Robert Samuelson is a Heartless Monster

I'm surprised yesterday's Robert Samuelson column hasn't come in for more derision:

We need to have a candid debate about health care in 2008, but the odds are against it. The fact that covering the 47 million uninsured already looms as the centerpiece of this debate is a warning sign that it won't be serious. We're told that the uninsured are our biggest health-care problem, but they aren't. Runaway health spending is.

Yowza. It seems to me that what "our" biggest health-care problem is probably has a little something to do with who we are. Evidently the plight of the uninsured isn't a big problem for Robert Samuelson, but it's a problem for an awful lot of the uninsured people. Similarly, the risk of losing insurance is a problem for an awful lot of people. Maybe if we all got paid Samuelson's salary to churn out inane columns, everyone would share his perspective on the world. But it's really a bizarre perspective. He moans: "These proposals would inflict 'pain,' and candidates who embraced them would invite political ruin." Pain would invite ruin because people don't like policies that will make them worse off. It's a perfectly reasonable thing for voters to want to avoid.

Photo by Flickr user PPDigital used under a Creative Commons license

Comments

"I'm surprised yesterday's Robert Samuelson column hasn't come in for more derision"

Do people still read him? Whenever I see his name under a column my eyes wander to some more worthwhile piece.

Posted by d | December 7, 2007 9:32 AM

Are there no prisons? Are there no work houses?

Posted by El Cid | December 7, 2007 9:35 AM

Both issues are intertwined. If we didn't spend such gargantuan amounts of money keeping the dying alive a few days or weeks longer, when the chances of long-term survival and the quality of life are both zero, there'd be ample funds available to cover the uninsured.

Of course we also drastically under-spend on preventative medicine and medical research, but that's another issue.

Posted by Peter | December 7, 2007 9:38 AM

Another example of a conservative holding up someone else's pain as a great virtue.

I've got an idea: since pain is such a virtue, let's improve the character of the upper income brackets by repealing Bush's tax giveaways.

Posted by Virginia | December 7, 2007 9:39 AM

Matt - You travel in generally prosperous circles - relatively speaking. Right? Yet, even you must know plenty of people - well off people - who are afraid to quit bad jobs and start innovative businesss, because they cannot risk leaving their family without health insurance.

You cannot estimate the lost revenue from taxes that never was - because people could not risk becoming uninsured.

Posted by Comment | December 7, 2007 9:46 AM

Fuck the poor and uninsured -- the main problem is that my insurance co-pay went up!

Posted by Gore/Edwards 08 | December 7, 2007 10:07 AM

Especially annoying is the assumption that politicians could do the "right thing and impose pain on people, but they won't, because they enjoy increasing spending for its own sake.

Asshole.

Posted by SDM | December 7, 2007 10:12 AM

Especially annoying is the assumption that politicians could do the "right thing and impose pain on people, but they won't, because they enjoy increasing spending for its own sake.

Asshole.

Posted by anon | December 7, 2007 10:12 AM

Samuelson's solution is basically "all the poor people should consume less health care, and then more poor people will be able to get insurance."

A National Health Service is more like "all the rich people consume less health care, and then more poor people will be able to get insurance."

I fail to see what benefits Samuelson's plan has over the obvious alternative.

Posted by Mr. Noah | December 7, 2007 10:34 AM

Ultimately, Samuelson is right (if not particuarly tactful).

The problem with medicine is that it is very, very expensive, and with current rates of inovation, going to get much more so. Furthermore, most of the expense comes from cronic illnesses (diabetes, etc.) and from the complications of old age. Neither is well suited to the insurance model, as they involve guaranteed costs, not uncertain ones. More precisely, the only way to restrain these costs is by rationing treatment.

Samuelson argues, (not very convincingly) in favor of a market solution. Matt has argued elsewhere for universal coverage. From either standpoint, the uninsured cease to be an issue if your prefered solution is enacted .
The uninsured are thus a diversion from the main debate, which is about how we should distribute and pay for healthcare.

