This discussion/interview between Ezra Klein and Rep. Paul Ryan is the best thing I’ve seen in the health care debate in months.  Given Ryan’s position as a GOP point man on health care reform, his comments on Wyden-Bennett ought to give hope that maybe it could get enough GOP support to pass if the Dem leadership were willing to push it.  Regardless, the entire back-and-forth is interesting on both sides.  Even if you disagree with Ryan, I think you’ll also find it refreshing to hear a semi-prominent GOP politician speak knowledgeably and seriously about health care reform.

“If Obama’s efforts to create a viable regulatory framework in which individuals can buy private health insurance (a) pass congress, and (b) turn out to work well and be popular, then you can imagine a version of Ryan’s plan being put into place. But in the absence of that kind of reform, I just don’t see how you can do this, which is presumably why the implementation is delayed all the way to 2021 which helps Ryan avoid needing to think about implementation details.” ~ Matt Yglesias, writing about Rep. Paul Ryan’s alternative budget

I think Yglesias actually makes a pretty strong point here.  While I’m overall fairly sympathetic to Ryan’s budget – he does, after all, balance it (at least according to the CBO report [pdf]), something virtually no other politician is willing to even propose – I think there is a fundamental flaw with implementing a healthcare voucher program without first fixing the broken, dysfunctional health insurance market.  The exchanges created in Obamacare would be one way to do this. 

What Yglesias does not point out, however, is that Ryan’s budget proposal also puts an end to the tax exemption for employee benefits.  Simply coupling this tax reform with the ability to purchase insurance across state lines creates an entirely new health insurance market.  Suddenly people on the individual market are given the same tax preference as people who receive their insurance from an employer.  Health insurance drifts away from employers and becomes personal and portable.  People wouldn’t lose coverage when they left their jobs.  Meanwhile, insurers would lose their long-held local and state monopolies and be forced to compete nationally, driving down costs both through added competitive pressures and by the better bargaining powers that these large, national firms would have, with their much larger, national cost-sharing pools.

Of course, the hard questions in healthcare will center around two inextricably linked concepts – pre-existing conditions clauses, and individual mandates.  Almost all modern democracies have some form of universal coverage, and the only way that it has been achieved with any semblance of a free market has been by doing away with pre-existing conditions clauses and implementing some sort of individual mandate.  If the former is done without the latter, nobody would buy insurance until they were sick – defeating the purpose (and the viability) of insurance to begin with.

Other alternatives exist, of course.  My personal preference is a model along the lines of Singapore’s healthcare system, which mandates health savings accounts and then picks up the tab on any costs above a certain flat percentage of income.  This puts healthcare directly in the hands of the consumer (cutting out insurance companies altogether) and provides them with catastrophic coverage if something should go wrong.  Furthermore, by placing costs and transactions directly in the consumers hands, it keeps costs from skyrocketing.  The mandated savings would be flat, but the catastrophic coverage functions progressively, covering less and less as income rises.

Either way, before any privatization of Medicare and Medicaid can occur, the private insurance market must be transformed.  Paul Ryan has shown true grit in crafting a budget that is actually balanced, but the possibility of backlash to cuts in entitlements is very real if the systemic problems in our healthcare system aren’t taken care of first.  Both Yglesias and Ezra Klein see this budget as a sort of draconian rationing of benefits for seniors and poorer Americans. If the insurance market could actually be fixed, however, then the system of vouchers which Ryan proposes would be adequate and possibly even better alternatives to the status quo.

“When Newt Gingrich is trying to pull you back to the center, you’ve gone so far right that the average voter can’t see you any longer.” ~ Ezra Klein Pretty much.

Over at the Dish, Patrick Appell linked to Ezra Klein’s back and forth with Grist’s Tom Philpott about the benefits, or lack thereof, of organic food versus “conventional” food.

The exchange was initiated by this interaction between Klein and a Post reader,

Santa Fe, N.M.: I saw a report today on a study finding that organic food isn’t any healthier than conventional food. Is buying organic a waste of money, in your opinion?

Ezra Klein: Honestly? Yes. It’s definitely not healthier, at least not according to any study I’ve seen. There’s some argument that it’s more environmentally friendly. But it’s not something that I’m convinced is worth a premium. I’d rather buy from a local farm that uses some pesticides than a major producers who has gone organic.

To which Philpott responds by saying,

Well, Ezra, here is a study, released last year by the U.S.-based Organic Center, that comes to a conclusion quite different from the U.K. agency’s findings. It’s called “New Evidence Confirms the Nutritional Superiority of Plant-Based Organic Foods.” The Organic Center recently released a cogent rebuttal to the U.K. findings as well.True, the Organic Center is funded by Big Organic companies like Dean Foods (owner of Horizon Dairy) and Whole Foods, which have an interest in promoting organics as healthier. But I’ve never seen the Center’s scholarship successfully challenged.

Klein counters with,

At any rate, the hard evidence of health benefits for organic foods has been mixed at best. There are no long-term studies showing that consumption of organic foods will make people healthier over a long period of time. That’s not to say organic foods are bad. They may taste better, or be more environmentally friendly. And we may even eventually find that they are healthier. But I’m much more worried about getting people to eat fruits and vegetables in general than I am about getting fruit and vegetable eaters to switch to organics. And what we do know is that organic produce is more expensive and harder to find.

