HEALTHCARE….Matt Yglesias offers some thoughts on various healthcare plans that are making the rounds:
The point of things like Clinton’s plan, Haase’s plan, New America’s idea, etc., etc., etc. is that you can successfully convince some substantial bloc of interests out there to support rather than oppose your plan, and some other bloc to stay on the sidelines. I don’t think that sort of “negotiating with ourselves” makes sense. It amounts to trying to guess what kind of plan you make be able to get insurance companies, or the AMA, or General Motors (or what have you) to support.
I think this is correct, and I’d like to amplify on it a bit. Matt is suggesting that the main obstacle to national healthcare in the United States isn’t really public opinion, it’s special interests ? and he’s right about that. If your plan eliminates the role of insurance companies, then insurance companies will fight it. If it pays doctors less, the AMA will fight it. If it caps the price of wonder drugs, pharmaceutical companies will fight it. Put all these groups together, and it wouldn’t matter if Jesus himself descended from the throne of heaven to endorse your plan. In the real world, it would be DOA.
This means that any workable plan has to buy off special interests to one degree or another. But Matt says the way to do this is not to make concessions now but to stick to our guns and wait for them to come to us. Then we’ll talk.
That’s right. One of the fundamental principles of bargaining ? one that amateurs get backward constantly ? is that you should always make the first offer and then wait for a counteroffer. If an employer offers you $40,000, that’s the de facto starting point and the best you can probably do is bump that up 5% or 10%. But if you ask for $50,000 in the first place, then the onus is on them to bump it down a bit. You’ll probably end up doing better and there’s almost no chance you’ll end up doing worse.
The danger, of course, is that if you ask for too much you’ll get turned down flat. But guess what? That’s not what usually happens. Usually you get a counteroffer. George Bush understands this principle at a gut level, and that’s why he’s not afraid to toss out extreme proposals and stick to them.
Any serious healthcare plan has to take account of special interest opposition. That’s just life. But instead of twisting ourselves into pretzels over this, we should do what Cato did 20 years ago on Social Security and adopt our own “Leninist” strategy of co-opting natural allies and buying off the opposition over the long term. Time is on our side here, and if we stick to what we know is right ? and a good national healthcare plan is right ? the public will respect it and the special interests who oppose it will eventually cave in to reality.
We’re not going to pass any plan anytime in the near future, but when the time is right we’ll be better off if the starting point is the plan we really want, and it’s our opponents who have to offer concessions. That’s the way to do business.