SUBSCRIBE NOW WELCOME BACK. Do you want to continue reading where you left off? New Republic subscribers can pick up where they left off no matter which device they were previously using. SUBSCRIBE NOW

Go Home David Brooks Has a Health Care Idea!

POLITICS FEBRUARY 26, 2013

David Brooks Has a Health Care Idea! The conservative reform that wouldn't screw the poor

David Brooks is nothing if not gracious. On Friday, the bespectacled and occasionally besieged New York Times columnist had a tantrum, or what qualifies for a tantrum by his mild-mannered standards. He did so by criticizing President Obama for failing to provide leadership in the debate over the sequester and fiscal priorities. High on the list of Obama's alleged sins was a supposed failure to offer substantial cuts to entitlements, particularly Medicare.

Within a few hours, every blogger with a grasp of policy and access to a laptop had pointed out the error: Obama has offered several key concessions, including a few that Brooks himself had endorsed. Brooks quickly appended a correction to the online version of his column and then, Tuesday, started his new column by saying that last week's was "unfair." "The White House approach is not what I would like, but it is more balanced than I described," he wrote. That's the kind of humility we see too rarely in writing about policy.

Brooks also used his column to talk up some new ideas, among them a Medicare proposal that comes from Yuval Levin, a conservative writer who is editor of National Affairs and a fellow at the Ethics and Public Policy Center. The idea, which Levin first unveiled in New York Times op-ed earlier in February, is to raise the eligibility age for Medicare—but in a different, relatively novel way.

Past proposals, like the one Republican leaders have endorsed, called for gradually raising the age at which all seniors can enroll in Medicare. Critics pointed out some problems with this scheme—among them, the fact that many seniors desperately need the financial protection of government-provided insurance, because they have so little money or, in the worst of cases, have no job at all. Levin would address this problem by adjusting the eligibility age based on wealth, so that wealthier seniors had to wait longer to enroll in the government program but less wealthy seniors did not. Levin is still working out the specifics, but he tells me, via e-mail, that this scheme would probably save the federal government a lot of money—maybe not $125 billion over ten years, as the previous proposals would have yielded, but a big chunk of that. At the same time, he says, it would protect lower-income seniors.

Based on Levin's description, the plan would not attract a lot of support from liberals. And that's because of a basic difference in worldview. Conservatives (like Levin) want to reduce the number of people on government-run insurance: They believe it will decrease not just government health care spending but society's overall spending on health care, while minimizing interference with the free market. Liberals (like me) think more government spending on health care is just fine, as long as we pay for it, because programs like Medicare are actually more secure and more efficient. Shrinking the Medicare rolls, we believe, merely shifts the burden of health care spending onto employers and individual seniors—who, if anything, are less able to bear that burden than society as a whole. But this is precisely the sort of serious, honest debate that we should be having—the kind that's been largely absent from the political dialogue in Washington.

And who's to blame for that? It’s not hard to imagine Obama endorsing a scheme like Levin's, since, during the 2011 debate over fiscal policy and then briefly during the 2012 sequel, Obama was willing to embrace the earlier, more conservative version of the eligibility age increase.1 This horrified many liberals, and not for the first time, but that's precisely the point: Obama has repeatedly shown a willingness to alienate his base and make concessions, if that is what it takes to make a deal with the other party. Republicans have not shown a similar willingness—not then, in the debate over the debt ceiling and Bush tax cuts; not now, in the debate over the sequester cuts. And the pundits, from Joe Scarborough to Ron Fournier, refuse to recognize that intransigence for the obstacle that it is.2

More conservative pundits, like Brooks, are the ones who might actually have some influence on the right—if not directly on Republican party leadership, then indirectly through their audience in the business, legal, and media establishments. But that won't happen if they don't speak more loudly. Brooks's civility is a virtue I genuinely admire, but this would be a good time for him to get mad.

SHARE YOUR THOUGHTS

Show all 8 comments

You must be a subscriber to post comments. Subscribe today.

