I have seen the future, and its name is Orydencare.
We saw a glimpse of this emergent system with the presentation last week of Democratic Sen. Ron Wyden and Republican Rep. Paul Ryan's plan to reform Medicare.
It's a mixed bag of subsidies, private insurance, and regulated exchanges that looks an awful lot like Obamacare plus a public option. Medicare beneficiaries would receive "premium support" to buy a private health plan or traditional fee-for-service Medicare.
If something like Wyden-Ryan ever becomes law, and if Obamacare remains on the books, then the U.S. healthcare system will have achieved a rough sort of policy convergence, which I'm preemptively dubbing "Orydencare."
It ignores the basic point of the Ryan reform (and of conservative reforms of the rest of our health-care system), which is to move our system in the direction of more market competition to improve its efficiency and reduce the growth of costs. Ryan's Medicare reform would use a form of premium support to do that while Obamacare's reforms of the under-65 market would use a form of premium support to push in the opposite direction.
Levin's point would be valid if we were talking about normative ethics (note the "means" and "ends" in the title of his post). Levin is taking a Kantian line that what really matters is the directional intent of market-based reform.
But I don't think that's the right way to think about policy outcomes. New York Times columnist Paul Krugman is right in this respect: Paul Ryan or Ron Wyden's state of mind—what they're hoping to achieve in the abstract—ultimately isn't that relevant. What matters is the end result (which makes Krugman the "consequentialist" here, I suppose).
I'm assuming (safely, I think) that neither party is ever going to completely get its way on the issue of healthcare. At some point, one hopes, the system will find a new equilibrium. And if we're going to continue to have a welfare state in the post-crash era, Republicans are going to have to assent to it.
The examples of Medicare Part D, pre-Obama student loans, and now Wyden-Ryan suggest that federal intervention into the marketplace can be intellectually kosher as long as it features some element of market competition.
The Paul Krugmans and Jonathan Chaits will insist that direct federal subsidies in some cases are cheaper and more efficient—that government/market hybrids are prone to wasteful corporate socialism.
But I see no way around the reality of consensus politics. We're either going to have competition-infused entitlements, or we're going to have paralysis.
The future is Orydencare—and you're going to like it!
- Read Scott Galupo on why Republicans are the best hope for entitlement reform.
- See a slide show of 10 things that are (and aren't) in the healthcare bill.
- See photos of healthcare reform protests.