Simple

David Brooks, in the waning days of TimesSelect, offers up a fairly positive take of Hillary Clinton's new health care plan. Still this gives me pause:

As she spoke, memories of the Clinton years wafted through my head — government by seminar running into the late hours. But as she will tell you (before you even have a chance to ask), she has learned a lot since the early 1990s, and while the conversations may still be endless, they are also more restrained.

And it’s true. The plan she unveiled yesterday is much simpler than the one she came up with 14 years ago. Back then, she and her staff were like technocratic engineers, one of her advisers told me, trying to patch every last gap in their edifice. This time they were content to leave the details of the plan to Congress.

That all seems smart, but in terms of actually enacting a health care reform, this sort of ducking of the complexity issue isn't going to fly. The "plan" she released yesterday is, like the plans from Edwards and Obama, much simpler than what her task force came up with back in the day precisely because a "plan" of this sort isn't legislation. Nevertheless, at some point before it becomes law, a plan is going to need to be fleshed out. And when it is it's going to be very complicated.

And not because of some flaw in the program, but just because health care is a fundamentally complicated topic. The "complexity" objection to the old Clinton plan, meanwhile, was fundamentally bogus. It was a complicated plan, but existing health care finance and regulations are extremely complicated. The ins-and-outs of your private plan are complicated. Everything about health care is complicated.

Which means that, fundamentally, complexity will always be out there as something folks determined to find a pretext with which to bash a proposal can use. And since there will always be folks out there looking for pretexts, that means that at some point the politics of the complexity issue need to be confronted head-on, rather than through measures to devise a non-complicated plan.

Photo by Flickr user Ernstl used under a Creative Commons license

Comments

True, but the politics of the complexity issue do not really have to be addressed head on by Congress, or even under the glare of the media...the politics of the complexity issue can be addressed head on like the vast majority of public policy. Congress can simply leave the complex details to the designated federal agency, which will go through a comprehensive and transparent process to iron out them out.

It happens all of the time, and not only on small-time legislation.

Posted by fatinspanish | September 18, 2007 12:52 PM

Actually, maybe someone could ask Two-faced Dave what REPUBLICANS did to fix health care in the 12 years they had power after sabotaging Hillary's 1993 effort.

Maybe someone could ask Two-faced Dave why he has NEVER criticized REPUBLICANS' failure to act --whereas he is quick to mock Hillary's 1993 effort to fix the problem.

Actually, maybe we should ask Two-faced Dave why he gets to use our public airwaves.

Posted by Don Williams | September 18, 2007 1:04 PM

The "complexity" objection to the old Clinton plan, meanwhile, was fundamentally bogus. It was a complicated plan, but existing health care finance and regulations are extremely complicated. The ins-and-outs of your private plan are complicated. Everything about health care is complicated.

Right. As I recall, the most compelling objection to the 1993 Clinton Health Care plan, the one that caused public support to tank, was the claim that it would restrict the choice of doctors. (Of course, HMO plans were increasingly restricting the choice of doctors anyway, but this was the key objection.)

Clinton now claims that the new plan will enhance consumer choice rather than restricting it. We'll see.

Posted by LaFollette Progressive | September 18, 2007 1:12 PM

Clinton now claims that the new plan will enhance consumer choice rather than restricting it.

Heh - she could probably offer the same plan she offered in 1993 and it would "enhance consumer choice" - given how limiting our silly HMO and PPO insurance plans have become. I had to drive 20 miles to a lab to get bloodwork done even though there was one right in the building that my doctor uses because the one in his building wasn't covered by insurance. When I switched jobs, I had to switch doctors because my new plan didn't have his hospital on their preferred providers list.

Yeah - insurance companies sure have been the bastion of protecting "consumer choice" over the last 15 years.

Posted by NonyNony | September 18, 2007 1:48 PM

exactly what is david brooks' objection to people in the executive branch sitting around and trying to come up with the best policies?

that trusting george bush's gut and dick cheney's thuggish instincts has worked so well?

i used to have the excuse of the paywall to ignore brooks; now i will have to use the honest reason, which is that he's an ignorant ass.

