The DLC and the Medicare Drug Plan
Folks interested in the TNR-DLC-blog wars should check out Ed Kilgore's rundown of where the DLC concurs with and where it dissents from the list of policies Atrios thinks the blogosphere basically supports. Mostly, things stack up as you'd expect, with the DLC and the blogosphere concurring on near everything. The divisions, however, are surprising.
Where Atrios thinks bloggers agree that Medicare should run the Medicare drug program, Kilgore dissents that the DLC "opposed the current plan, but [we] think the problem is cost and complexity, not the basic idea of offering choice and competition, a la the federal employees' plan." Of course, cost and complexity are absolutely intrinsic to the primacy of private insurers (and I'm sorry to see Kilgore buying into the GOP spin that terms privatization "cost and competition."). So far as I know, none seriously dissent from the belief that Medicare pays more than the VA, Canada, Britain, France, or any other socialized system because it's barred from using its market power to negotiate. The current king of the free market, Wal-Mart, dominates on cost and crushes the competition by throwing their weight around, and it's schizophrenic to value the free market but bar Medicare from adapting the tactics most successful within market rules.
This is, of course, what frustrates liberals about the DLC. There's no coherent policy reason to support a Medicare Part D style structure. Even if they oppose the current arrangement, protesting that they believe choice and competition should remain ascendant essentially confines them to very similar programs. That makes for bad policy. It also relies on a willful decision to ignore all evidence from all examples of contrary systems that achieve better results. From the tiny Veteran's Administration to the majority of developed countries, denying the superiority of centralized bargaining for pharmaceuticals requires slapping your hands across your ears and "la-la-la"ing till the other discussants put away the uncomfortable facts. Indeed, while I'd be interested to see a policy defense on this count from Kilgore, my sneaking suspicion is that it's an example of the DLC's fetish for opposing anything that smacks of traditional liberalism. And, in the end, no matter how many points of agreement we all have, it's hard to be allied with a group deeply committed to discrediting the proposals of mainline progressives.















One of the central tenets of the DLC is that dogmatic liberal ideology results in neither sound public politics or smart politics. At its best, this results in a creative pragmatic approach to policy problems. The DLC is able to split the difference between the market fundamentalist proposals of the right and the overly centralized policies of old-school liberalism. (For an example where this works well, look to the DLC's market-based incentives approach to environmental policy.)
The problem with health care policy however, is that a purely pragmatic analysis results in a conclusion that old-school liberalism is right. Given the perverse incentives that the market provides to insurers, a single-payer system is a much more a efficient way of providing health insurance than anything the free market or a hybrid system can come up with. The DLC, however, cannot embrace single payer because it conflicts with their own dogma that old-school liberalism has to be at least somewhat wrong. Which given the fact that the DLC was started to free the Democratic party from dogma, is itself quite ironic.
May 10, 2006 2:08 PM | Reply | Permalink
If I had a piechart showing carved up to show why I left the Democratic Party, the DLC would be one whole side of the pie plus a slice of the other side.
The freedom to negotiate with drug companies -- and all other "providers" -- is non-negotiable!
May 10, 2006 2:49 PM | Reply | Permalink
There is also the issue of credibility. The list Kilgore gives indicates he and Wittman opposed the bankruptcy bill. But it was DLC acolytes in the Congress who supported it. The comment by Atrios was to UNDO the bankruptcy bill; not who supported it initially. I think we can gather from the Kilgore obfuscation that the DLC does NOT support UNDOing it. I have not heard in all of this where the DLC stands concerning foreign policy, its support for internatiomal institutions, its opposition (ho, ho) to a military solution on Iran, the prompt withdrawal of US troops from Iraq, and movement away from neo-colonialist Bush/DLC policies .
May 10, 2006 3:54 PM | Reply | Permalink
Well, here is the DLC Wittman Moose for you. (And Ed has returned to the mega-security theme today too.) I fear if you are one of us sorry liberal types who retain considerable passion for health care and the poor (18,000 Americans die every year due to inadequate access to health care) and you still retain the idea that war kills people on purpose you are apparently stealing American tax money from another agenda.
May 10, 2006 5:46 PM | Reply | Permalink
What on earth does Wittman's dismissal of Iranian propaganda have to do with Ezra's point regarding the DLC's position on heatlh care? There are plenty of forums on this site devoted to bashing the DLC's position on national security - it would be nice to stay vaguely on topic for a change.
May 10, 2006 6:05 PM | Reply | Permalink
The intersecting demand and supply curves that represent the delivery of medical care boggle the mind. Kilgore is not wrong to say cost and competition have a place in the medical market;however, he and others fail to acknowledge that one of the biggest inefficiencies that afflicts competitive markets is demand inducement.
Drug companies induce demand with every single ad they run in all media. Doctors induce demand with all the follow-up visits. Hospitals induce demand by building new facilities and adding beds. Outpatient surgicenters and endoscopy centers induce demand. Most of all, our culture medicalizes every ache and pain and codifies them with "new" diagnoses. The media at large rush to print or air "new" research that trumpets something new to worry about.
All the while, health insurance companies rake in the dollars by raising premiums to employers who write off the costs of both premiums and self insurance as operating expenses and charging insureds in the individual market outrageous prices.
And we wonder why we're spending so much money on prescription drugs not to mention medical care?
May 11, 2006 4:25 AM | Reply | Permalink
Crissie's point on induced demand is absolutely crucial and rarely mentioned.
Medicare is extremely efficient at paying bills. They do very little to actually impact demand for health care services- i.e. manage care. Private insurance companies, for all their negatives, have at least tried a number of different methods for accomplishing this.
Regardless of the public/private sector nature of our future health care system- someone has to moderate demand.
May 18, 2006 10:58 AM | Reply | Permalink