8 comments

Adjust co-pays based on income not eligibility. Higher income seniors who are eligible for Medicare are much more likely to empathize and identify with lower income seniors who are eligible for Medicare, even if the higher income seniors have to pay more. What Brooks and like-minded people want to do is break the bond between higher income seniors and lower income seniors so the former are more likely to break from the lower income counterparts and oppose Medicare. They aren't as interested in "saving" Medicare as in ending it.

- rayward

February 26, 2013 at 4:52pm

You must be a subscriber to post comments. Subscribe today.

I would like to know why the prescription drug benefit to the drug companies is not talked about, speaking of a known obvious way to save federal tax dollars.

- Nusholtz

February 26, 2013 at 8:53pm

You must be a subscriber to post comments. Subscribe today.

From the article: "More conservative pundits, like Brooks, are the ones who might actually have some influence on the right—if not directly on Republican party leadership" Most right leaning folks consider Brooks a joke. He's another McCain: A milquetoast RINO that the left loves to hold up as someone that is somewhat reasonable on many issues. Please don't use Brooks as an example of right leaning thinking.

- seattleeng

February 27, 2013 at 11:22am

You must be a subscriber to post comments. Subscribe today.

Amusing coming from Brooks, because means-testing the benefits is a de facto upper income tax increase, although a relatively inefficient way to go about it. Are we to believe that the Republicans would ever allow such a thing?

- roidubouloi

February 27, 2013 at 11:25am

You must be a subscriber to post comments. Subscribe today.

Per seattle, above, Brooks has the same problem as Romney. He tries, tries, tries to pander to the insane right, but also wants not to be dismissed as a joke by sane. An impossible situation. He will never get any lovin' on the right. But his cornball almost always ill-informed policy proposals (if one can dignify his usually vapid whining as such) have nothing to commend them to anyone who is not a self-styled "independent," which generally means a head as empty as Brooks'. The poor thing.

- roidubouloi

February 27, 2013 at 12:58pm

You must be a subscriber to post comments. Subscribe today.

Controlling costs is not difficult. In Canada, we do that all the time without affecting the coverage (in person terms) of the program. We just cut payments to doctors. The same goes for drug benefits. Provinces are getting together to use their buying power to reduce drug costs. In the US, it is an article of faith that physicians and insurance companies and drug manufacturers should not be affected at all by national health policy. That's just absurd.

- icarusr

February 27, 2013 at 1:14pm

You must be a subscriber to post comments. Subscribe today.

By Brooks' own admission, he has gotten mad, but the problem is that he keeps directing his anger at the wrong people. Contra-Seattle, please feel free to use Brooks as an example of right-leaning thinking. The people Seattle has in mind aren't 'right-leaning', they are standing straight-up in deep right field.

- Fishpeddler

February 27, 2013 at 1:16pm

You must be a subscriber to post comments. Subscribe today.

Rayward, I agree that conservatives true goal is to end Medicare. However, I'd like to see income-based eligibility because ti will finally give to the lie that the market can (and wants to) provide affordable medical insurance to the n risk pool that seniors present. When the press starts reporting that seniors with six-figure incomes and 7-8 figure assets are sent into the poorhouse because of medical expenses (non-catastrophic at that) most Americans may finally take their heads out of their asses and demand we reform our system that at the very least borrow the best ideas from (sacre bleu!) European countries (e.g., Germany, Denmark, Sweden, Switzerland) and Japan. (nd yes, I've noticed the absurdity--and violation of insurance 101--of pooling all seniors in a pool. One should think that anyone with even a tenuous grasp of risk management concludes that we need some sort of universal system.

- tec619

February 27, 2013 at 11:13pm

You must be a subscriber to post comments. Subscribe today.

1

Obama eventually abandoned the idea. And while politics surely played a role—many Democrats hate the idea, it doesn't poll well—policy also did. His advisers concluded, rightly in my view, that raising the eligibility age shifted costs to the elderly rather than reducing spending overall.

2

Among those writing about this problem today are Greg Sargent and Josh Marshall

SHARE HIGHLIGHT

0 CHARACTERS SELECTED

TWEET THIS

POST TO TUMBLR

SHARE ON FACEBOOK

Close