Can The Two Party System Come To An End?

The two party system is seriously broken when we were given a choice as terrible as Donald Trump or Hillary Clinton for president. More people voted for third  parties in 2017 than in other recent elections which lacked a big name candidate, but others see third party voting as futile. It is a sign that the two party system might be due to collapse when an establishment writer such as David Brooks writes a column about The End of the Two-Party System.

While I don’t entirely accept his rational for this, it is clear that both parties are divided. True conservatives don’t fit into a party led by Donald Trump. True liberals and progressives, including many supporters of Bernie Sanders, don’t fit into a party led by an authoritarian right warmonger like Hillary Clinton, or a party which consider her fit for its nomination. Brooks concluded his column writing:

Eventually, conservatives will realize: If we want to preserve conservatism, we can’t be in the same party as the clan warriors. Liberals will realize: If we want to preserve liberalism, we can’t be in the same party as the clan warriors.

Eventually, those who cherish the democratic way of life will realize they have to make a much more radical break than any they ever imagined. When this realization dawns the realignment begins. Even with all the structural barriers, we could end up with a European-style multiparty system.

The scarcity mentality is eventually incompatible with the philosophies that have come down through the centuries. Decent liberals and conservatives will eventually decide they need to break from it structurally. They will realize it’s time to start something new.

We do need something new, regardless of whether it is for the reasons which Brooks discussed.

There are structural barriers as Brooks noted. Earlier this month The New Republic looked at Why America Is Stuck With Only Two Parties:

It wasn’t always like this. There was a time in American politics when it was relatively easy to jump-start a new political party and get it into the mainstream. That was how the Republican Party—the only third party in American history to become a major party—displaced the Whigs (along with several smaller parties) between 1854, when it was founded, and 1860, when it propelled Abraham Lincoln to the presidency.

It took three things to create a party back then: people, money, and ballots. Parties were responsible not only for recruiting and nominating candidates for office, but they also printed and distributed their own ballots (typically with the help of partisan newspaper publishers). Thus, there were very few barriers to entry: Candidates didn’t have to petition to appear on a ballot, and new parties were free to endorse candidates from the more major parties, so their nominees ran less risk of being labeled spoilers. Essentially, parties could contest for power just as soon as they had backers and supporters. This was what happened to the Liberty and Free Soil parties in the nineteenth century: Starting in the mid-1840s, as the two dominant parties—the Whigs and Democrats—hewed to the pro-slavery forces in their ranks, these new formations sprouted quickly and began gathering anti-slavery advocates.

In 1848, Free Soil nominated former President Martin van Buren after the Whigs supported slave owner Zachary Taylor for president, and got 10 percent of the national vote. Crucially, they were able to do this after the Whig convention that summer because there were no legal obstacles to getting him on the ballot. Six years later, in July 1854, the Republican Party held its first convention and swept the Michigan statehouse and executive branch that very same year. By 1856, its presidential candidate John Fremont won a third of the popular vote and 114 electoral votes.

That’s no longer possible: Today, third parties can’t mount their own presidential bids after they learn whom the two major parties have nominated—there simply isn’t enough time between the end of primary season and the general election to gain meaningful ballot access in enough states to win an Electoral College victory. Evan McMullin, the former CIA operative who ran for President in 2016 as an anti-Trump alternative to Hillary Clinton, was only able to get on the ballot in 11 states because he entered the race so late. It would’ve been easier in the 1800s: McMullin wouldn’t have had to collect millions of petition signatures and hire expensive lawyers to get on the ballot.

The article went on to how the two major parties use ballot access to make it difficult for third parties to compete. The two major parties also conspire to prevent competition in other ways, including restricting access to the debates. While true that these are major obstacles, knowledge of how the major parties maintain their monopoly also presents strategies to work at to achieve change.

