Health Bill - Brooks Nay, Krugman Yea.

In a column titled "The Hardest Call", David Brooks shares his angst before hopping off the Obama Express Distress:

The first reason to oppose this bill is that it does not fundamentally reform health care. The current system is rotten to the bone with opaque pricing and insane incentives. Consumers are insulated from the costs of their decisions and providers are punished for efficiency. Burkean gradualism is fine if you’ve got a cold. But if you’ve got cancer, you want surgery, not nasal spray.

...if this passes, we will never get back to cost control. The basic political deal was, we get to have dessert (expanding coverage) but we have to eat our spinach (cost control), too. If we eat dessert now, we’ll never come back to the spinach.

So what’s my verdict? I have to confess, I flip-flop week to week and day to day. It’s a guess. Does this put us on a path toward the real reform, or does it head us down a valley in which real reform will be less likely?

If I were a senator forced to vote today, I’d vote no. If you pass a health care bill without systemic incentives reform, you set up a political vortex in which the few good parts of the bill will get stripped out and the expensive and wasteful parts will be entrenched.

Hmmph.  The basic political deal was that Dems would create a huge new middle class entitlement.  Over the next fifty years they would then troll for votes by "fighting" for the little guy while spending other people's money on his health care.  The long term impact on innovation and the quality of care would probably be disastrous, but the next election is less than a year away, so whee-hee!

Krugman supports the bill and explains the game, if you read between the lines:

But let’s all take a deep breath, and consider just how much good this bill would do, if passed — and how much better it would be than anything that seemed possible just a few years ago. With all its flaws, the Senate health bill would be the biggest expansion of the social safety net since Medicare, greatly improving the lives of millions. Getting this bill would be much, much better than watching health care reform fail.

...Bear in mind also the lessons of history: social insurance programs tend to start out highly imperfect and incomplete, but get better and more comprehensive as the years go by. Thus Social Security originally had huge gaps in coverage — and a majority of African-Americans, in particular, fell through those gaps. But it was improved over time, and it’s now the bedrock of retirement stability for the vast majority of Americans.

Brooks at least offers a bit of liberal bait in explaining the importance of cost control:

The second reason to oppose this bill is that, according to the chief actuary for Medicare, it will cause national health care spending to increase faster. Health care spending is already zooming past 17 percent of G.D.P. to 22 percent and beyond. If these pressures mount even faster, health care will squeeze out everything else, especially on the state level. We’ll shovel more money into insurance companies and you can kiss goodbye programs like expanded preschool that would have a bigger social impact.

Well, yes - if we spend all our money on health care it will crowd out other possible uses for those resources.  Meanwhile, we have a nation where something like a third of adults are obese, and we can't figure out how to reduce health costs?  It's very expensive to take care of people who won't take care of themselves, even relying on other people's money.  (On that note, the Massachusetts Medicaid success in bringing down smoking from awful to merely preposterous levels is encouraging if verified.)

Comments

[MaryD]

May I stipulate that David Brooks is a moron?

[anduril]

You may. And I'll second that...notion.

[narciso]

THe ayes have it the motion has been carried

[Thomas Collins]

TM, if one simply looks at overall transfer payments from the Federal Government, states and localities (whether made directly to the beneficiary or to service providers for services provided to the beneficiary), I am very skeptical that smokers and the obese cost the government more $$$$$$$ than folks who keep themselves fit as a fiddle into their 100s. I am not in favor of "death paneling" the elderly. However, I do think that those who both complain about the cost of government and then also complain about governmental costs caused by those who don't bow in the direction of every health or fitness craze ought to recognize that their complaints are based more on moralism (being out of shape is a sin) than hard headed cost analysis.

[anduril]

Oh boy--a thread featuring David Brooks and Paul Krugman! This should be a dead one.

Yesterday--or was it the day before?--someone criticized me for linking to Steve Sailer. I've also been criticized for constantly criticizing "Neocons." Here's my chance to kill two birds with one stone. I'm going to link an article by Steve Sailer in which he actually praises--of all unlikely candidates for Sailer's praise--David Frum!

