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Is Health Care Reform a Vacation from Deficit Reduction?

Greg Mankiw, the Harvard professor whose textbooks are hallmarks of introductory economics, has a story he'd like to share. He asks us to imagine we have a friend who constantly spends more than he earns (friend = America). This friend tells you he's going Bermuda. This is another metaphor for health care spending. Here's the conversation:

Friend: I am going to take off a few days from work and fly down to Bermuda for a quick vacation.

You: But isn't that expensive? Won't that just add to your growing debts?

Friend: Yes, it is expensive. But my plan is deficit-neutral. I have decided to give up that half-caf, extra-shot caramel macchiato I order at Starbucks twice every day. I really don't need that expensive drink. And if I give it up for the next three years, it will pay for my Bermuda trip.

You: Well, then, how are you going to solve the problem of your growing debts?

Friend: I am going to figure that out as soon as I return from Bermuda.

You: But in light of your budget problem, maybe you should give up Starbucks and skip the Bermuda vacation. Giving up Starbucks could be the easiest way to start balancing your budget.

Friend: You really aren't any fun, are you?

I don't like this very much, because it's a great example of two sides talking past each other. Mankiw wants to make the point that health care reform could add to the debt, even though the CBO has scored most of the Senate versions as reducing the debt by around $100 billion. That's fine. He might be right. Many economists have conceded as much.

But it's strange to say that a health care bill that lays the groundwork for responsible changes represents a vacation from our deficit reduction policy. Deficit reduction will have to come from inside health care, and the bill has a lot of ideas for making it happen. Mankiw might have incorporated that point into his dialogue this way:

You: But isn't Bermuda expensive? Won't that just add to your growing debts?

Friend: Yes, it is expensive. But it's not really a vacation. There's a conference in Bermuda on managing personal finances. Yeah, yeah, I know. Sometimes these conferences are a total waste of time. But I've spoken to a lot of friends who say this one is as good as they come. Also, if I simply rip up my Starbucks Advantage card and stop going there, I'll save enough money over the next ten months to pay for the trip. So that's what I plan on doing.

What frustrates me about the health care debate is that there's this remarkable tendency among brilliant people from both sides to offer high-larious caricatures of the opponent's argument to score points or make a splash. Mankiw has made some insightful and valuable contributions to the health care debate, so I know he understands the details of the bill. Surely he knows that the bill includes various attempts -- many of which are unscorable -- to bend the health care curve down. If doesn't like them, I'd love to hear why. But he can do better than compare this complex piece of legislation to a beach weekend.