Ultimately bigger changes such as rank order voting would be helpful. This would enable voters to choose more than one candidate, with their vote transferring to their second choice if their first choice is eliminated. The idea is to allow people to vote for a third party without feeling like they are wasting their vote. Voters might vote for a Green Party candidate first, and then have their vote go to the Democrat next. This pattern might often be seen, but in  2016 I probably would have voted for Jill Stein and then Gary Johnson, only voting for candidates opposed to our pattern of perpetual warfare. It is also hoped that with ranked order voting more people would vote third party, leading to better third party candidates, with them ultimately being able to win.

There are no doubt major obstacles to third parties actually challenging the major parties. It is debatable as to whether this is a better or worse strategy than to try to reform the major parties, but the two strategies are not mutually exclusive. Despite the major obstacles, we are closer to changing the system than at many times in the past. Dissatisfaction with the major parties is at a new high, with many young voters having no affiliation with either. The internet changes the rules, both for fund raising and campaigning, reducing traditional needs for the old party structures. The internet has the potential to alter politics as it has altered a lot of commercial activity.

Even if a third party does not become a major party, third parties have historically had their value in influencing the major parties, which desire their votes. Seeing the loss of votes to a third party could keep the Democrats from continuing to move to the right. On the other hand, people practicing lesser-evilism voting it makes it easier for the major parties to continue on their current path–which led to a choice as terrible as Trump v. Clinton.

Late Night Comics On The Trump Press Conference

After yesterday’s bizarre press conference from Donald Trump, which has me now wondering if Trump has gotten to the talking to pictures on the White House walls stage yet, it was inevitable that the late night comics would concentrate on it. It would have been comedic malpractice if they had not. Here are the highlights:

Stephen Colbert changed his monologue to cover the press conference for obvious reasons.

Jimmy Kimmel played the highlights.

Seth Meyers took A Closer Look.

Jimmy Fallon gave his impression of the press conference for his cold open.

James Corden gave his break down of what occurred.

Or perhaps the funniest commentary of all comes from the right wing which took Trump seriously. For example, Michael Goodwin wrote, Sorry, media — this press conference played very differently with Trump’s supporters. 

The president proved once again that he is the greatest show on Earth. Lions and tigers and elephants are kid stuff next to his high wire act.

Next time, the White House ought to sell popcorn.

Amid feverish reports of chaos on his team and with Democrats fantasizing that Russia-gate is another Watergate, Trump took center stage to declare that reports of his demise are just more fake news…

He did it his way. Certainly no other president, and few politicians at any level in any time, would dare put on a show like that.

In front of cameras, and using the assembled press corps as props, he conducted a televised revival meeting to remind his supporters that he is still the man they elected. Ticking off a lengthy list of executive orders and other actions he has taken, he displayed serious fealty to his campaign promises.

Or there is the laughable claim from Rush LimbaughTrump Triumphs Over Press.

To be fair to conservatives, many do see through Trump. For example, David Brooks wrote, What a Failed Trump Administration Looks Like. He began:

I still have trouble seeing how the Trump administration survives a full term. Judging by his Thursday press conference, President Trump’s mental state is like a train that long ago left freewheeling and iconoclastic, has raced through indulgent, chaotic and unnerving, and is now careening past unhinged, unmoored and unglued…

Democrats Cannot Handle GOP Rigidity & Extremism–This Time on Taxes

For the Republicans it is all or nothing on taxes. Either they get an extension of the Bush tax breaks on income over $250,000 per year or they will not support a continuation of the Democratic-supported tax breaks on income under $250,000 per year. As DougJ points out, the Republicans are engaging in Soviet style negotiations. (I’ve often pointed out other comparisons between the authoritarian right and the old USSR here). Steve Benen points out how it is impossible to compromise with these guys.

Even many people who generally support the Republican Party, but who are not totally bat-shit crazy, see the problem. For example, David Brooks recently said:

And my problem with the Republican Party right now, including Paul [Ryan], is that if you offered them 80-20, they say no. If you offered them 90-10, they’d say no. If you offered them 99-1 they’d say no. And that’s because we’ve substituted governance for brokerism, for rigidity that Ronald Reagan didn’t have.

