It’s been fascinating watching the scales fall from David Brooks’s eyes. Once an ardent booster of the president, he now gives voice to the segment of moderate voters who were lulled into believing President Obama was something other than what he turned out to be, a liberal statist. As he (and they) rub the sleep from their eyes, we see Obama’s 2008 facade of moderation crumble and the disassembling of a center-left coalition that carried him into office.
In looking at the president’s most cherished accomplishment, Brooks winds up where some conservatives have found themselves for some time, namely wary that there are grave infirmities in Obamacare beyond the individual mandate. Brooks writes:
First, while government has always had the power to regulate contracts and business activity, Obamacare compels people to enter into activity so that it can regulate them. This new ability to compel activity opens up vast new powers.
Second, Obamacare centralizes Medicare decisions — and the power of life and death — within an unelected Independent Payment Advisory Board. Fifteen experts are charged with controlling costs of from the top down.
Third, Obamacare would continue the centralization of the nation’s resources — absorbing an estimated $1.76 trillion over the next 10 years.
It is this aggregation of power that Brooks finds alarming: “I think the Obama administration made a disastrous error in centralizing so many of the cost-control elements of the new health care system. I don’t care how many comparative effectiveness research studies they commission, there is no way centralized dirigistes can keep up with a complex, innovative system. There is no way government can adapt quickly to failure.” That’s principally the IPAB he is talking about, and he is correct.
His conclusion is, dare I say, a bit Mitt Romney-like. Yes, try to expand coverage, but leave it up to states and individuals to work on “the means to get people there.”
This has not been well articulated by Romney, who has been playing defense. But Brooks makes the critical point that Romney must hammer home: A central reason why Obamacare is noxious from a policy standpoint is that it does centralize, dominate and occupy the field, scooping up private resources and crowding out both medical and policy innovation. It’s far worse than one state previewing one exceptionally disagreeable aspect of the bill (the individual mandate).
Over the past few weeks we’ve argued for a more well-rounded debate on more than just the individual mandate. The reason is a practical one: Whether the Supreme Court leaves these centralizing features undisturbed (leaving only a legislative avenue for repeal) or not (still leaving open the issue of what sort of health care system we want), there must be a political debate. That debate centers on whether we really want so many resources and decisions to be placed at the level of government — in fact, in a newly created specifically undemocratically constituted rationing board — farthest from the people and least amenable to reform?
This is indeed part of the larger argument that both Romney and Rep. Paul Ryan(R-Wis.) have been making. The question as to what kind of government we want and how much dependency on the federal government we should foster is at the heart of the Obamacare debate, but also the arguments about the debt, taxes, regulation and the division between public and private action. No one can say this election isn’t about important issues.