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What The Race for the Cure Tells Us About Healthcare Policy: The Paramount Issue is Cures, Not Coverage.

Posted Jun 06 2010 12:00am























When I read Frank Rich's column in The New York Times today, I knew that he would be beating up on Barack Obama for not beating up enough on BP and the oil companies.   As Rich puts it, Obama's "misplaced trust in elites both outside the White House and within it that seems to prevent Obama from realizing the moment that history has handed to him."  That is, Obama should be pounding away against BP, but isn't, because he is too impressed by big titles and big salaries.  Fair enough. 


But what was interesting to me was that while Rich was perfectly happy to puncture the overconfident presumptions of experts, he did not cite, for example, the Obama healthcare bill as another example of overreach. I mean: Let's ask ourselves--in view of what we have seen of the government's handling of the oil spill, who thinks anymore that the Obama administration has the restructuring of our healthcare system well in hand? Maybe they'll surprise us, but early signs are not promising. But  Evidently, for someone such as Rich, the idea that the healthcare bill might be too complicated, and too ambitious is just not something that fits within the permissible Rich-ian worldview.


But one who does make just that connection is The Atlantic's Joshua Green who seems to have inspired Rich (and me) with his piece , "When the Best and Brightest Fail," published on Wednesday.    Green works over Obama, too, for his misplaced faith in the oil companies, but he also adds the hubristic risk of financial bailout and the various stimuli that might prove to be too clever by half.   But, crucially, Green adds healthcare to his egghead litany: 


The main components of the health care bill owed a similar debt to expert thinking. Take cost containment. In 2008, the Congressional Budget Office published a dense study of the efficacy of 115 possible changes to the health care system, many designed to save money. Nearly all of them were incorporated into the legislation. And Obama chose the study's director, Peter Orszag, to run his Office of Management and Budget.


Best of luck President Kennedy -- I mean, President Obama, with your advisers, including Secretary McNamara Sebelius and White House advisers such as McGeorge Bundy Nancy Ann DeParle.   You will need it, as you struggle with your plan for transforming healthcare, based on a premise--the American people want to see restrictions on healthcare--that the evidence simply doesn't support.   Bad intellectual premise?   Demonstrably weak ability to execute?   Overconfident president?   We've been down this road before--and Green sees that it applies to healthcare, even if Rich does not.  


Lloyd Green (no relation to Josh) calls the Obamans "Ivy League Brownies," in ironic honor of Michael "Brownie" Brown, the hapless director of the Federal Emergency Management Administration during the Katrina disaster five years ago.     Then and now, the common thread is that the President just assumes that an underling is doing a good job, without properly evaluating the evidence of competence. 


Josh Green has written a terrific article on overreach, but Lloyd Green has coined a pithy phrase that deserves to stick.  
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