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Peter Orszag Brings The Pain, Nerd-Style

Washington Post opinion page editor Fred Hiatt frets that health care reform will likely be counterproductive. Hiatt argues that Congress is afraid to do the two most potentially effective reforms, changing the tax treatment of health care and creating an independent panel to control Medicare spending:

From the start, the Obama administration has said that health-care reform has to make health care both more accessible and less costly . If Congress does the first without the second -- guarantees a new entitlement without controlling costs -- it will bankrupt us, because health-care costs are rising faster than the overall economy is growing.

So far, though, that seems to be where Congress is headed, for two reasons: First, no one knows for sure how to control costs; and, second, the reforms that are likeliest to work are politically unpalatable....

The most logical big thing Congress could do would be to tax, as income, the value of the health-care benefits Americans receive from their employers. ... But many unions oppose this change, because they fear it would jeopardize their members' hard-won benefits, and so Democrats won't go for it...

The second big thing Congress could do would be to cede its power to regulate the minutiae of Medicare coverage. ... Now Congress is being asked to cede both power and a reliable fundraising source. And -- surprise! -- it doesn't much like that idea.

Now, it's true that Congress has balked at ending the tax deduction for employer-provided health care. But the Senate Finance Committee has proposed to tax benefits over a certain level, which is functionally the same thing. It's odd that Hiatt fails to mention this. Likewise, the Democratic bills do include an independent Medicare commission.

Peter Orszag gently points out, "If the concern is that these two provisions would not survive the rest of the congressional process, then say that — rather than suggesting that they aren’t already reflected in legislation."

To me, Hiatt's column reads as if it was written on the presumption that neither reform was part of the Democratic bills, and then, when an editor pointed out that they were, the language was softened to imply their absence without saying it outright. Hence, "seems to be where Congress is headed," "Democrats won't go for it," "doesn't much like that idea." All these are phrases that make the reader think the Democrats have abandoned these proposals, but don't quite say so, and aren't technically incorrect. After all, you can't say for sure which way health care reform "seems to be headed," and no doubt some Democrats don't like certain proposals.

To me, the notable thing here is Hiatt's impulse to criticize the people who are advocating the policies he favors. There have been a lot of disheartening developments on health care, and I've pointed out plenty of them myself. But the fact remains that Congress is on track to pass a massively important reform that makes great progress, by my standard and Hiatt's. Years from now, if he ever looks back at the drumbeat of skeptical commentary he published during the battle over these reforms, I wonder if he'll really feel that he accurately captured the important dynamics.