And to me, this rigidity comes from this polarizing world view that they’re a bunch of socialists over there. You know, again, I’ve spent a lot of time with the president. I’ve spent a lot of time with the people around him. They’re liberals! … But they’re not idiots. And they’re not Europeans, and they don’t want to be a European welfare state. … It’s American liberalism, and it’s not inflexible.

All true except Brooks left out the fact that Republicans are likely to even reject a Democratic bill which gives them 100 percent of what they initially asked for because their real goal is to deny the Democrats any political victories. If offered everything they wanted they would just change the goal posts and attack their initial position. We’ve seen this with many elements of health care reform with Republicans initially supporting measures such as mandates, an insurance exchange, and end of life counseling, but then attacking the same ideas when in a Democratic bill.

It is unfortunate that, while far better on public policy, the Democrats are out of their league in the spin wars. If the Democrats could compete with the Republicans here, we’d be hearing endless attacks not only of the inflexibility of the other side but of how the Republicans are denying the middle class tax cuts. Of course the Democrats are also the party which gave the vast majority of Americans a tax cut and have been powerless to stop the mindless zombies in the tea party movement from protesting against them for over-taxing them. They are also the party which saved the automobile industry and lost Michigan to the Republicans.

There are two general reasons for this. One is simply that the Democrats are not as good as Republicans when it gets to political argument and propaganda. Secondly,  Democrats do not have a friendly news media in their pocket as the Republicans have. Despite GOP attempts to play the refs by complaining of non-existent liberal bias, the media disproportionally leans to the right. Republicans can spread their talking points by initially feeding them to their house organ (F0x) from where they are picked up by the conservative-leaning legitimate news media. In contrast, what there is of left-leaning news media is independent and is not about to blindly repeat the Democratic talking points.

David Brooks Almost Becomes A Democrat

David Brooks says he was a liberal Democrat when he was younger, and I think that deep down he wants to be one now but something is holding him back. In today’s column he briefly pretends to be a Democrat again and likes some of what he sees:

I feel beleaguered because the political winds are blowing so ferociously against “my” party. But I feel satisfied because the Democrats have overseen a bunch of programs that, while unappreciated now, are probably going to do a lot of good in the long run.

For example, everybody now hates the bank bailouts and the stress tests. But, the fact is, these are some of the most successful programs in recent memory. They stabilized the financial system without costing much money. The auto bailout was criticized at the time, but it’s looking pretty good now that General Motors is recovering.

He found more to like about how Barack Obama is governing:

What can my party do to avoid the big government tag that always leads to catastrophe? Then I remember President Obama’s vow to move us beyond the stale old debates. Maybe he couldn’t really do that in the first phase of his presidency when he was busy responding to the economic crisis, but perhaps he can do it now in the second phase.

It occurs to me that the Obama administration has done a number of (widely neglected) things that scramble the conventional categories and that are good policy besides. The administration has championed some potentially revolutionary education reforms. It has significantly increased investments in basic research. It has promoted energy innovation and helped entrepreneurs find new battery technologies. It has invested in infrastructure — not only roads and bridges, but also information-age infrastructure like the broadband spectrum.

These accomplishments aren’t big government versus small government; they’re using government to help set a context for private sector risk-taking and community initiative. They cut through the culture war that is now brewing between the Obama administration and the business community. They also address the core anxiety now afflicting the public. It’s not only short-term unemployment that bothers people. What really scares people is the sense that we’re frittering away our wealth. Americans fear we’re a nation in decline

Brooks unfortunately took what could have been one of his best columns in a long time and ruined it by thinking in terms of right wing talking points. His fear when acting as if he was a Democrat became: “What can my party do to avoid the big government tag that always leads to catastrophe?” His hope:

Eventually, I see a party breaking out of old stereotypes, appealing to entrepreneurs and suburbanites again, and I start feeling good about the future. Then I take off the magic green jacket and return to my old center-right self. A chill sweeps over me: Gosh, what if the Democrats really did change in that way?

