Scott Brown and the critics ctd.
There are many things about Larison’s response to my post on Scott Brown that I agree with and a few things that I find quite puzzling. Larison is correct that Brown’s op-ed lacked any substantive plan to reduce the federal debt or cut spending. He was also right to note that this was an op-ed appearing one week prior to the election. If I had to guess, I imagine a study which sampled all candidate op-ed’s published one week prior to elections would reveal that a very small percentage of them told people things they didn’t want to hear.
That is not exactly an excuse for Brown’s lack of substance or creativity, but it is hardly damning to point to an op-ed which promises tax cuts, opposes future spending, and doesn’t really do much else coming from a Republican. He’s rallying what little base Republicans have in Massachusetts – and trying to define the gap between his policies and Martha Coakley’s.
Brown is, after all, anything but a die-hard conservative. He’s a liberal Republican, as most Massachusetts Republicans are – and have to be in order to have any hope there electorally. Larison claims that Brown wants it both ways on healthcare reform – backing RomneyCare while at the same time opposing the very similar bill in Congress. I don’t know what his motivations are – whether it is pure Romney-esque cynicism or whether it is an expression of federalism, and I wish he’d go into further detail on the matter – but I imagine it is more an expression of federalism than pure politicking. It is hardly inconsistent for a conservative to support local or state programs while opposing big federal programs after all.
Moreover, while Brown may be less than an ideal candidate in many ways, it is hard to fathom how he is anywhere near as bad as his opponent on any of a wide range of issues. Naturally, I would have preferred that he had lifted a few ideas from Bruce Bartlett, who is one of the only voices on the right coming up with substantive fiscal ideas for the coming decade- but this sort of thing is rare even among the best politicians in the days leading up to a vote. The problem may be that there are too many Scott Brown’s and too few Ron Paul’s in the realm of political ideas – too many boilerplate peddlers and too few Bruce Bartlett’s. For every Jeff Flake there are a dozen John Boehners. I’m obviously not thrilled by this, but it’s hardly surprising.
Setting all that aside for a moment, this line puzzled me the most:
Where I think the charge of “Romney-like cynicism” sticks is in Brown’s desire to have it both ways on health care. He voted for MassCare, which means that he endorsed the state’s individual insurance mandate, and now that he is trying to leave town he makes noises about controlling cost, which was something the legislature did not even attempt to address when the bill passed. Controlling cost is something a system with a universal mandate cannot do. [emphasis added]
There are a number of countries which have attained both universal coverage and far better cost-containment than ours which have relied heavily upon the individual mandate. The Netherlands requires its citizens to buy private insurance at a fraction of the cost Americans pay, and uses a system of reinsurance and regulated markets to ensure that costs remain low and everyone remains covered. Without the mandate the system would capsize. Indeed, many health care experts will tell you that without a mandate, cost-containment becomes much more difficult because it allows healthy people to opt-out of the insurance pool until they become sick.
This is one of the more serious flaws with the Senate HCR bill. Its mandate is far too weak, allowing healthy people to pay a trivial fine until they become sick whereupon they can simply purchase insurance from a provider who is legally bound to sell it to them. This sort of weak mandate will do a far worse job at containing costs than a strong mandate. Likewise, excluding illegal immigrants from the mandate and the exchanges will further exacerbate the difficulty at cost-containment, and prolong the very expensive practice of treating patients in emergency rooms rather than at preventative primary care facilities.
Rather than promise to filibuster health reform, I wish Brown would bring some of the experience he has had with Massachusetts reform to the table and work to strengthen the bill. That he will not is my only sticking point against Brown, but it is a very substantial sticking point.