David Frum And Immigration

Don't let the title turn you off--Sailer, as is his wont, covers a lot of ground in his inimitably literate and witty style. The breadth of coverage is hinted at in the opening paragraph:

Veteran neoconservative journalist David Frum’s judgment has proven so comically bad over the years that it’s easy to overlook how often his analysis is acute. Now that Frum’s comically long track record of inept enthusiasms and backstabbing has left him almost isolated, it’s time to look beyond his failures and review what he gets more or less right in his campaign to revamp conservatism

[Ignatz]

--...Bear in mind also the lessons of history: social insurance programs tend to start out highly imperfect and incomplete, but get better and more comprehensive as the years go by......--

......until they bankrupt the country.

[narciso]

Except for dealing with Iran, and signing on to the Guiliani campaign, Frum makes inept and maladroit seem like an aspiration, so his contempt for Sarah was not a " bug but a feature"

[anduril]

narciso, the 3rd paragraph in Sailer writes:

"But perhaps it’s not quite time to overlook the past … First, let’s review some of Frum’s legendary bad choices:"

and that's where the fun begins. But he also turns serious in his praise of Frum.

[Danube of Thought]

I assume this horrid legislation will pass in some form or another, and that it will survive constitutional challenges. What most interests me is whether between now and 2012 the electorate will give us a congress and a president who will repeal the whole thing. I think it's a close call at this point.

[anduril]

Now here's a thoughtful article on an important social topic--one which has a strong bearing on American electoral politics--from today's WSJ: Winning Not Just Hearts but Minds: Evangelicals move, slowly, toward the intellectual life.

A copy and paste job can't do justice to this article, but I'll have a stab at it:

John Mark Reynolds, a Biola University professor of philosophy, asserts that though Mr. Anderson accurately identifies the problem, he fails to see its cause. In "The Evangelical Intellect," he puts forth what he sees as the real problem: The new evangelical is not yet a true intellectual. Instead, the new evangelical is what Mr. Reynolds calls an intellectualist, or a person more concerned with appearing to be an intellectual than with actually being so. But Mr. Reynolds has a plan to take evangelicals the rest of the way; the solution he proposes is a return to the concept of Christendom, which he defines as a "culture created by the happy fusion of Greek and Roman philosophy with Jewish and Christian thought." This, he says, is a culture infinitely more engaged; intellectual as opposed to intellectualist; and all-encompassing.

...

...Many young Christians who grew up in the 1980s and 1990s, myself included, are trending toward intellectualism as a rejection of the experience of evangelicalism that we grew up in, with churches focused on reaching congregants' hearts to the exclusion of their minds. Many of the pastors and other leaders of these nondenominational congregations were not seminary trained; rather, they were impassioned speakers—converts, often, from the "Jesus Movement" of the 1970s. Though the situation has changed somewhat, seeker-sensitive megachurches continue to mass-market this feelings-based evangelicalism.

At the n+1 forum, all of the panelists discussed their move away from evangelical faith as a part of becoming intellectuals. I asked them whether such a shift was inevitable. Malcolm Gladwell did not respond, but James Wood answered by listing a series of names of those who are, in fact, both Christian and intellectual. Though he acknowledged that most of them—including the literary critic Terry Eagleton and Archbishop of Canterbury, Rowan Williams—were either Catholic or Anglican, not evangelical at all.

Christine Smallwood was less certain that such a creature could exist. She asked: "Is there something anti-intellectual at the root of an experience-based movement?"

The answer is yes, and that must determine the course of evangelicals' progression from decidedly anti-intellectual to intellectualist to intellectual. And, as this movement evolves from self-examination and moves into the public square, it may be that to fully achieve a robust intellectual culture, the "experienced-based movement" that is contemporary evangelicalism must recede, thus making way for Christendom.

