You were no doubt as eager as I was to see the official statement of Fix The Debt on the president’s inaugural address, so I was glad to learn via 5PM press release earlier this afternoon that:
As the President said during his inaugural address, we must ‘revamp our tax code’ and ‘make the hard choices to reduce the cost of health care and the size of our deficit.’ We couldn’t agree more.
On the tax code, sure. On health care, I continue to think this is a phrase that obscures much more than it illuminates.
Actually making choices that are actually hard is, obviously, politically unpopular. But in a perverse way, talking about making them has become very politically popular. Yet this is obviously perverse. If it at some point becomes impossible to avoid hard choices, then needless to say they must be made. But the right way to think about reforming health care policy is to start with the easy choices. At least the relatively easy ones. In any kind of budgeting situation, you want to start with the moves that are the least painful.
Increasing the flow of immigrants to the United States, for example, improves the budget situation at negative cost to most native born Americans. So does monetary stimulus.
And you can make this particularly easy by focusing on specific areas. In the field of software engineering, for example, increased immigration leads to a boom in worker productivity. The tough choice is that it also creates some economic losses for incumbent software engineers. But if you increase the volume of skilled immigration across occupational categories—computer programmers, yes, but also health care professionals and lawyers and architects—then the gains swamp the losses and everyone ends up better off. That would be an easy choice. Improving the pharmaceutical R&D process through more reliance on prizes and open research and less reliance on patents and monopolies would also be a pretty easy choice. Demagoguery about “death panels” aside, offering end of life counseling to Medicare recipients so that we don’t spend money on treatments that people don’t even want would be an easy choice. Trying to improve the management of the organ transplant system would, I suppose, unnerve some stakeholders but if we can find ways to do it it’s a pretty easy choice.
Looking for easy choices can sound like wishful thinking or even be wishful thinking—so far electronic medical records haven’t lived up to the hype—but it’s still worth reaching for. “Hard choices” rhetoric is often in practice a cover for lazy choices. “Raise the eligibility age to 67” is an easy sentence to write and explain, and it has the dubious benefit of raising health care providers’ incomes without requiring them to improve their services in any way, but it would be better to find some easier choices.