Posted by howard | September 18, 2007 1:59 PM

Matt --

I am probably the world's least-expert on health care policy (I went to see John Cohn at Politics and Prose once!), but:

I agree that "at some point the politics of the complexity issue need to be confronted head-on," but it doesn't seem unreasonable to me that that point should be after the election of the next President. After living through the Bush years, I sympathize in general with your trust-but-verify view of presidential candidates. But I think it really just is the case that there's some middle stage between "vague idea" ("we should all have healthcare!") and "legislative proposal" ("here's all 800 pages of S.2831, the Universal Healthcare Act!"). Hillary/Obama/Edwards have basically signed on to wanting universal healthcare, and have outlined broad approaches for what a new system should look like, and have given pretty good ideas of where they'd be willing to compromise to get to 50%+1 and what elements they think are just essential. Yes, they could try to weasel out of it once they're president, but health care is a very high-ranking concern in the minds of the public (as opposed to the minds of former Clinton economic advisors), and it's overwhelmingly likely that the next president will have an (increasingly populist-sounding) Democratic congress, so I see no reason to *expect* that to happen. Given that, why isn't A Commitment To Universal Health Care And A Pretty Good Strategy For Implementing Said Program...well, good enough? At least during the primaries...

Posted by Daniel Munz | September 18, 2007 2:04 PM

It is fatiguing that people constantly praise politicans for supporting "universal care." That is a meaningless bromide. As Senator Clinton's plan demonstrates, "universal care" can be achieved through regressive, corporatist policies. "Universal care" that is adopted by telling people to buy insurance isn't progressive or just. "Universal care" could be funded by numerous progressive methods, but it appears that the current Democratic front runners are avoiding such methods like the plague.

Posted by Father Figure | September 18, 2007 2:11 PM

For a non-expert, I think Daniel Munz talks a lot of sense. Part of what is distinquishing this year's (or I guess next year's) race from 1992 is that universal health care has been on the agenda from the get go, and candidates feel pressure to have an actual plan for getting there. Moreover, there is the experience of 1994 to reflect on: Hillary's plan is not that different from the 1994 plan, but she's going to great lengths to emphasize how it creates more choice, right at the get go. The framing bubble of 2005 may have long since popped, but it makes sense to try to frame this policy - and to focus the candidates public statements - on a simple and straightforward message, rather than on hairy details. Finally, given how similar the top 3 Dem candidate's plans are, it seems to me it is perfectly possible for, say, policy wonks waiting in the wings for the next Dem administration to begin hashing out the details. What

Posted by Rich C | September 18, 2007 3:10 PM

How great would it be if our emerging web journalists could just ignore David Brooks. Not only is the man a puff-brain, but the discussion resulting from considering one of his articles is less interesting or useful than asking readers how they make nachos at home.

T.A.Frank makes the same inside-the-Beltway mistake, asking why we read Maureen Dowd rather than Bob Herbert. Well, I don't read Maureen Dowd, because she's trivial. You might as well read the back of a cereal box.

Garbage in, garbage out. Matt reads Brooks and decides the complexity of health care details will have to be faced eventually. No. As fatinspanish points out, most of the details will be worked out like they are for any other agency- and undoubtedly, some of the toughest points will simply be dealt with, if they occur infrequently, by the old "exception to the rule".

The big issue that has to be won in public is cui bono. Winston Churchill once described a cabinet colleague of his who would choose two or three important and salient points in a discussion and defend only those, winning when "at the end of the day, he controlled those points- which included much debatable ground."

Dave Brooks is the 5-year-old caddy your golfing partner brings along to distract you with stupid questions. Learn to ignore it.

Posted by serial catowner | September 18, 2007 3:14 PM

I don't think simply offering government-provided insurance to every American is very complicated at all.

What makes plans complex is the desire of Hillary and other politicians to ensure our tax dollars are paid to insurance companies who contribute to their campaigns rather than going for care.

