Random Thoughts on Health Care

It's easy to get cynical about the process of the health care bills.  At this point, I'd say that conservative and liberal health care analysts both know the score.  Everyone knows that this bill won't work as advertised:  it will not cover as many people as promised, and it will run into budget shortfalls, if for no other reason than because Congress is not going to enact the cuts as written--they will get lobbied into repealing many of them.  Doug Elmendorf has done everything but hire a skywriter to make it clear that he doesn't think that any of the various bills will actually be deficit neutral--while doing his job, which is to score what's written, not his best guess at what will happen.

Liberals don't care, because they think it's worth it to cover more people.  Conservatives care, but their kabuki complaints about what everyone in the wonkosphere knows go mostly unheeded.  I find it hard to get too outraged about any of it; I'm against the bill, but I think that this part of the process is playing out about as well as you can expect.

But then you have moments like the one I experienced the other night, in which I sat in a room full of journalists from various sectors who are not quite as deep into the policy weeds as I am--they're political reporters, not wonks.  Good political reporters.  Very well informed political reporters.  And some of the questions really frightened me.

In quick succession, they asked a prominent budget wonk questions like:

1)  How come, if so much of the money that's available to be wrung out of the health care system is going to doctors and hospitals, Obama is attacking insurers?

2)  How this could possibly provoke a fiscal crisis if the CBO was scoring the bills as deficit neutral?

 . . . there were more, but I stopped writing in despair.

This stuff isn't even controversial.  I don't think that Ezra Klein or Jon Cohn would have a problem admitting that we'll be in big fiscal trouble if Congress behaves in the future as it has behaved in the past, or that the insurance industry isn't really hoarding big stacks of cash, and other stakeholders will have to take big hits in order to make any reform work.  They just think that it's worth it to cover more people, and also that this may provide a framework for future deliver services reform.  But everyone pretty much understands that whatever bill we get will not work as written.

We're all off in the woods battling over the appropriate discount rate for dynamic tax effects.  And we seem to have left a lot of more politically focused journalists behind.

I get the sense that this happens in administrations too.  The wonks understand that they have to make compromises, so they let bad policies through without a fuss in order to secure some larger agreement. (cough/steeltarrifs/cough).  The problem is, they sometimes forget to tell the political people that it's a compromise--and what the cost of that compromise is.