In particular, he’s wrong about healthcare reform. Ok, not everything; in 800 words he’s bound to hit something that accords with reality. But on the whole he has the wrong idea about what healthcare reform is, why we need it, and what will happen without it.

By ROSS DOUTHAT

Okay, so far so good.

When Democratic congressmen dream these days, they’re tongue-tied in town halls, fumbling with their microphones while they’re shouted down by slavering, pitchfork-wielding Limbaugh listeners.

Ross, darling, I’m fairly sure those are nightmares. Their dreams involve sick people in the country with, I’m told, the best doctors in the world being able to get quality medical treatment by leaping no higher hurdle than needing it. And apricot preserves, for some reason, but that’s not important right now.

But Barack Obama is wiser than most Democratic congressmen, and his nightmares are savvier. Instead of right-wing protesters, he dreams about old people.

He’s in the White House briefing room, presiding over a health care press conference. In the front row are the ancients of the D.C. media, and behind them is a sea of septuagenarians: some in wheelchairs, some clutching walkers, some dragging dialysis machines and the rest holding up Medicare cards like lighters at a Doors concert.

And everybody has a question.

What the hell are you talking about, Ross? Obama is shlepping around the western third of this country answering questions about healthcare reform. Since the only possible sense I can make out of this paragraph is that he’s somehow trying to slip something past the American people, what is this whistlestop tour about if not answering questions? (That link is from the super-secret underground publication The New York Times; you can’t expect a Times columnist to be familiar with it.)

If the Democratic Party’s attempt at health care reform perishes, senior citizens will have done it in, not talk-radio listeners and Glenn Beck acolytes. It’s the skepticism of over-65 Americans that’s dragging support for reform southward. And it’s their opposition to cost-cutting that makes finding the money to pay for it so difficult.

Yeah, I’ve seen the same videos he has—well, probably not, but I’ve seen the same videos he’s been able to, and I’m not seeing a lot of elderly retirees. A lot of people (particularly the armed ones) look about my age, and I’ve got a ways to go before I hit Medicare age.

That’s because they’re the ones whose benefits are on the chopping block. At present, Medicare gives its recipients all the benefits of socialized medicine, with few of the drawbacks. Once you hit 65, the system pays and pays, without regard for efficiency or cost-effectiveness.

There’s an obvious sarcastic remark I can make here, but I don’t want to be taken out of context. Let’s just say that “cost-effectiveness” shouldn’t apply broadly to health insurance, because it’s never okay to let someone die if they don’t want to.

For liberals trying to find the money to make health insurance universal, these inefficiencies make Medicare an obvious place to wring out savings. But you can’t blame the elderly if “savings” sound a lot like “cuts.” When the president talks about shearing waste from Medicare, and empowering an independent panel to reduce the program’s long-term costs—well, he isn’t envisioning a world where seniors get worse care, but he’s certainly envisioning a world in which they receive less of it.

“Cost-effectiveness” does narrowly apply to health insurance because we shouldn’t be spending money on things that aren’t helping at all. Providing care is never a waste of money, but that doesn’t mean we shouldn’t reduce the cost of providing care if it can be done without compromising quality.

Incidentally, the only person saying the Gubmint is gonna take your Medicare away is Ross Douthat and his cohorts and fellow travellers. I certainly haven’t seen anything of the sort in non-partisan explanations of the reform proposal.

This is politically perilous, to say the least — and Republicans have noticed.

Conservatives have marshaled various briefs against the Democratic health care proposals. They’ve argued that the plans will be too expensive, that they’ll cramp innovation and raise premiums for the already-insured, that they’ll encourage employers to drop coverage and discourage them from hiring.

These arguments have been effective, up to a point. But they aren’t nearly as effective as warning senior citizens that Barack Obama wants to take away their health care.

I notice that “effective” isn’t the same as “sound.” But if a system that ensures everyone, regardless of whether they can get employment through their work, encourages employers to drop insurance, so what?

That’s why Republicans find themselves tiptoeing into an unfamiliar role—as champions of old-age entitlements. The Democrats are “sticking it to seniors with cuts to Medicare,” Mitch McConnell declared. They want to “cannibalize” the program to pay for reform, John Cornyn complained. It’s a “raid,” Sam Brownback warned, that could result in the elderly losing “necessary care.”

The controversy over “death panels” is just the most extreme manifestation of this debate. Obviously, the Democratic plans wouldn’t euthanize your grandmother. But they might limit the procedures that her Medicare will pay for. And conservative lawmakers are using this inconvenient truth to paint the Democrats as enemies of Grandma.

Again, says who? Other than conservative media and the people who get alll their news from talk radio and FOX News. The whole death-panels thing is a manufactured controversy, because there aren’t any. So it’s kind of pointless to debate them.

You can understand why Republicans, after decades of being demagogued for proposing even modest entitlement reforms, would relish the chance to turn the tables. But this is a perilous strategy for the right.

Medicare’s price tag, if trends continue, will make a mockery of the idea of limited government. For conservatives, no fiscal cause is more important than curbing this exponential growth. And by fighting health care reform with tactics ripped from Democratic playbooks, and enlisting anxious seniors as foot soldiers, conservatives are setting themselves up to win the battle and lose the longer war.

Maybe Republicans will be able to cast themselves as the protectors of entitlements today, and then impose their own even more sweeping reforms tomorrow. That’s the playbook that McConnell, Brownback and others seem to have in mind: first, save Medicare from Obama; then, save Medicare from itself.

The first part of this should be fairly easy.

But for now, their strategy means the country suddenly has two political parties devoted to Mediscaring seniors — which in turn seems likely to make the program more untouchable than ever.

Though it’s really only one: Republicans fearmongering about what they claim (baselessly) the Democrats will do and Republicans fearmongering about what they really do plan to do.

In this future, somebody will need to stand for the principle that Medicare can’t pay every bill and bless every procedure. Somebody will need to defend the younger generation’s promise (and its pocketbooks). Somebody will need to say “no” to retirees.

That’s supposed to be the Republicans’ job. They should stick to doing it.

Remember, caring about ones grandmother=liberal.

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