Changing Health Care: What’s the Challenge?: The Balance Sheet : The New Yorker

Not to beat up on David Brooks two days in a row, but his Op-Ed piece in today’s Times is a bit peculiar. Brooks’s argument in the piece is that instead of pushing for incremental reform, the Obama Administration should be pushing for fundamental reform, and particularly that it should be pushing for the kinds of reforms that can bring about serious cost control in the health-care industry. This is a reasonable position, even if I think Brooks is dramatically underestimating the difficulty of selling this idea to the American public, and even if he also seems strangely indifferent to the importance of helping people who are currently uninsured get affordable insurance (even in the absence of cost controls). What’s strange about Brooks’s piece, then, isn’t the thesis. Instead, it’s his assumption that the Obama Administration is somehow unaware of—or indifferent to—the importance of cost controls. So Brooks writes that if he were advising Obama before next week’s big speech on health care, he’d “ask Obama to go to the Brookings Institution Web site and read a report called ‘Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth.’ ”


I like James Surowiecki. David Brooks too. But they're talking past each other in their respective pieces. Common malady.

Putting aside all of the specific policy pros and cons of the current debate, it seems to me that Obama is committing one fundamental error in his push for health care reform, compounded by another of near equal magnitude: He hasn't focused his proposal and supporting arguments, and he's run too far out ahead of the centrist majority whose support is critical to effecting any major change in how things are done in our country.

I think that this is Brooks' central point, although it's obscured by his less compelling specific assertions and opinions. And Surowiecki is quarreling with a straw man argument about Obama being in touch and listening.

My two cents:

Obama needs to say in effect, "I believe that there are many things that can, and likely should be improved about how we deliver and pay for health care in this country. But right now, I want to focus us all on one thing: [INSERT HERE: (1) We should be getting a lot more value for our money, or (2) We can't leave the 40 million of our neighbors who want and need health care out in the cold without an affordable way to get it, or (3) The system is stacked with too many unfair advantages in favor of powerful interests, and all of us are getting hurt and paying the bill as a result]. Further, I believe we know what to do about it, and now's the time to roll up our sleeves and do it. This is not about hoisting one agenda over another, or some big social engineering project. It's simply about fixing a problem that we need to deal with now, for our own good, and for the good of our children. Here's how…."

By allowing a smorgasbord of ideas, developed in Congress with minimal guidance from his administration, to bubble up as "his" plan, it was inevitable that it would lack focus (or even coherence).

By focusing his bully pulpit remarks almost entirely on the need to do something, RIGHT NOW, he's left many folks, (especially in the center, where they don't have animating agendas that pre-define their views on matters such as this), with the most basic of questions:

  1. What problem are we trying to solve?
  2. What are we going to do about it, exactly?
  3. If it involves spending more money, where will than come from?
  4. How will it effect me and my family?
  5. Why are you rushing to push something through, when the answers to 1 – 4 aren't clear? (I'm not sure I can grant you a "Trust me…" on this just yet — don't know you well enough.)

If you want to get something complex done, you'd better focus. And you had better make sure that when you look back at your supporters, most of them are still there, right behind you.

Posted in Current Affairs.

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