Brooks managed in the same column to show the benefits of Obama’s economic plans while also fearing they will tagged as big government. He worried about having “the same old tax debate” while ignoring the fact that Obama included some of the biggest tax cuts in history in his stimulus package.

The difference between the parties is that the Democrats are trying to solve today’s problems, even if not always in the right way, while Republicans have taken an extremist and inflexible position. They say no to virtually everything, and would never think of joining Brooks in finding things to praise in some of Obama’s policies.

Republicans certainly would not echo Brooks and admit that the differences generally are not big government versus small government. It was clear to most people, even if not David Brooks, that in 2008 the Democrats were the party which was “breaking out of old stereotypes, appealing to entrepreneurs and suburbanites again.”

Republicans will label the Democrats as the big government party, regardless of whether it is true. Never mind how much government grew under the Republicans, or that it is Republican policies which wind up infringing upon the rights of individuals far more than those of Democrats. Even the major “big government” program passed by the Democrats, health care reform, is made up of ideas initially proposed by Republicans.

If David Brooks wants to move beyond stereotypes and really wants to pursue pragmatic solutions to today’s problems there really is only one choice among the major political parties. If he could overcome his biases he would even realize that even for someone who calls himself center-right, at present the positions of the  Democrats are far closer to the views of any sane people than the extremism which now dominates the Republican Party.

Embracing One’s Meandering Cat

I initially wasn’t going to bother responding to David Brooks‘ column today–until I read Pete Abel’s response. Brooks, perhaps thinking being a New York Times columnist gives him the authority,  presumes to understand the thoughts of all independents.  In the end he uses what he claims to be the views of independents to justify calling on the Democratic Party to do what he believes should be done.

One problem with the column is in discussing independents as a cohesive block of voters. I’ve already discussed the vast differences between independents in previous posts, such as here. There is no single position held by independents.

Abel cites a line from the column before proceeding to debunk Brooks’ premise. The line of interest, and the primary reason why I’m actually writing this post, is “Independents are herds of cats who find out what they think through a meandering process of discovery.” This leads to Pete Abel’s conclusion:

I shouldn’t tell Brooks how to write his column. Hell, he’s paid to write it, and I’m writing for nothing. Still … in floating test arguments for conservatives, Brooks’ seems to forget his meandering-cats metaphor and the import of that metaphor, namely: If in 12- to 18-months’ time, the cats can skew conservative, it’s entirely possible they’ll skew liberal in another 12- to 18-months, especially if the economy continues to heal and the masses get accustomed to new, more egalitarian health care rules.

See, that’s the problem with cats and independents, including this one. We’re sometimes forgetful, and very easily distracted.

Pete embraces Brooks’ characterization as a wandering cat while using it to show where Brooks is wrong. The more I think about it, the more I also like the description of  “a meandering process of discovery.” Of course stress the fact that for many of us there was a process, and there is discovery. If looked at in the right way, meandering is not necessarily bad. This is far preferable to the ideologues, both on the left and right, who are always certain that all the answers are contained in their ideology.

I certainly have meandered over the decades. During my meandering, I’ve looked at the conservative movement and the Republican Party. I read magazines such as National Review and Human Events. Even decades ago, well before Fox,  I saw many of the features of the conservative movement which we see today. Their use of the rhetoric supporting freedom was not matched by their policy positions. The conservative magazines created an imaginary world which contradicted what I read from more objective sources. Just as is the case now, conservatives would “explain” this by complaining of a biased press which was hiding the truth.

