A minor spot in our debates

The Post has two people who write on the economy, George Will and Robert Samuelson.  Both of them are conservatives.  Both of them stink at it.  Not long ago Samuelson argued that investing in rail transit would be a waste of money, because it serves so little of the country.  He forgot to mention such notions as population density, etc.  

Today he writes about health care.  In classic Samuelson fashion, he argues that controlling costs is somehow logically impossible:

Americans generally want three things from their health-care system. First, they think that everyone has a moral right to needed care; that suggests universal insurance. Second, they want choice; they want to select their doctors — and want doctors to determine treatment. Finally, people want costs controlled; health care shouldn't consume all private compensation or taxes.

Appealing to these expectations, Obama told Americans what they want to hear. People with insurance won't be required to change plans or doctors; they'll enjoy more security because insurance companies won't be permitted to deny coverage based on "pre-existing conditions" or cancel policies when people get sick. All Americans will be required to have insurance, but those who can't afford it will get subsidies.

As for costs, not to worry. "Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan," Obama said. He pledged to "not sign a plan that adds one dime to our [budget] deficits — either now or in the future." If you believe Obama, what's not to like? Universal insurance. Continued choice. Lower costs.

The problem is that you can't entirely believe Obama. If he were candid — if we were candid — we'd all acknowledge that the goals of our ideal health-care system collide. Perhaps we can have any two, but not all three.

Baring the fictional–yes fictional–scenario where you get to chose your own doctor and your own care (your insurance company does so long as you "qualify," which means so long as you don't get sick), every other industrialized democracy in the world has solved this problem.  They get more than we do for half of the cost.  That's just true folks.  As Obama has argued over and over, one problem we suffer from here in our capitalist paradise is a lack of competition in health insurance.  There is simply no incentive to deliver it cheaper.  So you can have all three indeed.  We should have all three.  If we can't get all three, we will suck.

For contrast, here is something Nicholas Kristof got right:

After Al Qaeda killed nearly 3,000 Americans, eight years ago on Friday, we went to war and spent hundreds of billions of dollars ensuring that this would not happen again. Yet every two months, that many people die because of our failure to provide universal insurance — and yet many members of Congress want us to do nothing?

Here, by the way, is Samuelson's view on the affordability of the Iraq war:

Yes, that column made big mistakes. The war has cost far more than I (or almost anyone) anticipated. Still, I defend the column's central thesis, which remains relevant today: Budget costs should not shape our Iraq policy. Frankly, I don't know what we should do now. But in considering the various proposals — President Bush's "surge," fewer troops or redeployment of those already there — the costs should be a footnote. We ought to focus mostly on what's best for America's security. 

He is referring to a 2002 column where he argued we could "afford" the Iraq war, a war which, by the way, would cost more than any health care fix (I can't find the original article on the Post's website).  And indeed, who can disagree with this closing remark on that column?

But I am certain — now as then — that budget consequences should occupy a minor spot in our debates. It's not that the costs are unimportant; it's simply that they're overshadowed by other considerations that are so much more important. We can pay for whatever's necessary. If we decide to do less because that's the most sensible policy, we shouldn't delude ourselves that any "savings" will rescue us from our long-term budget predicament, which involves the huge costs of federal retirement programs. Just because the war is unpopular doesn't mean it's the source of all our problems. 

A minor spot, unless it's health care.