Friday, February 26, 2010

David Brooks "Dull as Expected" on health care reform

The headline to David Brooks' column proclaims cheerfully that the health care summit was "not as dull as expected!"  But David Brooks here is dim as expected -- as dim as ever on health care.

His signature charge, here and elsewhere, is that the Democrats are not serious about cost control because supporters of the excise tax on expensive policies have allowed that tax to be weakened:
Fifth, you got to see at least one area of bipartisan agreement. Neither side was willing to be specific about how to cut costs and raise revenue. The Republicans continued to demagogue efforts to restrain Medicare spending. The Democrats (and the Republicans) conveniently neglected to mention the fact that they had just gutted the long-term revenue source for their entire package, the excise tax on high-cost insurance plans. That tax was diluted and postponed until 2018. There is no way that members of a Congress eight years from now are going to accede to a $1 trillion tax increase to pay for a measure that the 2010 Congress wasn’t brave enough to pay for itself.

First, it is just plain slander to assert that the Democrats are unwilling to be specific about how to raise revenue.  The House bill has no excise tax, but it is deficit neutral -- it raises money from other taxes, such as a surtax on high earners, while the Obama plan published in advance of the summit adds a new Medicare surtax on capital gains for high earners.  Second, as Atul Gawande has documented in exhaustive detail and as a group of top health care economists led by Dr. Alan Garber has affirmed, the bill deploys just about every means of cost control that health care experts deem to have potential  -- coordinated care teams, incentives for results and penalties for not meeting standards on measures such as hospital readmissions, a MedPAC commission with real authority -- and yes, the excise tax, albeit delayed.

Third, it is always suspect to speak of "courage" when dealing with collective bodies.   The excise tax has not been weakened because of a lack of "courage." Indeed, Obama has gone to the mat for it as he never did for the public option -- as Ezra Klein predicted he would long ago. Unions and their closest allies in the House have had the 'courage' to risk the entire bill to weaken this tax.  Cost control hawks have had the "courage" not to let it go.  Any further "courage" on their part would doom the bill to failure.

"Courage" in fact comes to mean strange things when you're trying to run a slalom course on a luge shoot -- as Democrats have had to do, since the 200+ Republicans in Congress have had the "courage" to uniformly oppose a centrist bill for purely partisan gain (such "courage" is actually cowardice for the substantial minority of Republicans who doubtless recognize that the billl is the best our political system can produce). You want to see real courage, look at Jay Rockefeller, a chief proponent of the public option in the Senate, doing his best to quash the burgeoning movement to reintroduce the public option into the reconciliation negotiations.  Rockefeller opposes the movement because he knows it increases the long odds against the House passing the Senate bill, which is the only route to getting comprehensive reform.

Finally, Brooks himself lacks the courage -- or perhaps the awareness -- to engage a rebuttal by Jonathan Chait of his claim that the excise tax will never be enacted. Chait cites the Center on Budget and Policy Priorities to show that Congress has enforced all its cuts to Medicare reimbursement except the one poorly designed measure that Republicans repeatedly cite to prove that cost controls in the health care bill won't stick.  And both Chait and Ezra Klein have made the point that Obama has done all he could to keep the excise tax in the bill.  Klein captures the Brooks dynamic perfectly:
As for the broader political point, David Brooks is having a weird year. If you read his columns, it really is the case that he is much more in agreement with the Obama White House than with most members of his party or most members of the Democratic Party. But he's still got his tribal loyalties, as we all do. He's handled that tension by attacking Obama for deviating from the conservative things Obama wants to do and Brooks wants him to do but that Obama can't find any conservative votes for.

Rather than praising Obama for protecting the excise tax against unions, House Democrats, and Senate liberals and hammering Republicans for refusing to give Obama the three or four or five votes he'd need to keep that tax strong (or better yet, replace it with a cap on the employer exclusion for health-care benefits), Brooks attacked Obama for making the concessions that kept the excise tax in the bill. That doesn't make much sense, given that Brooks supports the excise tax and Obama is protecting the excise tax. But it makes a lot of sense if Brooks is groping for a way to disagree with a White House that he inconveniently agrees with.

So come on, Brooks, engage with Klein and Chait. You have nothing to lose but your residual assumptions.

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