PS: I don't mean to claim that Universalists would cease to worry about the unisured if we moved to a free market for care. Just that their concern for the uninsured is subsumed by a more general argument that everyone should have access to care. I'm sympathetic to this point of view, but it doesn't mean that Samuelson is stupid (or even necessarily wrong) if he disagrees.

Posted by heedless | December 7, 2007 10:34 AM

On the positive side, I haven't read a comprehensive health care reform package that wouldn't inflict a lot of pain for someone. Until we can come to grips with the end-of-life ethics (see Peter above), preventative and chronic health regimes, and deal with the vast agency problems in the health care industry, we'll continue to have runaway costs and sub-optimal health care for most.

Posted by mike c | December 7, 2007 10:38 AM

I am frequently taken aback by prominent political commentators who don't understand the fundamental principle of democratic government. The idea is that, of course politicians are motivated by selfish desires, so the whole idea is to structure a system that will pin their political careers to the general well-being of the public. If something leads to political ruin in a democracy, then it is a bad idea, and should lead to political ruin. Now, obviously, since it's an imperfect system, interests are not always perfectly aligned, so there will be policies (carbon taxes, bankruptcy "reform"), where the politically difficult thing to do would be best for the country. But the default presumption should be that good politics and good policy are aligned, while most commentators presume precisely the opposite.

Also, Peter, I'm glad that you have the power to discern, in advance, cases in which the chances of long-term survival are zero. I just hope that you join the X-Men rather than the Brotherhood Of Mutants.

Posted by OhioBoy | December 7, 2007 10:45 AM

I am frequently taken aback by prominent political commentators who don't understand the fundamental principle of democratic government. The idea is that, of course politicians are motivated by selfish desires, so the whole idea is to structure a system that will pin their political careers to the general well-being of the public. If something leads to political ruin in a democracy, then it is a bad idea, and should lead to political ruin. Now, obviously, since it's an imperfect system, interests are not always perfectly aligned, so there will be policies (carbon taxes, bankruptcy "reform"), where the politically difficult thing to do would be best for the country. But the default presumption should be that good politics and good policy are aligned, while most commentators presume precisely the opposite.

Also, Peter, I'm glad that you have the power to discern, in advance, cases in which the chances of long-term survival are zero. I just hope that you join the X-Men rather than the Brotherhood Of Mutants.

Posted by OhioBoy | December 7, 2007 10:46 AM

Isn't he another one of these guys whose mothers were frightened by C. Aubrey Smith?

Posted by Jeffrey Davis | December 7, 2007 11:11 AM

I just can't be bothered to read Robert Samuelson anymore, even to lampoon him. Not only is he a worthless tool of his class, but his columns are nearly as boring as the Code of Federal Regulations.

Posted by low-tech cyclist | December 7, 2007 11:21 AM

Well, some years ago Robert Samuelson told me I needed to lower my expectations and all would be well. So I did: I lowered my expectations of Robert Samuelson. Drastically.

Posted by Michael Bérubé | December 7, 2007 12:34 PM

Evidently the plight of the uninsured isn't a big problem for Robert Samuelson, but it's a problem for an awful lot of the uninsured people. Similarly, the risk of losing insurance is a problem for an awful lot of people.

Nice strawman. He didn't say lack of health insurance is not a problem at all, he said it's not the biggest problem.

The benefits of insurance are grossly exaggerated by "universal coverage" fetishists. There is abundant evidence that health insurance is unlikely to make much difference either to someone's health or to their financial security.

Posted by Mixner | December 7, 2007 12:46 PM

Hey, I vote for the Code of Federal Regulations as being more interesting than one of Samuelson's columns. At least that's stuff that has applications somewhere, but I've never seen Samuelson write anything that wouldn't better be used as birdcage liner.

Posted by grumpy realist | December 7, 2007 12:53 PM

Nice shot, Matt. Well-aimed and brilliantly executed. But then Samuelson did do you the courtesy of painting a huge, illuminated target on his own ass.

