Knowledge is for Sissies
Virginia Postrel did a post which asked what I think is a very reasonable question: If the Obama Administration is so sure that we can eliminate lots of medical costs without a reduction in health outcomes, why doesn’t it actually do this for Medicare first and prove it, before restructuring the U.S. healthcare sector around its theories?
Peter Orszag at OMB responded. As far as I can see from his email as reproduced phone conversation as summarized at Ms. Postrel’s blog, his response to this specific point boils down to this:
Medicare First—changing Medicare and waiting to see how it works before messing around with the rest of the health care system—won’t work politically.
Ah.
UPDATE: As per Ms. Postrel’s comment here, and her original post, she quoted Peter Orszag from a phone conversation, rather than recieving an email from him.
How ‘bout chu be honest here too, Dr. Manzi.
Universal healthcare is something the electorate wants.
If Obama gives it to them then refuglicans will be spending extra decades in the political wilderness.
YOU don’t like universal healthcare for some authenitc socioenomic reasons….but you have a political reason as well.
I personally don’t think the GOP is going to survive. In evolutionary theory of culture refusal to evolve is memetic extinction.
But like the Whigs, a new party will arise to balance the 2-party system.
— matoko_chan · Jun 6, 06:42 PM · #
What a zinger, Jim! Oh ha ha look at the Obama administration and all their hemming and hawing over the politically possible. And oh yeah, Obama only ran on universal healthcare and then got elected. But how silly is it that he doesn’t want to take a detour from that mandate and run a multi-year experiment on Medicare suggested by the blogger peanut gallery? What a fraud. You and Meagan got him good.
— Steve C · Jun 6, 06:50 PM · #
The original Manzi post is (uncharacteristally) content-free, just a sort of placerholder to a much more interesting Postrel post (which, granted, is a weblog Accepted Convention).
Commenters above aside I think Postrel’s original point — which has always been my bitch with the Kevin Drums and Ezra Kleins — is a good one. Look: I think we need universal care. I think it’ll be expensive and involve some trade-offs. When I hear Klein telling me, no, it’s cheaper, I think, nuh-uh. Ever been to a military medical facility? They have every kind of record-keeping advantage you want — and the docs see way fewer patients per day than their private sector analogues and are in many ways demonstably less efficient despite having a healthier pool of patients; indeed MEDCOM has fought to keep metrics of performance and cost out of MTFs (NB I think there’re other reasons you want to have MTFs anyway, obviously). And Postrel’s question is one I’ve always wondered — OK, there’s waste in Medicare: fix it! Surely that’s orthogonal to fixing American healthcare… the “it’s poitically not doable” is a weird dodge. (Although, I’d like to see what Orsazg actually said). Surely, with a majority in Congress that’s not opposed to reforming Medicare simply because it doesn’t want to make a government program look good, then if it’s really very clear how to reduce Medicare expenses, it’s politically very, very doable! And it gives you a stronger hand when you go to reform healthcare more broadly. So there’s a valid, simple question. And there’s people getting pissed that it’s being asked. What does that mean?
— Sanjay · Jun 6, 07:15 PM · #
Once again, I think the quality of discussion here would go way up if you guys cracked down on the most obvious trolls. I don’t even bother looking at most comment threads any more, because too often it’s just the same handful of commenters griping.
— Stuart Buck · Jun 6, 07:38 PM · #
Sanjay:
Thanks for the informed commentary. I put the second link in so that readers could see the whole reply.
— Jim Manzi · Jun 6, 08:47 PM · #
The quote above is not an email but my summary of a phone conversation that resulted from an email asking to talk to me. On my blog post, the direct quotes are indicated in quotation marks.
— Virginia Postrel · Jun 6, 08:57 PM · #
Sanjay, all politics are informed by the respective bases.
The repubs had 8 years to do something about medicare and universal healthcare.
They didn’t.
It is too late for the repubs to anything but nitpick the democratic proposal, or offer an intelligent and informed counter proposal.
……and Dr. Manzi is a hypocrite for ignoring the implications of universal healthcare to the party that implements it and the political motivations involved.
In this sort of situation neither side can effectively explain the intricacies of opposing proposals to their respect bases….my suggestion is that the republicans make the medicare experiment into a counter proposal and try to sell it to Obama……and their base. I betcha the repub base is not going to be wildly excited about medicare reductions.
