Two Ways on Health Care

Ezra Klein breaks down the shape of the health care debate:

On each side, the plans are basically united. The Republican plans make you pay more for your healthcare so you'll buy less. They do this by weakening the protection that insurance offers from health expenses. The Democratic plans bring everyone into the system, then use that leverage to reform the insurers and extract savings through efficiencies of scale.

This is why I do agree with Mark Kleiman that as far as domestic issues go, there's relatively little reason to focus on the fine-grained differences between the different candidates in the primary. If you're a liberal, the Democrats are all close enough to each other that the differences are bound to be swamped by the distance between what's proposed and what will actually come out of the legislative process. Much more important, as Mark says, to think about which candidate is likely to be most helpful (or least harmful) downballot or about who you trust most in the basically discretionary field of foreign policy.

Comments

"extract savings through efficiencies of scale."

What's the government's track record on this so far, with its current health care programs such as Medicare and Medicaid? It seems that whatever savings there are in Medicare come not through "efficiencies in scale" but in policies such as fixing physician reimbursements at below-market rates -- and in spite of this, Medicare costs continue to increase at more than double the rate of inflation.

Posted by Fred | October 1, 2007 9:59 AM

I'm not sure that there really is a Republican "plan" here. Most of the proposals being floated (by actual candidates) seem like no more than effectless window-dressing with, at most, some minor goodies for the upper classes, but no real change of any sort for anyone else. The GOP seems to be whistling past the graveyard here, hoping that if they just wait long enough the issue will go away again.

Posted by JonF | October 1, 2007 10:03 AM

Much more important, as Mark says, to think about which candidate is likely to be most helpful (or least harmful) downballot

Kleiman keeps arguing that obama will be helpful in downballot races. helpful to whom? he's running on the americans for obama ticket, last i checked there weren't any other obamas running.

Posted by matt | October 1, 2007 10:05 AM

"Most of the proposals being floated (by actual candidates) seem like no more than effectless window-dressing with, at most, some minor goodies for the upper classes..."

Actually, limiting the tax deductibility of employer-sponsored health insurance, as Bush has proposed, would take "goodies" away from the "upper classes".

Posted by Fred | October 1, 2007 10:12 AM

Re: Only because they made him in the first place. They know every last detail of his structure - that's why they could unmake him.

Except that the upper class often purchases private health insurance rather than getting it through work (since most of them do not work anyway but live off their investments). Hence Bush's proposal would be to their benefit since they could, for the first time, deduct their healthcare premiums. (By the way I am not knocking that concept-- I do think people who buy health insurance outside work should get the same tax break employees do. But I am under no illusion that that would solve the healthcare crisis.)

Posted by JonF | October 1, 2007 10:16 AM

Much more important, as Mark says, to think about which candidate is likely to be most helpful (or least harmful) downballot or about who you trust most in the basically discretionary field of foreign policy.

I'm not sure where the assumption that broad discretion exists only in the foreign policy field comes from, but it's not true. There may be more in foreign policy, but any Administration will have broad discretion on staffing agencies, for example. Look at the number of complaints about the Bush Administration that relate to staffing non-foreign policy agencies like FEMA and DOJ.

This in turn makes me wonder whether we would all be better served by admitting that Americans who pay attention to "character" (whatever that means) aren't more foolish than those who pay attention to "policy." After all, explicit policy can be affected by public disapproval or Congressional disapproval at the time of attempted passage or implementation. It's all the stuff that doesn't get watched that matters.

Posted by SomeCallMeTim | October 1, 2007 10:16 AM

SCMT- I agree the range of regulatory discretion is often greatly underappreciated. But, I still think that's often a policy issue too. After all, Bush's EPA, Justice Dept Civil Rights, FDA, and OSHA appointees don't enforce laws as a matter of policy. The Bushies view it as a feature, not a bug.

Posted by AJ | October 1, 2007 10:48 AM