[narciso]

First of all, Terry Eagleton, although more self aware than most is a Marxist, and Rowan Williams, is a fool, on all counts. So is this the intellectual current we are aspiring too. My first experience with Mr. Reynolds was a horribly maladroit review of Going Rogue, for First Things which echoes the work the attitude of FRum and Dreher. It seems the neo Gnosticism embodied in the work of Dan Brown, seems to be the goal

[abadman]

A thoughtful article that says think like me or you are stupid.

[narciso]

It does seem that among the goals here, is to strip out the morality, as well as any respect
for most traditional institutions, hence the dying Mainline protestant churches, the remaining cells of liberation theology.

[Frau Hoffnung]

"What most interests me is whether between now and 2012 the electorate will give us a congress and a president who will repeal the whole thing. I think it's a close call at this point."

DoT - The last time I saw something like this happen was in a vintage 1930s movie where someone runs in and shouts, "The Depression is OVER!" and everyone cheers. We will have to be our own deus ex machina if this train wreck can be avoided.

[Rick Ballard]

TC,

It's an argument from aesthetics made while driving the Eco-Pious from the liposuction clinic to the tanning salon.

Do obese smokers cost society more than investment bankers who rely upon mistaken algorithms to peddle incorrectly priced debt instruments to pension funds which go bust afterward and saddle underfunded government "pension guaranty" programs with the result of having relied upon "ratings" provided by rating firms which rely upon the investment bankers for their sustenance?

I'll take fatso, waddling up to Walmart while puffing on a Marlboro, thanks just the same. Ten thousand fatsos will cost society a helluva lot less than a few clutches of investment bankers.

[glasater]

I'll take fatso, waddling up to Walmart while puffing on a Marlboro..

Heh Mr Ballard...

Smokers pay huge taxes on the product they buy--far more than what they cost society with health issues.

[anduril]

narciso, the panelists (Gladwell, Wood, Smallwood) giving those evaluations (re Eagleton and Williams) are identified by the author as non-Christian.

among the goals here, is to strip out the morality, as well as any respect for most traditional institutions,

When Reynolds speaks of

a return to the concept of Christendom, which he defines as a "culture created by the happy fusion of Greek and Roman philosophy with Jewish and Christian thought

then I think there's something more going on. The fact is, of course, that that type of return to or revival of "Christendom" is what Benedict XVI has made the theme of his papacy. And pass no judgment here on the viability of such a project--I only say that there does appear to be felt need for that.

[narciso]

This movement is already in the public square, it's so much so, that 'our betters'
typified by the tenant on Pennsylvania Avenue
want to counter it, or if necessary suppress
it entirely, while leaving the door open for
a more militant current of another faith, which they consider more authentic. So that's not really the objection, I understand who Woods and Gladwell are, my objection was with
the choice of role models with this movement

[anduril]

the choice of role models with this movement

but who did you expect woods gladwell and smallwood would be assigning as role models? doesn't mean actual christians will pick eagleton and williams as role models--least of all those who are talking about

"a return to the concept of Christendom, which he defines as a "culture created by the happy fusion of Greek and Roman philosophy with Jewish and Christian thought"

[clarice]

Rick , you're my favorite. Don't tell the others.

[anduril]

Reid Must Get 60 Votes By Midnight Tomorrow

By Philip Klein on 12.18.09 @ 1:37PM

If Senate Majority Leader Harry Reid hasn't secured 60 votes by midnight Saturday, he won't be able to meet the ambitious deadline of passing a health care bill on Christmas Eve.

The reason is that in order to trigger the chain of events leading to a Christmas Eve vote, Reid would have to file cloture on his "manager's amendment" -- containing all of his final negotiated changes to the bill -- by the end of tomorrow.

Once Reid files that amendment, it will set up the key cloture vote on Monday at 1 a.m., requiring the support of 60 Senators to pass. While that would technically give him all of Sunday to win over Sen. Ben Nelson or any remaining holdouts, Reid would not be able to make any further changes to the bill in order to accommodate any Senator.

[brucet]

President Moooslim-boy in Chief sinking like a stone. This is actually getting painful to watch, even for me!

