to contract (it'll take 60 votes!)

why aren't the deficit hawks demanding a full inclusion of the excise tax? it's the one thing in here that nearly all economists agree will control costs. this should be the moderates' version of the public option.

Posted by: jfcarro | February 23, 2010 12:32 PM | Report abuse

The chief significance of Brooks' column will prove to be its role in signaling the latest pivot in mainstream punditry complaints about Obama and the Democrats. Having complained for weeks about the administration's unwillingness to compromise with Republicans seek bipartisan common ground, etc. etc., they are now (having been presented with a health care plan laden with Republican ideas) ready to begin sighing and moaning, with Brooks, about how terrible it is to see Obama knuckling in to the worst aspects of our political system, descending into the muck of deal-making, etc., rather than sticking to the high uncompromising principles he ran on.

Posted by: KWeberLit | February 23, 2010 12:32 PM | Report abuse

"Plus, at some point, we have to bet that Congress will be able to stick to cost controls. Otherwise, we're bankrupt one way or the other, and we may as well give people health-care coverage as the country rides out its final years of solvency."

That's as good as an honest rationale for the current health reform package as any I've seen.

Posted by: wisewon | February 23, 2010 12:34 PM | Report abuse


No one has the guts to recommend policies that truly control healthcare costs. Americans (and Europeans) are in denial of the massive size of the government's debt obligations ... Americans are in denial right now - they and their government are spending beyond their means. If you design the bill poorly like this one, you will bankrupt the nation. Then no one will be able to have affordable, quality care. So Ezra's argument (that you need health insurance to save tens of millions of lives) is based on the sustainability of the government's finances and taxpayer's willingness to pay more taxes - such sustainability is in serious doubt.

Posted by: RandomWalk1 | February 23, 2010 12:46 PM | Report abuse

Ezra: Couldn't a future Congress just repeal the excise tax with 50 votes through reconciliation?

Posted by: gocowboys | February 23, 2010 12:59 PM | Report abuse


They could, but unless they found offsetting savings/revenue, the excise tax would be back after 10 years. Moreover, if you vote to have cost controls now, at least you're forcing the issue and requiring the hypothetical future Congress to vote for repeal, rather than doing it in advance and never trying in the first place.

Posted by: etdean1 | February 23, 2010 1:51 PM | Report abuse

"Plus, at some point, we have to bet that Congress will be able to stick to cost controls. Otherwise, we're bankrupt one way or the other, and we may as well give people health-care coverage as the country rides out its final years of solvency."

EEEEK! Somehow I don't share your equanimity at that prospect. Hopefully our brand new massively expensive entitlement program, coupled with our already existing massively expensive entitlement programs will leave enough resources to fund our military defense against the Chinese and the rest of our creditors when they come to collect on our defaulted debts. Because if the liberals in Congress share your blithe disregard for the consequences of our insolvency, I definitely wouldn't take any bets on them being able to stick with cost controls.

But hey, for a few bright and shiny years, Democrats will have achieved their goal of universal health care, and that's what counts.

On the other hand, maybe the Demcrats can suffer the public backlash for increasing taxes, and when the time rolls around for paying out benefits, the Republicans will eliminate them, and then we can balance our budget. There's a silver lining in every cloud, if you just look hard enough for it.

Posted by: bgmma50 | February 23, 2010 2:15 PM | Report abuse

What evidence do you have that Republican control will lead to deficit reduction? That has pretty much NEVER been the case. If the Republicans are so concerned about our fiscal state, why was no attention paid under the Republican Congress and President just 4 short years ago?


Posted by: jjhare | February 23, 2010 9:29 PM | Report abuse

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