The two then get into a discussion of the environmental impacts of organic farming (Klein, Phillpot), all of which is a fine discussion as far as it goes. When it comes to discussion food and the agricultural industry environmental and nutritional components are important factors to consider and flesh out. But I think Klein and Philpott’s discussion misses, at least for me, one of the most fundamental desires and benefits of an organic diet: knowing just what you’re consuming. [Read more →]

Ezra Klein is worried that our dysfunctional debate over health care reform is symptomatic of broader problems with our democracy:

What we’re seeing here is not merely distrust in the House health-care reform bill. It’s distrust in the political system. A healthy relationship does not require an explicit detailing of the “institutional checks” that will prevent one partner from beating or killing the other. In a healthy relationship, such madness is simply unthinkable. If it was not unthinkable, then no number of institutional checks could repair that relationship. Similarly, the relationship between the protesters and the government is not healthy. The protesters believe the government capable of madness. There is no evidence for that claim, which means that there is no answer for it, either. That claim is not about what is in this bill, or what government has done in Medicare and Medicaid and the VA. It is about what a certain slice of Americans think their government — and by extension, their fellow citizens — capable of.

And Will Wilkinson thinks that Ezra is being deeply – dangerously -  naive:

It requires an amazing kind of selective amnesia to think that there is “no evidence’ that the U.S. government is “capable of madness.” The government of the United States invaded Iraq and its agents have killed many tens of thousands people on the basis of the fact that some Saudis trained in Afganistan flew planes into the World Trade Center, plus some lies. Torture, extraordinary rendition, indefinite detention, etc. I call that madness. Of course, Ezra means the other parts of government concerned with domestic affairs. But not the parts that break into peoples’ houses and destroy their lives for selling contraband herbs, or that subject us constantly to mendacious propaganda about drugs. Our government — and by extension our fellow citizens — is capable of terrible things and proves it every single day. Is it really possible to love government so much, to invest so much hope in its benevolent efficacy, that we grow blind to its evident capacity for evil?

I’m inclined to side with Will here; as he notes, it doesn’t take much more than a quick glance at the past eight years (or the whole of American history, really) to understand that our government, like any other, has immense capacity for evil.  That said, I don’t want to completely dismiss Ezra.  Yes, he’s wrong about the government’s capacity for “madness” but I’m not sure that that actually invalidates his argument.  After all, even by fairly lenient standards, these protesters aren’t very informed: they don’t have a terribly sophisticated knowledge of American political history, and they almost certainly aren’t aware of the “madness” of the past few years.  In fact, if they are aware of the previous administration’s transgressions, I’d be surprised if they were actually bothered by any of them.  In all likelihood, these are the people who were stoked about invading Iraq, and cheered on the administration after Abu Ghraib.

This is all to say that Ezra is, in some sense, completely right.  For the protesters and the teabaggers, there is absolutely nothing in their political ideology which would lead them to believe that the government was capable of madness.  Yes, you could say that these are “small government” conservatives with an inherent distrust of authority, but again, most of these folks sat through – and probably applauded – the massive Bush-era expansions in the size and scope of government.  My guess is that these are folks who have completely lost their faith and trust in the ability of government to represent them in their interest.  But, insofar that they lack trust, I don’t think it’s because they are hyper-aware of the government’s various misdoings and moral failings.  Instead, they no longer believe that America has the moral bearings to choose an adequate leader.  To them, Obama is utterly foreign and it defies belief that a majority of Americans could have elected him.  That they did not only signals that the system is broken, but that they are at its absolute mercy.

It’s that, I think, which is the source of the fear, the rancor and the sheer, unvarnished hatred.

*I’ve been looking for a way to use this song as a post title for weeks.

TWO UPDATES, SEE BELOW:

A common refrain I keep hearing for why Wyden-Bennett would have no chance of succeeding if it ever came to a vote is that even though it has bi-partisan co-sponsorship, the Republicans co-sponsoring it are merely using their co-sponsorship as political cover since they know it has no chance of actually passing.  Were Wyden-Bennett to actually come to a vote, they argue, not only would no more Republicans vote for it than have already signed on as co-sponsors, but most of the Republican co-sponsors would actively drop off.  As such, goes the refrain, advocacy of Wyden-Bennett is the surest way to guarantee that there will be no health care reform at all. 

I have two problems with this line of thinking, which largely seems to stem from this Ezra Klein post.  When I first read that post awhile back, I thought it made sense, although I thought Klein was ignoring that any remaining Republican support whatsoever would significantly undercut the power of the Blue Dogs to water down Wyden-Bennett in the way they have watered-down HR 3200. 

My first problem with this line of argumentation is its implicit assumption that HR3200, in whatever form it finally passes, would at least be an improvement over the status quo from the point of view of anyone who actually cares about health care reform.  However, as I’ve pointed out before, there are plenty of reasons to believe that it would not be enough of an improvement over the status quo (and would in fact double-down on the single worst element of our health care system) to justify the huge expenses associated with it, particularly at a time when our national debt is already disturbingly high and accelerating by the minute. 

My second problem is that this line of argumentation goes beyond mere cynicism (which I fully support) to the point of automatically assuming the worst of one’s political enemies regardless of whether there is evidence for that assumption.  [Read more →]