The Healthcare Two-Step

| Mon Jun. 15, 2009 12:05 PM EDT

Ezra Klein says that Tyler Cowen has a point when he argues that we're running the risk of enacting a healthcare bill without effective cost controls:

But it is baffling to watch him blame this on the Obama administration. As he himself says, the White House is firmly behind the most promising proposals on cost....What stands in the White House's way is Congress. And, more often than not, it's the Republicans in Congress. Liberals, after all, will sacrifice almost anything to radically expand coverage. This leaves cost-conscious conservative facing a bit of a dilemma. They can attack the most vulnerable parts of the policy — the cost controls — in the hopes of bringing the whole thing down. The downside to that, of course, is that liberals simply jettison cost-controls to protect the coverage expansion. For a fiscal conservative, this should be considered the worst of all worlds.

I don't know about Tyler specifically, but this is par for the course for conservatives in general, who basically have two critiques of national healthcare plans.  First, they yell and scream that we're busting the budget if cost controls aren't firm enough.  At this rate, healthcare will be 99% of the federal budget by 2050!  But then, if you concede the point, they yell and scream that your cost controls are rationing medical care.  Do you want to stand in line for months just to get a flu shot, the way they do in all those European hellholes!?

Conservatives can bounce back and forth between these mutually hypocritical positions pretty much forever.  Why?  Because they're effective.  The first makes earnest liberals feel guilty because we basically agree as a policy matter.  The second is the greatest public argument against national healthcare ever invented, regardless of whether or not it's actually true.  The combination of the two has won the day for conservatives for decades.  Why give up a winning strategy now?

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