I have enough of my own issues to pay attention to, so I’ve been doing my best to scrupulously ignore the running health reform debate, but in this town there are limits to what can be blocked out. As I understand the current state of play, we will still have a mandate and a “non-discrimination” rule, which more or less abandons any pretense that insurance is about managing risk (which is to say, that it’s actually insurance). So we’re eliminating the rationale for the role private insurance companies play in our system, but insisting that it continue to revolve around them and, even better, handing them an enormous subsidy. What we’ve eliminated is the counterweight designed to check costs, because that part, according to a logic I completely fail to fathom, is especially socialist.
What’s remarkable about this is how naked and brazen it is. That is, I can’t come up with any remotely coherent pretext for thinking this particular policy combination makes sense on any set of background assumptions or values. (Which isn’t to say the same system with the public option was much more coherent.) Contemplate how extraordinary that is: There’s almost always at least some fig leaf of an ideological principle or an economic argument strung up in front of even the most naked interest group grab. But nobody seems to be even pretending this compromise amounts to anything but an open bribe to the very insurers whose existence it renders unjustifiable. I understand, and am sympathetic to, the argument for moving toward a more genuinely marketlike system. I understand the argument for single payer. I understand the arguments for different kinds of hybrids—baseline public provision with private coverage as a supplement. I don’t understand this at all, and I don’t understand who (but an insurance company) could be happy with it. Progressives and conservatives are both obviously unsatisfied, but you’d at least expect that the part progressives are pissed about would count as a victory for conservatives—a move that concedes some important value to them. Yet I can’t see any way that it is: The plan sans public option is not one whit more “free-market,” and arguably less so, to the extent one can make such judgments at such a distance from the genuine article. It just shifts some of the subsidy from the government to profit-seeking firms that can hire lobbyists. Awesome.
This is what I think is missing from my colleague Michael Cannon’s tiff with Ezra Klein. Michael is right that it’s a gross slander to imply that anyone who opposed some particular health reform bill must just be callously indifferent to the terrible human costs of inaction—the consequences of alternative policies are precisely the crux of debate. But Ezra is right that this justification doesn’t work very well for Joe Lieberman, who does not appear to have some alternative reform in mind, and who does not generally seem to hold the kind of economic views that would render his opposition intelligible as a principled stand.
I admitted at the outset that I have not been paying incredibly close attention here. Still, given how many of my friends are pundits or reporters focusing almost exclusively on this issue, I’ve probably absorbed as much information about the debate by osmosis over beers as normal people outside D.C. who are trying to pay attention. If there’s a coherent defense that could be made of this particular Frankenstein—that is, a policy defense, not the obvious realpolitik explanation—I’d be curious to hear it.