Posted by Henderstock | December 7, 2007 1:49 PM

It's always seemed obvious to me that providing health care to people who could afford it is part of why the price goes up so fast.

The same thing happens with cars, but with cars we have like 400 million used cars to supply those who can't afford to buy new. With new cars the price goes up absurdly because the people who buy new cars are absurd. The car companies would be crazy not to take advantage of this fact and, from their point of view very sensibly, they focus their efforts on the top-of-the-line buyers. Even those who buy the cheapest cars in the product line-up are hoping their brand choice will reflect the allure of the most expensive cars in that line.

As long as the health care market is serving people who say they don't care what it costs, prices will rise.

Posted by serial catonwer | December 7, 2007 1:50 PM

It's sad that Matt has such a vendetta against RJ Samuelson. Samuelson is not always on the money, but his basic approach, comparing underlying policy questions to the public political debate is a valuable one, and sometimes, as in this column, he gets it right. Certainly coverage should be a part of the debate (and Samuelson is clearly not saying otherwise here), but the real problem is costs. Fundamentally it is a question of resource allocation. If we could come up with a coherent approach to health care expenditures, solutions to the coverage problem would be much easier to come by. And the almost exclusive focus on coverage (as in the Great Mandate Debate), allows candidates to duck the really hard questions. Matt is doing himself, Samuelson, and all of us a disservice with these silly attacks on Samuelson.

Posted by J.B. | December 7, 2007 2:09 PM

"Matt is doing himself, Samuelson, and all of us a disservice with these silly attacks on Samuelson."

Spot on. Samuelson's real crime is asking tough questions that don't have easy answers. The Dr.Phil and Oprah part of America just won't stand for that.

Posted by kafka | December 7, 2007 2:40 PM

When the likes of Samuelson are spending most of their time defending against universal coverage, instead of hatching schemes to destroy Social Security - Then you know things are getting better in this country.

Posted by David | December 7, 2007 3:40 PM

Robert Samuelson is a Heartless Monster

With this kind of over-the-top name calling MY does himself a disservice.

Samuelson points out that many of the uninsured are young, healthy individuals that have rejected insurance based upon its outrageous cost.

From the movie "Say Anything:"
protagonist/Cusak - "If you guys know so much about girls, how come you are here at a Gas'NSip on a saturday night with no girls anywhere?"
"Joe" - "By choice man, by choice."

He does not say that it is not a problem, nor that there are not many deserving people who are not insured. He just points out that the root cause of these symptoms is the high cost of Medical inflation.

I think that Samuelson is right, that medical costs have run out of control and that many of the solutions he lists will help solve the problem. In my mind the biggest problem is that consumers do not see the cost of their procedures, so their is no direct pressure to contain them. The biggest roadblock to solving this issue is the insurance company middlemen.

Increased visibility into doctors' effectiveness and better access for patients' records should also help improve the overall industry's efficiency.

Posted by Keith | December 7, 2007 4:52 PM

Re: Samualson's proposal for a dedicated health care tax

I think we should have a dedicated war tax. I would love it if Americans got a firm reminder every year at tax time of how much we are squandering in Iraq. I would have been estatic if Bush's announcement of the surge had been generated stories about how this would increase the size of the war tax. It would be delightful to see conservatives who support lower taxes fighting with conservatives who want to invade every country in the Middle East.

Unlike Samuelson, I won't try to convince you that my proposal for a war tax is neutral and doesn't take a position on whether we should be in Iraq.

Posted by Kenneth Almquist | December 7, 2007 8:45 PM

The debate about health care costs that Samuelson thinks we should be having now actually occurred in 1993 and 1994. I'm not happy with the outcome of that debate, but if Samuelson wants people to take seriously the idea that we need to reopen the debate, he needs to explain why he thinks we need to reopen the debate, rather than just pretending that the previous debate didn't occur.

Posted by Kenneth Almquist | December 7, 2007 9:26 PM