If Republicans supported freedom in their rhetoric alone, libertarians were more consistent here.  Philosophically I come closest to libertarianism in the respect that I remain strongly committed to civil liberties. I would like libertarianism to be correct that everything else is also better when the government stays out. Unfortunately for holding such philosophical beliefs, I found that this is often not true. I also meandered away from the libertarian movement as I saw how easily libertarians were able to cherry pick facts to support their economic beliefs while ignoring any contrary evidence.

Practicing medicine and running a business made it clear that all the libertarian and conservative beliefs about health care which supported their opposition to “socialized medicine” were simply not grounded in reality. Libertarianism is unable to respond to the big problems which do require government action, such as the health care crisis and climate change. In response to such problems, libertarians and conservatives hide from reality and pretend the problems do not even exist.

Unfortunately I also found that libertarianism was often contaminated by its relationship to the conservative movement with libertarian beliefs often being twisted to lead to a decrease in personal freedom. This was especially apparent with Ron Paul’s presidential run. Many self-described libertarians justified his social conservatism, along with his view of states’ rights which would permit tyranny as long as done under the auspices of a state as opposed to the federal government.  At least Paul was consistent in his opposition to the Iraq War, with people calling themselves libertarian even finding ways to justify the war and the Patriot Act.

Well before the 2008 election I had meandered closer to the Democrats. If I would have ever considered voting Republican, the Bush years made that impossible. At least the Democrats offered an alternative to neoconservative foreign policy and to the social views of the religious right. Meandering to hang out with the Democrats, I also found that their views were far different from how they were characterized by the right. That is primarily because of their views being mischaracterized, but to some degree as Democrats had also meandered a bit over the years.

I might not agree with Democrats on all matters but at least, in contrast to Republicans, their views tend to be reality based, especially if you exclude the extremes on the fringes. In the case of Republicans, the extremists have taken control. Even when I disagree with a Democrat or someone on the left, it often comes down to a difference of opinion based upon the actual facts, as opposed to the fantasy-based arguments which have become even more common from conservatives.

I’ve meandered quite a bit in this post, (far more than I initially intended) but I guess this is appropriate considering the title. Getting back to Brooks, Pete has it right. Independents are scared right now, but can easily meander back to the Democrats if they see signs that we are on the right track next year. Republicans might have picked up a couple of wins this week, but they mean very little when looking back at previous off-year elections. Independents might meander, and a few will meander back to the Republicans, but many of us will not. Back in 1992 I initially thought it might be a good thing to have a Republican Congress to counter Bill and Hillary Clinton. After seeing what they did, I won’t make that mistake again. On this point at least, I hope Pete is wrong about independents being forgetful.

David Brooks Praises Obama on Education

Praise for Barack Obama’s education plans comes from an unexpected source–David Brooks. A portion of his column:

The news is good. In fact, it’s very good. Over the past few days I’ve spoken to people ranging from Bill Gates to Jeb Bush and various education reformers. They are all impressed by how gritty and effective the Obama administration has been in holding the line and inciting real education reform.

Over the summer, the Department of Education indicated that most states would not qualify for Race to the Top money. Now states across the country are changing their laws: California, Illinois, Ohio, Wisconsin and Tennessee, among others.

It’s not only the promise of money that is motivating change. There seems to be some sort of status contest as states compete to prove they, too, can meet the criteria. Governors who have been bragging about how great their schools are don’t want to be left off the list.

These changes mean that states are raising their caps on the number of charter schools. When charters got going, there was a “let a thousand flowers bloom” mentality that sometimes led to bad schools. Now reformers know more about how to build charters and the research is showing solid results. Caroline Hoxby of Stanford University recently concluded a rigorous study of New York’s charter schools and found that they substantially narrowed the achievement gap between suburban and inner-city students.

The changes also will mean student performance will increasingly be a factor in how much teachers get paid and whether they keep their jobs. There is no consensus on exactly how to do this, but there is clear evidence that good teachers produce consistently better student test scores, and that teachers who do not need to be identified and counseled. Cracking the barrier that has been erected between student outcomes and teacher pay would be a huge gain.

