Tuesday, October 30, 2007

Deja Vu: DeLong on Health Care Reform -- and Ira Magaziner

Bred DeLong cannot be on good terms with Ira Magaziner. Today he resurrects a 1997 book review including this paragraph:
Grasping Reality with Both Hands: Brad DeLong's Semi-Daily Journal:

... So those were his two maor flaws: a love of complexity, and the instincts of a consultant--no, three major flaws: his judgment was also very poor. Remember: this is a guy who, without knowing anything about nuclear physics, testifies before congress that America has no choice but to pour lots of money into research into Cold Fusion. This is a man who thinks at the end of the 1970s--a time of record high energy prices and rapidly-growing competition from new producing nations like Brazil and Korea--that what America really needs to do is to invest in more brand-new integrated steel factories. Combine Magaziner's flaws with the sense at the start of 1993 that possibilities were unbounded--that, as one (anonymous) senior White House aide put it, no one in the White House '...was thinking about the fact that Bill Clinton got only 43 percent of the votes. He was on top of the world. He was young, he was good-looking, he gave a good speech. The world was full of hope'--and you have the setting for a policy-planning disaster....
Clinton still hangs with Ira; one hopes he's changed over the years.

What I dimly remember of the Clinton plan, besides a level of media analysis far beyond anything any media corp would tackle today, was that it seemed dishonest.

The plan only made sense (to me) if there were quite a few limits on how money could be spent in the pursuit of "health", and, by implications, limits on what people could choose to do.

This is, of course, always true of any health care service. The main variation among them is whether wealthy people can opt out and take their money with them.

The catch was nobody was allowed to discuss this. We were all to pretend that we'd get universal coverage and nobody would lose anything they had. Even people who had no idea what the plan was smelled something fishy about that ...

PS. For the record, I think we should have no-frills healthcare guaranteed to every US citizen as a birthright. This does mean, however, that the non-wealthy have to wait for expensive stuff to get cheap, which generally takes 2-3 years post release. Those can be long years.

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