Contra David Brooks on ObamaCare - Blog of the Century

Contra David Brooks on ObamaCare - Blog of the Century:

This last point highlights aspects of political economy which Brooks prefers to ignore. He writes that there is no way planners can know]”how Congress will undermine any painful cuts the executive branch does make.” Brooks finds this a powerful insight regarding (say) single payer. The very same point applies to his own preferred solution: the extremely complicated and politicized mechanisms required for premium support. The firms which operate Medicare Advantage serve the healthiest segment of retirees with little apparent savings to show for it. Indeed these firms have been able to lobby Congress for wasteful additional subsidies beyond those required in traditional Medicare.

Brooks is right to worry our health system’s administrative complexities and its political vulnerabilities to special-interest lobbying. He’s wrong to believe that a centralized approach to health policy created either problem. He’s also wrong to believe that health reform has made these problems worse. He might ponder, for example, why so many privileged interests from the insurance industry on down dislike or oppose the new law, and are so keen to destroy measures such as the Independent Payment Advisory Board.

As Paul Starr notes in his essential Remedy and Reaction, our overly fragmented, overly incremental approach to politics is the real culprit here. It makes our resulting health policies too complex, too costly, too vulnerable to special interest pleading.

Hamilton and his friends created an amazing political system which served us well for 200 years. That system does not always serve us well today.

Well said. I like to think of the scene in Animal House (when they walk out and say they're not going to listen to anyone badmouth the US of A) whenever I hear someone argue that we cannot match the quality and efficiency of our European cousins, particularly those in Germany and France. Consider that they are having serious debates about how they are spending too much - while covering everyone and getting better results with no waiting times, mind you - when they are spending a third to half less of their GDP on health care than we are!

Finally, listening to the SCOTUS today, the catastrophic illness and ER visits kept coming up as the talking points about the need for insurance. As anyone in health care knows, the other key to having access is to PREVENT catastrophes and ER visits and maintain health and reduce costs for everyone!

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