Friday, June 26, 2009

Audacity of Incrementalism?

I see signs of a sellout by the Obama folks and Democratic "centrists" on the public healthcare option. If this doesn't happen a lot of thanks should go to Paul Krugman whose forceful reasoning and barbs may give President Obama the spine to make a stand.

In his Times' June 22 column, "Health Care Showdown" Krugman exposes the "centrist" Democrats led by Senators Ben Nelson and Kent Conrad. Both of these men oppose or undermine the public option for apparently ulterior motives, be it campaign contributions, outright corruption, or aspirations to become power brokers. Their group as well as the Republicans have to know that the public option will vastly lower prices and benefit payers and patients. Proponents of this option are emphasizing that it will compete with private plans that patients are free to opt for, or retain. So any switch to the public plan will be purely voluntary, because it is a cheaper and/or better choice.

Opinion polls show wide support for this option by a 72% to 20% margin according to the most recent survey. Still, Nelson and Conrad can afford to ignore voter sentiment (often misplaced, but not this time) because neither is up for re-election till 2012, and Nelson enjoys high ratings in his Nebraska state. Whatever their reasons, or that of other Democratic "centrists" and the Republicans, we can be sure they are knowingly refusing to act in the public interest.

However, Obama can push through effective reforms if he really wants to. He doesn't need to keep seeking bipartisan support that dilutes reforms to the point of making them trivial. Thanks to the Congress reconciliation process he doesn't need a 60 vote filibuster-proof support in the Senate, but just a simple 50 vote majority that Democrats can easily manage.

This is where Krugman's other Op-Ed of yesterday titled "Not Enough Audacity" comes in. It makes effective arguments for Obama to not settle for half-measures, as he shows some signs of doing. It's worth reading both of Krugman's articles to really get it, but here are key excerpts:

"The point is that if you’re making big policy changes, the final form of the policy has to be good enough to do the job. You might think that half a loaf is always better than none — but it isn’t if the failure of half-measures ends up discrediting your whole policy approach.
Which brings us back to health care. It would be a crushing blow to progressive hopes if Mr. Obama doesn’t succeed in getting some form of universal care through Congress. But even so, reform isn’t worth having if you can only get it on terms so compromised that it’s doomed to fail.

"And that’s why the public plan is an important part of reform: it would help keep costs down through a combination of low overhead and bargaining power. That’s not an abstract hypothesis, it’s a conclusion based on solid experience. Currently, Medicare has much lower administrative costs than private insurance companies, while federal health care programs other than Medicare (which isn’t allowed to bargain over drug prices) pay much less for prescription drugs than non-federal buyers. There’s every reason to believe that a public option could achieve similar savings...

"Indeed, the prospects for such savings are precisely what have the opponents of a public plan so terrified. Mr. Obama was right: if they really believed their own rhetoric about government waste and inefficiency, they wouldn’t be so worried that the public option would put private insurers out of business. Behind the boilerplate about big government, rationing and all that lies the real concern: fear that the public plan would succeed..."

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