Why Not Run On Coverage?

by Patrick Appel

Clive Crook isn't optimistic about health care reform controlling costs:

We will get a substantial increase in coverage, which is good, but without meaningful action on cost control, and the necessary revenue will be raised, if at all, in stupid ways. One thing that surprised me about Obama's statement today was that he continues to emphasize cost control, as opposed to wider access, as the principal driver of reform. It is obvious by now that Congress has no stomach at all for cost control, and is arguing mainly over how to raise the taxes necessary to pay for wider coverage. Obama's selling proposition, so to speak, is therefore beside the point; moreover this rhetorical defect is obvious, which is not like him at all.

...What would be so wrong with saying we must have health reform to address economic insecurity--note this is not just about the 40m uninsured; people with insurance are worried about losing it--and that the price in higher taxes is worth paying. It happens to be true, after all. That should count for something. Is it really so hopeless a platform?

Marc explains their logic:

The basic problem with the cost argument is that it elides over an important point, one that the White House wants to make publicly but cannot: in order to reduce costs in the short term, reform will cost something extra in the near-term. A deeper point they cannot make: it may take MORE money to build a better system. Only when that system produces better outcomes -- this would be years off -- can true cost-savings be realized.

The White House allows for a ten-year window for health care to become deficit neutral. The CBO's fairly static (and bottom-line tough) scoring of health care legislation, a legacy of Orszag's tenure over there, is certainly complicating the argument from cost.  But it's the only major argument that plays well with the voters (and members of Congress) the White House believes are crucial to getting something done.