;)
Aren’t old people and puffy whiteguys about all you have left in the party anyways?
— matoko_chan · Jun 6, 09:35 PM · #
In a benefits situ, the republicans will lose from 2008 forwards…….because the republican intelligentsia has to pretend to be non-intellectual to show solidarity with their base.
The democratic intelligentsia just has to bribe theirs.
— matoko_chan · Jun 6, 09:51 PM · #
Mr. Manzi, that doesn’t help. My issue was that Postrel paraphrased Orszag.
makoto_chan, do you try to have original thoughts, or to look up stuff, or anything? Here’s some facts for you. In 1992 my buds and I were stoked. The Democrats won what was at the time an unprecedented victory and took the presidency, continued a long time controlling both houses of Congress, took the majority of state governorships and of state legislatures. They had more — not less — control over the government, at least in terms of numerical advantage, then the Republicans had in those eight years. Their President was elected with a mandate much more focused on healthcare, I think, then Obama’s.
Remember the flood of progressive legislation? No? Don’t have universal healthcare? Who didn’t do anything about it? Whose frickin’ base killed that?
Which is my point, and why Postrel’s query is good. Passing this thing will be a bitch. If Orszag — or Obama — believed what they said, then she’s giving them good advice. Manzi and Postrel offer that advice to flush out the administration because they don’t think the administration believes it (neither do I but I still think, unlike those two, that it’s worth doing: I think that’s the Kaus position too).
Calling Manzi hypocritical here is mildly dumb. Your argument comes from the idea that in providing socialized medicine the Brits got the public to buy into one party for a long time (NB this model didn’t work everywhere) and you think, hey, the Dems can buy off voters here. Maybe, or maybe it’s BS. The worry is — and I do worry about this — that we’re in a debt mess. If it gets hard to issue American debt and spending needs to be cut back — or taxes massively raised — then the same giveaways may be seen as taking back a lot of government benefits too: then where’s your buyoff? I don’t think that has to be what happens, but Manzi’s been pretty clear he thinks it’s likely, so, there’s no real conflict here. From a strict, “I want what’s good for Republicans” standpoint he has an argument — I think it’s wrong but I wouldn’t be surprised if he doesn’t — that, screw it, let the Democrats take the hit for universal healthcare.
— Sanjay · Jun 7, 01:39 AM · #
Sanjay:
Yes, I recognized my error after Ms. Postrel’s comment and corrected the post.
— Jim Manzi · Jun 7, 02:48 AM · #
But isn’t medicare more efficient than generic health insurance?
— cw · Jun 7, 03:14 AM · #
I’m not old enough to know any of that sanjay.
The past is dust.
My point remains that medicare cuts are unsalable to what’s left of the republican base…….why on earth would Obama want to do it for them?
And just like medicare and the prescription drug benefit, once universal healthcare is instantiated it is not easily gotten rid of.
— matoko_chan · Jun 7, 05:30 AM · #
The current problem with conservatives is not that they are out of good ideas….it is that they are out of good ideas that they can sell to the base.
;)
— matoko_chan · Jun 7, 01:38 PM · #
Sanjay / matoko et al:
I wasn’t trying to make a partisn political point. I believe that making huge bets in th absence of important information that it’s possible to get is not a good idea unless you absolutely have to. I believe that experiments are the best way to get such information.
The Medicare First ideas struck me as a really great idea – as is typical of really great ideas, once you here it, it just seems so obvious. The Orszag response seemed extremely interesting because he’s about the most informed possible respondent, and he didn’t have an answer that was something like “here are the risk pool issues that make this invalid” or whatever, but was instead, by Postrel’s paraphrase, that it’s not politcally expedient.
— Jim Manzi · Jun 7, 03:14 PM · #
CW;
“But isn’t medicare more efficient than generic health insurance?”
In a word, NO. Details to follow.
(Now if by “more efficient” you mean less administrative overhead, you MAY have a point (though very debatable) but if you mean in terms of dollars spent per “outcome” then NO.)
— C3 · Jun 7, 03:38 PM · #
pfft, my argument applies to both sides.
Neither side of the base has the substrate to get why that would be a good idea, which is why neither side will propose it.
Obama is a machiavellian pragmatist with liberal tendencies.
To effectively oppose him, you need a machiavellian pragmatist with conservative tendencies.
And srsly, that ain’t Sarah Palin.
