Any health reform passed this year (or next) is unlikely to include Cowen’s cost-related suggestions or any other serious measures to reduce costs. That’s why the current debate over health reform is just the beginningcall it Health Reform Debate 1.0 (beta). Debate 2.0 will be about costs, specifically about payment reform.
Drum chimes in:
Agreed. Coverage first, cost controls second. It would be great to do it all at once, but politically there's really no alternative to the way we're doing now.
Douthat is on Cowen's side. I'd love a polity in which a real conservative told people that costs should be controlled first before anyone gets insurance extended to them. The idea is to make the prize conditional on the sacrifice.
But there is no conservative voice like that in American politics day, if by conservative you mean a politician eager to tell the public to take its fiscal medicine. The rot started with Reagan, but it has gotten steadily worse.
I had hope with Gingrich in 1994 but a decade later, with the GOP in full control of everything, they exploded spending and passed Medicare D whose unbudgeted costs (though better than expected) make Obama's fiscally neutral (according to the CBO) health insurance reform seem like peanuts. I long for an American Thatcher - someone with real brains, real courage and an ability to tell Americans they need to buckle under, pay more taxes and slash entitlement spending.
But we have no Thatcher. By default, then, I side with Obama. The GOP has no serious plan to expand insurance coverage and no serious plan to restrain costs. Obama at least says he's serious about cost control, there are some cost control mechanisms (that need strengthening) in the Senate bill, and we can hold him accountable for fiscal restraint in the coming year and thereafter.
In politics, it's always the least worst option. And in my judgment on that criterion, given a need to do something, Obama is simply the only credible one we have. Give him a chance but hold him accountable for the fiscal results. And soon.
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