Thursday, February 26, 2009
At the brink of global ruin, many Americans suddenly seem willing to consider sensible ideas that were always deemed unthinkable, and to reject foolish notions that were once deemed brilliant. Soon we may be mature enough to observe how other developed countries address problems that have baffled us for generations.
Nationalizing major banks, temporarily at least, is a radical notion that today looks far more prudent than handing over hundreds of billions of additional dollars to the clowns and crooks who wrecked the financial system. Privatizing Social Security, which meant turning over another trillion dollars to the Wall Street geniuses whose reckless greed drove us into penury, no longer appears so alluring. Even a few repentant right-wingers -- notably including Alan Greenspan, the former "maestro" of money -- now gaze dolefully into the mirror and wonder where they went so wrong. (Here's a hint: The trouble began during those lonely evenings spent perusing the addled works of Ayn Rand.)
So as President Obama convened his "fiscal responsibility summit" and then delivered his first address to Congress, the voices of free-market fundamentalism were muted in Washington, if not on cable television. The anticipated onslaught against Social Security from those claiming to represent future generations did not materialize at the Obama summit -- and neither did the presidential capitulation that liberals had feared. Instead, the White House wonks insisted on discussing the actual threat to America's future solvency, namely the swelling price of health care for the retiring generation of baby boomers and its effect on Medicare and Medicaid.
The problem with these programs, which have done so much to improve the health of America's poor and elderly, is neither the size of the boomer cohort nor even their impending geezerhood. The problem is the rate of cost increase per beneficiary, according to a landmark study released two years ago by the Center on Budget and Policy Priorities (and described with admirable clarity by Ezra Klein on the American Prospect website on Feb. 23).
Respected across the political spectrum for the accuracy and relevance of its data, that liberal think tank happens to be the former professional home of Peter Orszag, the Obama administration's budget director. The center's insights into federal spending will inform policy at the highest level -- which means that reforming the way we finance and deliver medicine will be central to this government's fiscal planning. Although there are many other matters that must be addressed if we are ever to regain control of deficits when economic growth resumes -- from the abuse of tax shelters by the super-rich to the absurd rip-offs by military contractors -- the biggest money is in the health sector.
But how can we cope with rising costs when we have yet to achieve the basic national goal of providing universal coverage? Perhaps now Americans will look abroad and notice that other countries provide quality care to all of their citizens, spending less than half what we do and achieving better outcomes.
In the coming decades, countries in Europe, as well as Canada and Japan, will be able to invest their resources in energy and education, while we try to figure out how to borrow enough to keep our hospitals open. What they all have in common is that they do not devote a huge proportion of their health spending to the profits of insurance companies -- and they negotiate budgets with health providers, such as pharmaceutical companies.
The superior performance of these alternatives is at long last coming to the attention of the mainstream media, which has so long ignored it.
As always, Congress will resist change on behalf of the insurance and pharmaceutical lobbies, preferring to do nothing. But perhaps in the coming years, the public will realize that such feckless politicians should be told to go do nothing somewhere else.
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