Against The Current


I think it is more likely is that [healthcare] passes, and fails spectacularly. There are too many moving parts, and if any of them breaks, the whole thing rapidly starts to spin out of control and eat a gigantic hole in the deficit. If it does break, I think that Democrats keep control of Congress just long enough to explain why they keep having to enact whopping new tax increases every few years. Republicans don't need to improve their message. They just have to wait for Democrats to recover their reputation as tax and spend politicians who woefully underpredict the cost of everything they propose.


Among Democrats and liberals, there is a belief that Republican opposition to the various Democratic proposals represents a kind of "nihilism," and that because Baucuscare resembles proposals offered by liberal and moderate Republicans in the 1990s, today's opposition is obviously unprincipled if not insane. My sense is that we've learned a great deal about health reform over the intervening period, and that, as Christensen, Grossman, and Hwang have argued, it is disruptive competition that promises substantial improvement in the cost and quality of medical services over time. I'm increasingly convinced that the only way to move in this direction is to create a system of universal catastrophic coverage and universal health savings accounts, as proposed by Martin Feldstein and a number of others. The emerging consensus among congressional Democrats moves us in a very different direction, towards a highly centralized, highly regulated system that will give entrepreneurs very little room to dramatically improve care. With that in mind, I don't think opposition is "nihlistic"; rather, I think it's responsible.