A challenge to the ‘fiscally responsible’

A CHALLENGE TO THE ‘FISCALLY RESPONSIBLE’…. For the better part of the year, “centrist” lawmakers have said their highest priority in the health care reform debate is cost savings. For all the talk about the public option, abortion, and coverage for immigrants, the principal concern for many was fiscal responsibility.

That’s not unreasonable — costs are spiraling, and a serious long-term threat looms. Paul Krugman explains today that this threat is precisely why “centrists” should love the reform bill pending on the Hill.

Are we talking about real savings, or just window dressing? Well, the health care economists I respect are seriously impressed by the cost-control measures in the Senate bill, which include efforts to improve incentives for cost-effective care, the use of medical research to guide doctors toward treatments that actually work, and more. This is “the best effort anyone has made,” says Jonathan Gruber of the Massachusetts Institute of Technology. A letter signed by 23 prominent health care experts — including Mark McClellan, who headed Medicare under the Bush administration — declares that the bill’s cost-control measures “will reduce long-term deficits.”

Bending the cost curve, lowering the deficit, getting Medicare spending under control, fiscal responsibility … these are the kinds of things that should make the bill pretty appealing to the usual suspects.

But Krugman’s even more salient observation has to do with reform’s conservative opponents, who, ironically, oppose the kind of efforts they claim to support.

[T]he G.O.P. has focused more and more on an effort to demonize cost-control efforts. The Senate bill would impose “draconian cuts” on Medicare, says Senator John McCain, who proposed much deeper cuts just last year as part of his presidential campaign. “If you’re a senior and you’re on Medicare, you better be afraid of this bill,” says Senator Tom Coburn.

If these tactics work, and health reform fails, think of the message this would convey: It would signal that any effort to deal with the biggest budget problem we face will be successfully played by political opponents as an attack on older Americans. It would be a long time before anyone was willing to take on the challenge again…. That’s why anyone who is truly concerned about fiscal policy should be anxious to see health reform succeed. If it fails, the demagogues will have won, and we probably won’t deal with our biggest fiscal problem until we’re forced into action by a nasty debt crisis.

And just to flesh this out a little further, the same Republican lawmakers railing against cost-control efforts now are the same Republican lawmakers who usually position themselves as champions of fiscal responsibility. Why the contradiction? Because they care more about preventing a Democratic victory than their own purported policy priorities.

Nevertheless, Krugman’s column is a reminder that the Senate reform bill gives the “centrists” everything they said they wanted. In a saner political world, they’d be reform’s biggest cheerleaders.