Duncan even seems to have made some progress in persuading the unions that they can’t just stonewall, they have to get involved in the reform process. The American Federation of Teachers recently announced innovation grants for performance pay ideas. The New Haven school district has just completed a new teacher contract, with union support, that includes many of the best reform ideas.

Limbaugh, Beck, Hannity, O’Reilly, And The Decline of the GOP

There are multiple factors involved in the Republican Party’s decline from a major political party to a regional fringe party. One is that they began to follow the lead of people in the media such as Rush Limbaugh, Sean Hannity, Bill O’Reilly, and now Glenn Beck. What they fail to recognize is that people such as Limbaugh and Beck are not representatives of their mainstream but are the modern day equivalents of the right wing extremists of the past. They display the same extremism, bigotry, hatred, and contempt for true American values as the right wingers who marched around in sheets in the past. While today they have larger audiences thanks to the media, they are just as poor a model for the Republican Party. While William Buckley, Jr. and other conservatives distanced themselves from the worst extremists of their day, the modern Republican Party has been deluded by their media following into believing they speak for their members. David Brooks explains that they do not:

Over the years, I have asked many politicians what happens when Limbaugh and his colleagues attack. The story is always the same. Hundreds of calls come in. The receptionists are miserable. But the numbers back home do not move. There is no effect on the favorability rating or the re-election prospects. In the media world, he is a giant. In the real world, he’s not.

But this is not merely a story of weakness. It is a story of resilience. For no matter how often their hollowness is exposed, the jocks still reweave the myth of their own power. They still ride the airwaves claiming to speak for millions. They still confuse listeners with voters. And they are aided in this endeavor by their enablers. They are enabled by cynical Democrats, who love to claim that Rush Limbaugh controls the G.O.P. They are enabled by lazy pundits who find it easier to argue with showmen than with people whose opinions are based on knowledge. They are enabled by the slightly educated snobs who believe that Glenn Beck really is the voice of Middle America.

So the myth returns. Just months after the election and the humiliation, everyone is again convinced that Limbaugh, Beck, Hannity and the rest possess real power. And the saddest thing is that even Republican politicians come to believe it. They mistake media for reality. They pre-emptively surrender to armies that don’t exist.

They pay more attention to Rush’s imaginary millions than to the real voters down the street. The Republican Party is unpopular because it’s more interested in pleasing Rush’s ghosts than actual people. The party is leaderless right now because nobody has the guts to step outside the rigid parameters enforced by the radio jocks and create a new party identity. The party is losing because it has adopted a radio entertainer’s niche-building strategy, while abandoning the politician’s coalition-building strategy.

The rise of Beck, Hannity, Bill O’Reilly and the rest has correlated almost perfectly with the decline of the G.O.P. But it’s not because the talk jocks have real power. It’s because they have illusory power, because Republicans hear the media mythology and fall for it every time.

Quote of the Day

Referring to the bizarre story from David Brooks on how he “sat next to a Republican senator once at dinner and he had his hand on my inner thigh the whole time,” Andrew Sullivan commented: “Mercifully, I avoid dinners with Republican senators. It’s usually far too gay a scene for me.”

Medical Inflation and Comparative Effectiveness

Back in the 1970’s Gerald Ford tried to fight inflation by having people wear WIN badges, standing for Whip Inflation Now. David Brooks (or possibly an editor at The New York Times) has applied the slogan to a column on  health care costs without even giving Ford credit. Brooks is generally correct that little that is being proposed will significantly lower health care costs, but there is one point where I disagree with his evaluation:

There are several ideas floating around that could reduce inflation, but they are neutered in the current bills. For example, many people believe that comparative effectiveness research would bend the cost curve. The current bills would pay for that research but negate the effects by allowing everybody to ignore the findings.

