April 24, 2014

The Can’t-We-Do-Better Blue Dogs

In today’s Washington Post, Harold Meyerson complains that the centrist “Blue Dog” Democrats have a “can’t do” attitude when it comes to health care reform:

[O]ur government used to actually pave roads, build bridges and allow for secure retirements by levying taxes on those who could afford to pay them. To today’s centrist Democrats, this has become a distant memory, a history lesson they cannot grasp. The notion that actual individuals might have to pay to secure the national interest appalls them. In the House, the Blue Dogs doggedly oppose proposals to fund universal coverage by taxing the wealthiest 1 percent of the nation’s households…

Centrist Democrats’ opposition to health reform verges on the incoherent. A caucus (the Blue Dogs) formed ostensibly to promote balanced budgets now disapproves of the proposed taxes that would cover the expenses of the new programs. The congressional centrists say, commendably, that they want to squeeze more economies out of the system, but they oppose giving more power to an agency that would set the payment scales for physicians…

[A]ct on behalf of the nation as a whole, even if it means goring Wall Street’s or Wal-Mart’s oxen? Perish the thought. Pass a health-reform bill that will cover 45 million uninsured Americans and slow the ruinous growth of health-care spending? Not if somebody, somewhere, actually has to pay higher taxes. Hey, we’re America — the can’t-do nation.

But Harold misunderstands.  It’s not that the Blue Dogs don’t want to do a major health reform that could both expand coverage and reduce health care costs (save money) at the same time.  It’s that they do want to do all that, in a fiscally-responsible and economically-wise way–yet so far, they haven’t really seen a specific plan that would achieve all that. The Blue Dogs are asking: “can’t we do better?”

How could we do better?  Harold’s colleague, Steven Pearlstein seems to have some ideas, even with his column that argues that “imperfect health reform” is better than no reform.  Steven hints that the President doesn’t seem to be pushing the “tough choices” that would make a real difference in containing health costs–and that we can’t really estimate (with any precision or faith, just yet) how large this difference would be:

[I]n trying to build public support for reform, President Obama has made promises that will make it even more difficult to bring all the pieces together into an effective and viable reform plan.

Let’s start with the promise, repeated often by the president and written explicitly into both House and Senate proposals, that if you like the insurance you have, you can keep it. But if we’re aiming to fundamentally restructure the system, is it really credible to say that we can have all the good parts of the old one with none of the bad parts?

We know, for example, that people like to decide for themselves what medical care they will consume and send the bill off to their insurer. And doctors and hospitals like being paid for whatever they do, no matter whether it is needed or is the most cost-effective treatment. We also know, however, that moving away from “fee-for-service medicine,” as it is called, is the key to taming runaway health spending and improving health outcomes. That will be a better system, but it will be a different one, and it won’t come unless it is pushed and prodded into being by the government…

[L]ong-term cost savings…might come from restructuring the way doctors and hospitals are paid or moving patients from solo practitioners to clinics that make better use of nurses and coordinate care among a variety of specialists. There is a general consensus among health-care experts that these are the reforms that will finally “bend the curve” of ever-increasing health-care spending, and CBO Director Douglas Elmendorf made headlines the other day by telling Congress that lawmakers had not been aggressive enough in embracing these reforms…[but at the same time t]here isn’t enough knowledge to say with any precision how much would be saved and when the savings would materialize.

…and Steven points out that there are much smarter ways to raise revenue to pay for health care reform than the darned surtax idea–if it weren’t for the President’s darned campaign promises:

One way to pay for universal coverage, of course, would be to tax those who are likely to benefit most from slowing the growth of health insurance premiums, such as workers who already get their health insurance tax-free. But Obama has also boxed himself in on that issue by reiterating his promise never to raise taxes on anyone who makes less than $250,000 a year. Having a little flexibility on that issue would go a long way to putting together a final package.

A CNN story explains that centrist Democrats are frustrated with the House health bill:

WASHINGTON (CNN) – New questions about the fate of the health care bill were raised Wednesday as some fiscally conservative Democratic House members said Congress is not close to reaching an agreement…

“We are making progress; however, we have a long way to go,” Rep. Mike Ross, D-Arkansas, a leader of the fiscally conservative “Blue Dog Coalition,” said in a written statement.

One of the Blue Dogs’ concerns is ensuring that any change to the health care system does not add to the federal deficit…

“Some of the issues that the Blue Dogs have put forth are issues that we all are concerned about,” [House Speaker Nancy Pelosi] told reporters. “We want to squeeze as much savings out of the system as we can before we seek any [new tax] revenue. [But] you can only go so far.”

So it’s not that the Blue Dogs are saying “no can do”… It’s really that they believe that we can do (and should do) better.

--Cross-posted from Economistmom.com