Posted by Dilan Esper | September 18, 2007 3:17 PM

A simple plan:

One the first day of the new presidency, Clinton/Obama/Edwards - with great fanfare - submits a bill that would repeal all current healthcare for all members of Congress. Threaten to veto every and all legislation unless and until that bill has been enacted. Let the Congress explain to their constituents why they cannot pass this simple bill.

Then state that you will not sign any heathcare for Congress unless and until it is subject to the same rules as that available for every other American.

Healthcare reform will be accomplished within 6 months - max.

Posted by FitzRoy | September 18, 2007 3:35 PM

What makes plans complex is the desire of Hillary and other politicians to ensure our tax dollars are paid to insurance companies who contribute to their campaigns rather than going for care.

Or, put another way, the only thing guaranteed in this "universal" coverage is the insurance companies' profits.

Posted by Kevin | September 18, 2007 3:36 PM

Government by seminar? That's better than government by meatheads who don't do seminars.

Brooksie: you're attempts to pander to the hoi polloi are pathetic. Are you telling me you really personally think seminars are a bad thing? You're saying that the university professors in their faculty seminars and grad students in their grad seminars strike you as unserious people who aren't smart enough to get things done like George Bush and crew?

Puh-lease. Back when Clinton was holding "seminars," government worked. We didn't make world-historical, stupid-ass blunders because people actually thought what they were doing through and were forced to defend their ideas.

Posted by Junius Brutus | September 18, 2007 6:21 PM

Matt fundamentally misunderstands the "complexity" argument. So, for his benefit, I'll translate it to an easier context: Iraq during the Saddam era was very complex. So of course the transition to the non-Saddam era is also going to be very complex. Therefore, according to Matt, nothing at all. Whereas most people would, I think, say, well, for goddsakes, don't go messing around with it unless you're absolutely sure you have to, because it's very complicated.

Similarly, the health care system is complex. I'm sure some smart people think they've thought of everything. But it's very complicated. Don't go screwing around with big things, unless you're absolutely sure you have to. Changes at the margins are preferable, because they aren't nearly so risky.

Junius, tell me, how did Senator Clinton vote on that "world-historical, stupid-ass blunder"? Did she vote the wrong way because she didn't run a seminar first?

Posted by Thomas | September 18, 2007 6:42 PM

"What makes plans complex is the desire of Hillary and other politicians to ensure our tax dollars are paid to insurance companies who contribute to their campaigns rather than going for care."

Absolutely right! Hillary's plan would turn the uninsured into captive consumers of insurance company products. This is political cowardice at it's absolute worst.

Posted by kafka | September 18, 2007 7:22 PM

Oh, come on, she's not offering to do the insurance companies any favors, she's going to turn them into de facto government agencies, as much captive suppliers with government dictated terms and prices, as the consumers will be captive customers. Everybody will dance on their strings, insurers and insured, and the strings all lead to Hillary.

It's classic facism: Instead of abolishing business, as the socialists would, the government maintains it's outward forms, while taking over control.

Posted by Brett Bellmore | September 18, 2007 7:54 PM

I'm not buying it. It's complex now therefore it must always be complex? No.

How about everybody's covered and no one is left out? Simple.

Posted by Garuda | September 18, 2007 10:34 PM

I don't think simply offering government-provided insurance to every American is very complicated at all.

Sure, that's very simple. Until, that is, you start trying to write the rules that govern the program. Then it'd get . . . complicated. Medicare is a very complicated program. It's the nature of the beast.

Posted by Matthew Yglesias | September 19, 2007 12:38 AM

Matt:

Medicare is complicated, but only in the sense that health insurance itself is complicated; i.e., Medicare acts as insurer and has rules governing payment of claims and an infrastructure for claims payment, fraud deterrence, determining scope of coverage, co-payment collection, etc.

But what Hillary et al. propose to do is to graft on top of this the additional complexities necessary to ensure that taxpayer money be paid to insurance companies to reward her campaign contributions rather than to pay for care.

In other words, in order to ensure that her contributors get our money which is entrusted to her, she has to make the system much more complex. Whereas the correct public policy is no more complex than what already exists.

Posted by Dilan Esper | September 19, 2007 2:33 PM