Hey big gov luvin libs, you better get used to saying "Madame President" in three short years.

Go Sarah Go!

[Charlie (Colorado)]

I'll just crankily note that there is very very little clinical evidence that obesity can be brought into long-term remission by anything other than bariatric surgery.

[anduril]

From Kim Strassel today:

Consider North Dakota. A recent Zogby poll showed 28% (you read that right) of state voters support "reform." A full 40% said they'd be less likely to vote for Democratic Sen. Byron Dorgan next year if he supports a bill. In a theoretical matchup with Republican Gov. John Hoeven (who has yet to announce), Mr. Hoeven wins 55% to 36%. Mr. Dorgan has been in the Senate 17 years; he won his last election with 68% of the vote. This should not be happening.

In Arkansas, 32% support this health-care legislation. Sen. Blanche Lincoln, also running next year, trails challengers by more than 50 points among the 56% of voters who strongly disapprove of the health plan. Senate Majority Leader Harry Reid, the public face of health reform, can barely break 38% approval in Nevada. In Colorado, where 55% of voters oppose a health bill, appointed Democratic Sen. Michael Bennet told CNN he'd vote for a bill even if it "cost him his job." Give the freshman credit for honesty.

That's in line with the Washington Examiner's editorial:

Still hovering over the Senate is that magic number of 60. The inevitability mythmakers would have us believe that Sen. Joe Lieberman, I-Conn., is the last remaining Senate holdout on the road to 60 votes. That will come as news to half a dozen other Senate Democrats, most notably Sens. Evan Bayh of Indiana and Ben Nelson of Nebraska. Obamacare appears to have reached its high-water mark and has nowhere to go now but down.

and they add:

Oh, and don't forget that Obamacare isn't the only issue the Senate must address in coming days: The defense appropriation, Patient Protection and Affordable Care Act, and the debt ceiling increase must also be voted on before the Senate can adjourn for the holidays.

Well, scratch defense, but...

[Dennis D]

Does anyone take Bolsheviks like Krugman seriously anymore? Didn't they suffer enough humiliation when the Berlin Wall went down?

[Porchlight]

Lieberman splits DC:

With a major winter storm moving in, Senate staff is setting up cots in Hill offices to spend the night in preparation for an important procedural vote early Saturday morning that all 60 Democrats are likely needed for — except TPMDC has confirmed that Sen. Joe Lieberman has beat it back to Connecticut for the Sabbath.

Link goes to TPM, fair warning.

[anduril]

Porchlight, my take continues to be that this thing is simply being played out by the "moderates." No one can tell me that Dorgan (see above) isn't praying for this thing to just go away. No matter what, somebody will need just a little more assurance about some concern, etc. They'll take turns keeping it going, let it die a lingering death. I mean, Lieberman leaving town. Please. Like he didn't know that some health care vote might come up? Not buying that. But, hey, he's having some fun, and that's great. Couldn't happen at the expense of a nicer bunch of people.

Why would you be apologetic about linking any informative article? People here are way too uptight.

[narciso]

Because TPM, doesn't have a great track record
of accuracy, and it's a netroots favorite, which has disseminated false rumors before

[JorgXMcKie]

A small question: without Ted Kennedy, where's the 60th vote?

[Jane]

Paul Kirk - the temporary replacement - MA changed the law to put him in just for this vote. The MA senate race is Jan 19th but the MA legislature decided Teddy, who was absent for the year before, had to be replaced in the meantime.

[Captain Hate]

Over at AoS they're reporting that Ben Nelson has been bought off. Gee there's a shocking situation: A donk with no integrity

[RichatUF]

What a surprise.

Almost feeling that this whole thing has been a dog-and-pony show.

[Jane]

And yet there is still no bill.

[mockmook]

Smokers pay huge taxes on the product they buy--far more than what they cost society with health issues.

Posted by: glasater | December 18, 2009 at 01:11 PM

Is it the smokers fault that his health costs are borne by "society"?