— matoko_chan · Jun 7, 05:03 PM · #
I don’t understand the snideness regarding Orszag’s response. There are lots of good ideas that don’t get implemented because they aren’t politically possible. Rather than just restating what a great idea it is and characterizing his response as “knowledge is for sissies”, why not tell us why you think he’s wrong?
My opinion is that it’s going to be hard enough (perhaps impossible) to pass a decent health-care bill that has both carrots, such as coverage for the currently uninsured, and sticks, such as cutbacks in funding some types of health care. Passing a bill that is largely just cost-saving measures directed at a single group with an aggressive, influential lobbying arm (AARP) that has already stated opposition, doesn’t sound all that much easier than passing a more comprehensive bill. Plus, even if you could pass such a bill now, you don’t know what the political climate will be after the time needed to evaluate its effectiveness has passed (this is true even in scenarios where the bill has been a net positive in terms of cost savings).
— Ratufa · Jun 7, 05:33 PM · #
Ratufa:
Please see my reply above at 11:14AM
— Jim Manzi · Jun 7, 06:21 PM · #
“My point remains that medicare cuts are unsalable to what’s left of the republican base…….why on earth would Obama want to do it for them?”
Because in about 8+ years it goes under. (http://www.nytimes.com/2009/05/13/us/politics/13health.html)
— C3 · Jun 7, 09:01 PM · #
well..in 8 + years it will be someone elses problem…..isn’t that the Republican model?
hahahaha
— matoko_chan · Jun 7, 10:35 PM · #
Stuart: do you believe it’s a baseless, “troll”-like point that Jim applies a multiplier of 0.0 to arguments that involves what’s politically possible, and some higher multiplier to a theoretical position that, if adopted, would completely digress from the mandate handed to Obama during the last election?
Here is some satire, or what you might (inaccurately) call a troll: President Hayek Jr is elected with a mandate for eliminating entitlements, legalizing marijuana, privatizing the police force, and returning to the gold standard. In the course of executing on what the Prez has promised to do, Paul Krugman writes an article on the NYT op-ed page proposing that means-testing might be a better way of saving money on entitlements.
Hayek’s administration responds, saying this is not within the realm of the politically possible. Do you think Jim Manzi or Virginia Postrel would write snarky blog posts endorsing experimentation with means-testing, or do you think they would rediscover an appreciation for the practical aspects of the political process?
The ultimate blame for the statist healthcare situation we are about to end up with (for good or for bad) lies with a libertarian thought elite who made it safe for the Republican party not to tackle these issues when they were in power. When everyone’s raises come in the form of maintaining the same level of benefits they had the year before, yeah, there’s going to be a movement toward the guy with the statist solution. It’s a solution, it might be. It’s something. Perhaps if the libertarians had been more sensitive to the politics of the problem prior to now they could have had some say in the outcome.
— Steve C · Jun 8, 12:36 AM · #
Steve C:
I take your point.
Without respect to whether or not Pres. Obama has a mandate for this, I think that a President can “have a mandate to do X”, and still not do it because he’s not sure it’s a good idea. Pres. Obama may be confident that his plan is a good idea (or, more practically, better than the probability cloud of potential outcomes if he avoids pushing action now). It doesn’t seem to me that his version of health reform is so obviously or not a good idea. More precisely, it doesn’t seem to me (to the extent that such a thing is knowable) that a non-ideological observer wouldn’t want more evidence before making a very long-term commitment to restructuring ~15% of the economy.
He’s President, I’m not, so his opinion counts a lot more than mine. Fair enough. Blaming the “libertarian thought elite” for whatever program, if any, that he pushes seems to me like a real stretch.
— Jim Manzi · Jun 8, 01:23 AM · #
I don’t mean to say that they deserve all of the blame (well I did say that and that’s a little silly). But let’s say you’re for shifting medical decisions and costs on to individuals – a fine idea, one without a lot of precedent, but hey it could work. Why weren’t we talking about it in 1999 or 2002? Ok here we are now in a situation that we feel is broken and immoral, and we want to take something off the shelf that works and put it in place. It’s way past time for tinkering, the political moment is now.
WRT Obama’s mandate, yes he can decide not do something because the facts change. Those would have to be some pretty serious facts though – a bazillion uninsured, healthcare costs going up at insane rates, and a public that expects someone to do something about it all.
— Steve C · Jun 8, 06:22 AM · #