I think Robert Samuelson is a smart guy, and when the occasion calls for center-right curmudgeonly criticism, he's usually the center-right curmudgeon I seek out. But his column today is just weird.


The first few paragraphs are all about how Democratic politicians appear to be egoists. They want their names on a big important health care bill and that makes them big fat narcissists! So look, if Robert Samuelson were named Thucydides, and if Max Baucus were Athenian, and if this were one of the first political observations ever recorded in history, it would be a really insightful point. But this is 2009. Politics is old now. And it's just weird to frame a health care critique around the complaint that politicians are self-aggrandizing.

Then, getting his fingers in the sticky weeds, Samuelson starts to pick at the Baucus health care reform bill. It won't save thousands of lives because

many people don't even sign up for insurance to which they're entitled. An Urban Institute study estimated that 10.9 million people eligible for Medicaid or the Children's Health Insurance Program in 2007 didn't enroll.

Am I missing something here? The Baucus bill mandates universal health care coverage! It addresses exactly the problem Samuelson states by forcing every American to buy health care, with a government subsidy if needed. Samuelson goes on to complain that

the proposals don't force the major structural changes in the delivery system that might curb uncontrolled health spending, which is the central problem.

What are the delivery system changes in the Baucus bill? Reading Samuelson, you might think zero. That would be wrong. There's comparative effectiveness research. There's the billions Obama's spent on electronic records in the stimulus bill. There are pilot programs and an "innovation center" fund to test ways to move away from costly fee-for-service. There's MedPAC, the independent advisory counsel that will try to make difficult decisions Medicare delivery and payments...

A veritable buffet! Some of them might work. Other might not.  But what are these "major structural changes" Samuelson seeks? What makes him think they could pass Congress? What makes him think they would even work, since (as he acknowledges) it's difficult to take profits away from established industries? That would make an interesting column. There's always next week.

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