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David Brooks Has a Health Care Idea!

The conservative reform that wouldn't screw the poor

David Brooks is nothing if not gracious. On Friday, the bespectacled and occasionally besieged New York Times columnist had a tantrum, or what qualifies for a tantrum by his mild-mannered standards. He did so by criticizing President Obama for failing to provide leadership in the debate over the sequester and fiscal priorities. High on the list of Obama's alleged sins was a supposed failure to offer substantial cuts to entitlements, particularly Medicare.

Within a few hours, every blogger with a grasp of policy and access to a laptop had pointed out the error: Obama has offered several key concessions, including a few that Brooks himself had endorsed. Brooks quickly appended a correction to the online version of his column and then, Tuesday, started his new column by saying that last week's was "unfair." "The White House approach is not what I would like, but it is more balanced than I described," he wrote. That's the kind of humility we see too rarely in writing about policy.

Brooks also used his column to talk up some new ideas, among them a Medicare proposal that comes from Yuval Levin, a conservative writer who is editor of National Affairs and a fellow at the Ethics and Public Policy Center. The idea, which Levin first unveiled in New York Times op-ed earlier in February, is to raise the eligibility age for Medicare—but in a different, relatively novel way.

Past proposals, like the one Republican leaders have endorsed, called for gradually raising the age at which all seniors can enroll in Medicare. Critics pointed out some problems with this scheme—among them, the fact that many seniors desperately need the financial protection of government-provided insurance, because they have so little money or, in the worst of cases, have no job at all. Levin would address this problem by adjusting the eligibility age based on wealth, so that wealthier seniors had to wait longer to enroll in the government program but less wealthy seniors did not. Levin is still working out the specifics, but he tells me, via e-mail, that this scheme would probably save the federal government a lot of money—maybe not $125 billion over ten years, as the previous proposals would have yielded, but a big chunk of that. At the same time, he says, it would protect lower-income seniors.

Based on Levin's description, the plan would not attract a lot of support from liberals. And that's because of a basic difference in worldview. Conservatives (like Levin) want to reduce the number of people on government-run insurance: They believe it will decrease not just government health care spending but society's overall spending on health care, while minimizing interference with the free market. Liberals (like me) think more government spending on health care is just fine, as long as we pay for it, because programs like Medicare are actually more secure and more efficient. Shrinking the Medicare rolls, we believe, merely shifts the burden of health care spending onto employers and individual seniors—who, if anything, are less able to bear that burden than society as a whole. But this is precisely the sort of serious, honest debate that we should be having—the kind that's been largely absent from the political dialogue in Washington.

And who's to blame for that? It’s not hard to imagine Obama endorsing a scheme like Levin's, since, during the 2011 debate over fiscal policy and then briefly during the 2012 sequel, Obama was willing to embrace the earlier, more conservative version of the eligibility age increase.1 This horrified many liberals, and not for the first time, but that's precisely the point: Obama has repeatedly shown a willingness to alienate his base and make concessions, if that is what it takes to make a deal with the other party. Republicans have not shown a similar willingness—not then, in the debate over the debt ceiling and Bush tax cuts; not now, in the debate over the sequester cuts. And the pundits, from Joe Scarborough to Ron Fournier, refuse to recognize that intransigence for the obstacle that it is.2

More conservative pundits, like Brooks, are the ones who might actually have some influence on the right—if not directly on Republican party leadership, then indirectly through their audience in the business, legal, and media establishments. But that won't happen if they don't speak more loudly. Brooks's civility is a virtue I genuinely admire, but this would be a good time for him to get mad.

  1. Obama eventually abandoned the idea. And while politics surely played a role—many Democrats hate the idea, it doesn't poll well—policy also did. His advisers concluded, rightly in my view, that raising the eligibility age shifted costs to the elderly rather than reducing spending overall.

  2. Among those writing about this problem today are Greg Sargent and Josh Marshall