Ever so gently, the Obamaphile David Brooks breaks the news to his readers: Democrats’ Medicare mentality is built on denial. He writes:
Some Democrats simply want to do nothing as Medicare careens toward bankruptcy. Last Sunday on “Face the Nation,” for example, Nancy Pelosi said, “I could never support any arrangement that reduced benefits for Medicare.”
Fortunately, more responsible Democrats are looking for ways to save the system. This is where the philosophical issues come in. They involve questions like: Who should make the crucial decisions? Where does wisdom reside?
The best he can say for the Democrats is that those willing to acknowledge a problem with the existing system place unrealistic faith in government bureaucracy with no track record of success:
Democrats tend to be skeptical that dispersed consumers can get enough information to make smart decisions. Health care is phenomenally complicated. Providers have much more information than consumers. Insurance companies are rapacious and are not in the business of optimizing care.
Given these limitations, Democrats generally seek to concentrate decision-making and cost-control power in the hands of centralized experts. Under the Obama health care law, a team of 15 officials will be created to discover best practices and come up with cost-cutting measures. There will also be a Center for Medicare and Medicaid Innovation in Washington to organize medical innovation. Centralized officials will decide how to set national reimbursement rates.
He says the jury is out as to whether the Democrats’ plan or the Republicans’ plan is superior. (Of the latter he says, “Republicans point out that Medicare has tried to control costs centrally for decades with terrible results. They argue that a decentralized process of trial and error will work better, as long as the underlying incentives are right. They suggest replacing the fee-for-service with a premium support system.”)
And he points out that Rep. Paul Ryan’s plan is the sort of approach liberals used to offer. (This is a reversal on liberals’ claim that the individual mandate was originally a conservative idea). But in the end there is no doubt where Brooks stands: “In the age of the Internet and open-source technology, the Democrats are mad to define themselves as the party of top-down centralized planning. Moreover, if 15 Washington-based experts really can save a system as vast as Medicare through a process of top-down control, then this will be the only realm of human endeavor where that sort of engineering actually works.” Ouch.
So could it be that the Democrats are whistling past Medicare’s graveyard, and worse, vilifying the most logical approach to rescuing the entitlement plan? Well, if Brooks thinks so, I guess the Medicare message war isn’t going as well as the liberal punditocracy thinks.
Republicans should take heart: There are non-conservatives who are persuadable by reason and specifics. It would be best if they found someone entirely familiar with the facts, calm in his delivery and earnest in his approach to lead their party on this monumentally important issue. Gosh, do we know anyone who fits that bill?