Taking a Stand on Healthcare

Paul Krugman divides “everyone in the political class” into three categories, the enemy:

For conservatives, of course, it’s an easy decision: They don’t want Americans to have universal coverage, and they don’t want President Obama to succeed.

people of good will, i.e. members of the progressive wing of the Democratic Party:

For progressives, it’s a slightly more difficult decision: They want universal care, and they want the president to succeed — but the proposed legislation falls far short of their ideal. There are still some reform advocates who won’t accept anything short of a full transition to Medicare for all as opposed to a hybrid, compromise system that relies heavily on private insurers. And even those who have reconciled themselves to the political realities are disappointed that the bill doesn’t include a “strong” public option, with payment rates linked to those set by Medicare.

and collaborators with the enemy:

The people who really have to make up their minds, then, are those in between, the self-proclaimed centrists.


I won’t try to psychoanalyze the “naysayers,” as Mr. Orszag describes them. I’d just urge them to take a good hard look in the mirror. If they really want to align themselves with the hard-line conservatives, if they just want to kill health reform, so be it. But they shouldn’t hide behind claims that they really, truly would support health care reform if only it were better designed.

David Herszenhorn and Robert Pear, writing in a New York Times blog, take a somewhat less rosy view of the bills:

So what does the House health care bill really cost?

Throughout Thursday, news accounts, including our own, focused on $894 billion, the total cost given out by aides to the House speaker, Nancy Pelosi, before the official cost analysis was released by the Congressional Budget Office.

But a closer look at the budget office report suggests that the number everyone should have reported was $1.055 trillion, which is the gross cost of the insurance coverage provisions in the bill before taking account of certain new revenues, including penalties by individuals and employers who fail to meet new insurance requirements in the bill.

I’m not a member of the political class or a person of any influence but I’d divide things a little differently than Dr. Krugman does. I sincerely believe that more people should be able to obtain and afford healthcare. But I think that the only responsible way to do that is by reform in the system that effects cost reduction. Passing a healthcare bill that costs more than we can reasonably afford and is only paid for by assuming unachievable cuts in Medicare, a bill that its proponents are proposing to pass with a scant majority completely composed of Democrats and which may well be overturned by a future Congress is not a sincere attempt at extending coverage. It is merely counting coup.

6 comments… add one
  • Andy Link

    I guess I’m a collaborator. I’ve been basically called such on other blogs for not sufficiently demonizing the evil insurance companies and for not supporting the “competition” that proponents claims a public option would provide. I’m used to being in the position where partisans assume I’m with the “other side” when I don’t agree with their particular policy prescription.

    Frankly, Dave, I’m resigned to the reality that this country (esp. Congress) is going to drive the bus off a cliff before real reform occurs. If there is one thing Congress is good at, it’s doing nothing until after disaster strikes.

  • steve Link

    I have become convinced that there is no real force behind the idea of cutting costs. For some bizarre reason, we just do not care. Costs are a part of the regular ongoing discussions about health care in the rest of the world, not here. Find me a group that routinely advocates for cutting costs in between attempts at health care reform. This goes way beyond the issue of government or health insurance paying for health care. The rest of the first world pays for health care either through insurance, most of them, or government. We build Taj Mahal hospitals and surgicenters, the rest of the world builds simple bare bones facilities. Other countries invest in the IT to hold down costs. We have huge billing facilities.

    Build a committed constituency for cutting costs. Then you have a chance.


  • PD Shaw Link

    I’ve written my Congressman to support the Wyden proposals, and haven’t received a response. Last week, he joined with about 20 other moderate Republicans supporting the Medical Rights and Reform Act.

    So there is a moderate Republican proposal that focuses on cost. I wonder if Krugman has or will write about it, or if he thinks that it isn’t worth doing so because a Republican proposal isn’t going anywhere and it’s better to label the Republicans as obstructionists.

  • Can we see if the Nobel committee would strip him of his Nobel?

    But they shouldn’t hide behind claims that they really, truly would support health care reform if only it were better designed.

    Shorter Krugman, “Yeah, so the bills suck, but your still evil if you don’t want them!”

  • steve Link

    I thought that all the Republicans who initially supported Wyden had backed off.

    Dent is my Congressman. A small group of my fellow physicians, myself included, have met with him several times. My partner and I wrote up some recommendations for him. I have no idea if they were even read, but section 103 sounds a lot like one of our suggestions. We let him know that we thought costs should be the number one priority. We have written to both of our Senators and also went to Harrisburg to talk to some people there about the issue. This is a good time to do more than blog. Thanks for taking the time to write your Congressman P.D.


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