I know this sounds a bit strange, but paying for research on comparative effectiveness but leaving the ultimate judgement as to treatment up to the physician is exactly the right way to handle this. There are many areas where we have very poor data as to which treatments work best, such as with prostate cancer, despite tremendous differences in cost between various methods. If we had good data (which does not come from the pharmaceutical companies with a stake in the decision) such results would not be ignored. Doctors would be more likely to recommend the best treatment given the evidence. If doctors did not, plenty of patients would come in with data from the internet.

Such findings should not be mandatory. Practice guidelines which are relevant to most patients with a single disorder might not apply to patients with multiple disorders. Even studies which show that one treatment is generally best might find some exceptions. The preferences of the patient also need to be considered. In situations where there is a choice between long term medications and surgery, some patients might be reluctant to take time off from work, or be terrified by surgery. Other patients might be poorly compliant with medications, or have problems taking the medications, making a quick surgical intervention a better choice for them. Comparative effectiveness studies would be considered in making medical decisions, but they cannot provide the final answer.

David Brooks Is Right About Health Care Costs

I’m sure a lot of my fellow liberal bloggers will object to this viewpoint from David Brooks (partially because it is from David Brooks). The problem with such an argument is that David Brooks is right that current proposals will not significantly reduce health care costs in the near future:

Obama aides talk about “game-changers.” These include improving health information technology, expanding wellness programs, expanding preventive medicine, changing reimbursement policies so hospitals are penalized for poor outcomes and instituting comparative effectiveness measures.

Nearly everybody believes these are good ideas. The first problem is that most experts, with a notable exception of David Cutler of Harvard, don’t believe they will produce much in the way of cost savings over the next 10 years. They are expensive to set up and even if they work, it would take a long time for cumulative efficiencies to have much effect. That means that from today until the time President Obama is, say, 60, the U.S. will get no fiscal relief.

The second problem is that nobody is sure that they will ever produce significant savings. The Congressional Budget Office can’t really project savings because there’s no hard evidence they will produce any and no way to measure how much. Some experts believe they will work, but John Sheils of the Lewin Group, a health care policy research company, speaks for many others. He likes the ideas but adds, “There’s nothing that does much to control costs.”

If you read the C.B.O. testimony and talk to enough experts, you come away with a stark conclusion: There are deep structural forces, both in Medicare and the private insurance market, that have driven the explosion in health costs. It is nearly impossible to put together a majority coalition for a bill that challenges those essential structures. Therefore, the leading proposals on Capitol Hill do not directly address the structural problems. They are a collection of worthy but speculative ideas designed to possibly mitigate their effects.

The likely outcome of this year’s health care push is that we will get a medium-size bill that expands coverage to some groups but does relatively little to control costs. In normal conditions, that would be a legislative achievement.

I know we are supposed to hate David Brooks and disagree with everything he says but, not only is he right, he is saying the same thing I have said in several posts, including here and here. There is reason to believe some of these measures will save money in the long run if done right (a big if) but it will take years to see any savings. In the short run measures such as expanding health information technology and increasing preventive care will cost more money.

Preventive care is worthwhile and should be done regardless of whether it leads to saving money. While it probably will save money in the long run, there are also benefits to having a healthier population independent of any cost savings. The Obama administration has made a mistake in pushing for health information technology at this point as the technology is not yet ready for prime time. This could very well turn out to be a case of spending a lot of money which turns out to actually increasing health care costs without providing much benefit.

Brooks might also be right about only seeing a medium-sized bill. At the moment John Kerry’s 2004 health care plan is looking very good. Democrats will no longer embrace it as it is not a universal plan, but it would have significantly increased access to health care while reducing costs for employers and individuals. In the 1990’s we saw zero progress because Hillary Clinton convinced Bill to threaten to veto any plan which did not meet her standards. As a result we got nothing–which was unfortunate but preferable to HillaryCare. Obama is probably far more pragmatic on this issue than Bill Clinton was, and in the end will probably support a more modest bill if that is all that is possible. Hopefully Obama turns to John Kerry as opposed to  Hillary Clinton for ideas.