Tuesday, November 25, 2008

Health Care

Ezra makes a good point on Obama's appointments: that a lot of them seem tailored to the idea that health care needs to be fixed.

Latest evidence? Peter Orszag at OMB:

Orszag will be coming from the Congressional Budget Office, OMB's legislative cousin. There, he's shown an almost single-minded focus on health care reform. He's added dozens of health care analysts to the staff, reconstructed the health policy division's management structure, and is readying to release two major books on health policy options and CBO's health care scoring models that will be extremely central in how Congress looks at building a health care bill. Amidst all that, he's toured the country giving a slide show about the problems of the health care system, the overwhelming danger it poses to our fiscal condition, the incredible inefficiencies that beset the delivery, and the research that suggests reform could not only save money but also improve care. He's also acted as a powerful and credible counterweight to those who counsel incrementalism, or delay, on health reform. Indeed, when it became common to suggest that the bank bailout should displace ambitious agenda items like health care reform, Orszag took to his blog -- yes, he has a blog, did I mention that? -- to write:

Many observers have noted that addressing the problems in financial markets and the risks to the economy may displace health care reform on the policy agenda...Although it may not seem immediately relevant given our current difficulties, it will be crucial to address the nation’s looming fiscal gap — which is driven primarily by rising health care costs — as the economy eventually recovers from this current downturn. Indeed, our ability to address our current economic difficulties (through both financial market interventions and potential additional fiscal stimulus) would be severely impaired if investors were not so willing to invest substantial sums in Treasury securities without charging much higher interest rates. That willingness reflects the (currently accurate) view among investors that Treasury securities are extremely safe investments.

If we fail to put the nation on a sounder fiscal course over the next few decades, though, we will ultimately reach a point where investors would lose confidence and no longer be as willing to purchase Treasury debt at anything but exorbitant interest rates. If that were to occur, we would lack the kind of maneuvering room that we currently enjoy to address problems in the financial markets and the economy. So if you think the current economic crisis is serious, and it is, imagine what it would be like if we didn’t have the ability to undertake aggressive and innovative policy interventions because creditors were effectively unwilling to lend substantial additional sums to the Federal government…

In other words, one of Obama's top economic advisers will be an economist who has clearly stated that he thinks health care reform central to our fiscal future, who has said that he considers delay or denial a dangerous impulse, and who has proven himself willing to leverage his position and agency to argue that position. That's important, as it assures that there will be voices around Obama arguing that health care is more than simply another item on the lengthy liberal wish list.
Obama talked a lot about eliminating "programs that don't work", which would normally be worrisome. But I did like the example he used: huge subsidies for "millionaire farmers" that make more than $2.5 million a year, which is supposed to be the cutoff for said subsidies.

I also like that Obama out-and-out said "I have a mandate." He didn't say "progressive mandate", and I still think he really, really doesn't understand just how badly the Republicans want to ruin him, and how much it would benefit them if they managed to succeed. Still, it's definitely a positive step.

Edit: On the other hand...

Drop down a tier, as Yochi Dreazen of the Wall Street Journal wrote last week, and you find the Obama transition people using a little known think-tank, the Center for a New American Security (CNSA), as a "top farm team" to stock its national security shelves. The founders of the center are -- don't be shocked now -- former Clinton administration officials providing yet more "centrists" to an administration that seems to believe the essence of "experience" is having been in Washington between 1992 and 2000. CNAS, by the way, is officially against a fixed timeline for withdrawal from Iraq. In that, it seems typical of the coalescing national security team, almost none of whom, so far, opposed the invasion of Iraq (other than the president-elect). Having been anti-war is evidently a sign of inexperience and so a negative.
Bolding mine, and the sentiment expressed is depressingly predictable.

I think we're seeing the shape of things: domestically, there will be real change, since Obama appears hell-bent on getting health care reform done and is facing a crisis that conservative ideology would only make worse. Internationally, though, it feels like a party and electorate that decisively rejected the "foreign policy community" are still having it rammed down their throats. Which is ridiculous, considering how Obama distinguished himself, and is only going to further increase alienation between Americans and "their" official foreign policy.

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