Centralizing Power

     In his column in the New York Times on March 26, David Brooks (Philadelphia Main Line born and bred), in his usual way, managed to split the difference between liberals and conservatives.  Ascribing to himself a Hamiltonian view of government, he allowed for the constitutionality of the mandate for purchasing health care, but felt that the administration of the provision of health care dangerously centralized governmental power.  That may sound “moderate,” nevertheless it furthers the current conservative agenda, which is to sow distrust in government.

Brooks makes four arguments:  [My reactions are in brackets]

a)   “Obamacare” forces people into economic activity in order to regulate them.  As a result the government takes on new powers. [ It is not clear why this is so different than Social Security, where everyone is forced to pay into a trust fund, which can be drawn upon after age 65.  Everybody who is employed is forced to allow a percentage reduction from his/her paycheck. Sure it expands government, but it beats starving in your old age.]

b)   “Obamacare” centralizes cost control Medicare decisions in an Independent Payment Advisory Board.  [Brooks notes they are “unelected.”  One wonders which advisory-regulatory boards Brooks would have elected.  The Federal Reserve Board?  The National Transportation Safety Board?]

c)   “Obamacare” continues the centralization of the nation’s resources.  [Not so different than Bush, who added to centralization of healthcare with the addition of prescription drug coverage to health insurance.  Republicans always worry over costs of government, except when they do it. They worry about centralization of government but never about mega-centralization of global business, which undermines governments.]

d)  And, finally, “it would effectively make health care a political responsibility.”  [Well, now we get to the nub of the matter.  That’s the whole point.  The expansion of “coverage” has already occurred, with all the people who cannot afford, or simply do not buy, health insurance using hospital emergency rooms when they get sick.  Hospitals are “mandated” to treat everyone who turns up in an emergency room.  So health care is already a “political responsibility;” we have just shunted occasional basic care to hospitals.]

Brooks agrees with the final point.  So, the individual mandate is acceptable.  But Brooks feels it is an error to centralize the cost control elements.  “…the decentralized premium support model is a better way to control costs: government insists everybody has coverage but then encourages companies, families and Medicare beneficiaries to engage in a regulated process of discovery to find the best care at the lowest cost.”  Well, perhaps companies have the resources to engage in a process of discovery.  Does anybody know of any family or any Medicare beneficiary who actually went through a satisfying “process of discovery” that left them satisfied that they found the best medical care at the lowest cost?  Most people encounter medical care with their first jobs.  The choice is pre-packaged.  Most people stick with modifications of their early medical care insurance.  Job losses, job changes, family growth, divorces, and the like fashion the “market” for health care, not an open process of discovery by individuals who happen to be shopping for a service.

Hamilton is not the best guide.  Here, Obama is.