David Brooks Again

I don’t even have to read his columns anymore. I can see how nauseating they will be from the snip of the first paragraph on Memeorandum, as today:

Sometimes life presents you with a basic philosophical choice.  Americans are going to have to confront a giant one over the next several years.  —  It starts in the wonky world of Medicare.  As presently constructed, Medicare is based on an open-ended fee-for-service system.

You know what’s coming next. Let’s just go straight for the take-downs, starting with Jonathan Cohn:

Bureaucrats versus consumers. Government versus the market. If you’ve followed the debate over health care, then you’ve probably heard conservatives use these terms to describe how the Republican vision for Medicare compares to the Democrats’.

David Brooks is the latest. In his Tuesday New York Times column, he explains that “Democrats generally seek to concentrate decision-making and cost-control power in the hands of centralized experts” while “Republicans at their best are skeptical about top-down decision-making.” Brooks then goes on to suggest Democrats probably have it wrong and Republicans probably have it right.
Brooks writes as if the key distinction between Democratic and Republican plans for Medicare is the way they would manage the program, with Democrats entrusting experts to make key decisions about where to spend money and Republicans entrusting consumers. But that’s not the most salient difference between the two approaches. The most salient difference is that Democrats would preserve Medicare’s fundamental guarantee of health benefits at affordable prices. Republicans would not.

Scott Lemieux expands on Cohn:

Bobo engages in his trademark style of argument, focusing on abstractions and ignoring evidence about whether or not markets actually work for a given problem. Cohn does a good job pointing out the problems, and I think the most important one is near the end — the comparison with other countries.   Brooks asserts that “there is no dispositive empirical proof about which method is best.”  But the policies of virtually every other country in the world give us the chance to compare a relatively “free market” in health care to more state-oriented approaches, and the evidence is unambiguous.   The “free market” delivers coverage to many fewer people for more money, and usually far more money.   Although Brooks likes portraying debates between an imaginary ‘Burke” and “Rousseau” while casting himself in the former position, in this case it’s Brooks who’s ignoring all the empirical evidence to cling to his abstract beliefs about the benefits of markets.    And he does this despite the fact that — between the inelasticity of demand, lack of informed consumers, and strong incentives insurers have to deny coverage to vulnerable groups  — there’s no good reason to expect health care markets to work even in theory.

Paul Krugman takes a more indirect approach, since Brooks is his colleague at the Times:

I’ve been getting requests that I respond to my colleague David Brooks’s column today. Actually, I’ll just outsource it. Read Ezra Klein, Jonathan Chait, and Jonathan Cohn. The bottom line is, sorry, the evidence is indeed dispositive: decentralized, “consumer-based” health care is worse, and far more expensive, than universal systems run by the government.

The brilliant James Kwak has a lengthy critique of Brooks on Medicare. I will content myself with quoting an asterisked point at the end, which speaks to a particularly crucial point about the Ryan plan –Ryan’s claim that it’s a premium support, not a voucher, plan:

The difference is who bears the overall risk of health care cost inflation. In a premium support system, you have a market mechanism to promote competition, but you keep beneficiaries whole by making sure that the subsidies, in the aggregate, continue to pay the same proportion of health care costs. In a voucher system, like Ryan’s, you decouple the value of the subsidies from the cost of health care, shifting risk from the government to the individual.

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