Tuesday, March 23, 2010

Don't Judge a Brooks by its Cover

The healthcare reform bill is simultaneously a huge step and a small step - it's a huge step toward universal coverage and eliminating some of the absurdities in our nation's system of providing health care. As more of the population gains insurance, it should be possible for hospitals to route more patients out of the emergency room and into primary care, and to reduce the number of patients housed in emergency departments. Under EMTALA, the uninsured and underinsured must be treated until they're medically stable - they can't just be dumped in the street to die (at least not without recourse) - so ER's have become a de facto source of "free health care", and can be unduly burdened by the cost of caring for the indigent. It should become easier for people to shift between jobs, or to start their own businesses or work for startups, if reasonable insurance is available at a reasonable cost.

At the same time, without wanting to discount the importance of the reforms in the bill, as passed the bill will not make the present system sustainable. In no small part due to pressure from the political right, the bill attempted to solve all of the woes of the current system in a "revenue neutral" manner, meaning that some reforms are done on the cheap and a lot of costs is masked by accounting tricks, and by spending cuts or taxes that don't come into effect for years, leaving open the possibility that they won't become effective.

Within that context, with the Senate bill in final form, and the reconciliation bill being well-defined, it appears possible to get past the process and start talking about what we need to do next. Unfortunately, the Republican Party seems locked into its "say 'no' to everything" mindset, and thus not even one Republican vote is expected for the reconciliation bill - even though, by any reasonable measure, they should favor many of its provisions. Republican Members of Congress act like children, Senators vow to continue to obstruct this and any future legislation, and their operatives whine that passing a bill by a majority in the House and with 60 votes in the Senate signals the end of democracy.

So when I saw the New York Times RSS feed summarizing David Brooks' latest column as, "The passage of health care reform is the end of the century-long welfare project and the beginning of the task of saving the country from fiscal ruin", I had some small hope that he was going to move past process and start addressing the steps necessary to improve upon the bill and to establish sustainability. I know... I should have known better.

I have to admit I found some amusement in his back-handed compliment for President Obama and Nancy Pelosi as "possess[ing] the political tenaciousness that you only get if you live for government and believe ruthlessly in its possibilities", given how they are more typically characterized by right-wing pundits - and given that Brooks, himself, previously described their tactics as incompetent. Toward the end of his summary of the process by which the reform bill was passed, he did briefly acknowledge "gross misinformation" against the bill (skipping over how that tied into the "hostile public opinion" he also mentions in passing). But he remains stuck in the process, and still can't bring himself to address substance.

Brooks offers cloying praise of markets to criticize the reform bill, despite the fact that it leaves the insuring of most Americans to private insurance companies. Despite the fact that, in his words, "We spend 17 percent and are predicted to soon spend 20 percent and then 25 percent" while other nations, less slavishly devoted to the concept of a for-profit health insurance market "spend 10 percent or so of their G.D.P. on health care" - no mention of the fact that many of those other countries get equal or better outcomes despite their lower spending. No mention of the fact that Medicare is popular with its beneficaries, or that the V.A. outperforms most private insurers on quality measures. (Shhhhhh.)

You would think that by now even Brooks would be able to admit that there's no magic path to perfect health insurance coverage, and that any free market solution requires significant regulation and oversight, but it's so much easier to invoke "the markets" in a manner that seems based more in religiosity than in reality. So while I agree with Brooks' mention in passing that the current bill does not put us on a course to sustainability, it is fair to mention that by the only measures he has shared with us - the percent of G.D.P. any given nation spends on health care and the skyrocketing cost of health care in this country - he appears to be worshiping a false god. Other countries have managed to incorporate private insurance providers into their system of universal coverage, so perhaps Brooks should be turning to those countries to find out what has worked rather than personifying Einstein's definition of insanity.

Brooks also trots out the tired line that Democrats don't care about balancing the budget. You know, as compared to... Republicans? If we compare track records.... It never ceases to amaze me how pundits like Brooks can give the Republicans a free pass for creating a fiscal train wreck, then blame the Democrats who inherit the mess for not taking the nation's financial situation seriously enough. Is my memory failing, because I seem to recall that before Bush II took office we were being warned by Alan Greenspan that we were entering an era of sustained budget surpluses and might (gasp) pay off the deficit too quickly.

Boy, we were lucky Bush came along to "fix" things for us by cutting taxes on the rich and spending us into oblivion. Setting up a context for Brooks to demand (yes) a regressive "consumption" tax and Social Security and Medicare cuts for the middle class - that must be passed by a Democratic Congress and President. It's "the only responsible thing to do," right? How... convenient. (No, David, mentioning in passing that the Party primarily responsible for our present crisis is also unwilling to tackle it doesn't make up for your omitting that background.)

I had some small hope that Brooks might offer some suggestions to his own party - how they could join with the Democrats to pass a supplemental reform bill in lieu of the reconciliation bill that would create a more stable financial foundation for reform. But he can't even sputter out encouragement for them to join in the repeal of the "Louisiana Purchase", the "Cornhusker Kickback", or similar measures that the Democrats will now be cutting out of the bill without a single Republican vote of support. What's so hard about being part of the solution for once?

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