Over at TNR, Jonathan Cohn asks whether the Obama White House should have promoted a different message on health reform from the beginning, and makes a point that should be pretty obvious by now: administration efforts to respond to demands for cost control measures by deficit hawks earlier this year led to all the rationing talk that reform opponents are now using to scare Americans.
The trouble for Obama is that, in getting serious about cost, he gave critics lots of fat, juicy targets. Obama proposed to tie payments to quality; Betsy McCaughey said he would be giving doctors money for pulling the plug on grandma. Obama proposed to put a board of experts, using clinical evidence, to set Medicare payment rates; Sarah Palin interpreted that as creating a “death panel” that would declare the sick and disabled unworthy of treatment. The great irony is that by trying earnestly to craft a plan that could control costs, as well as expand coverage, Obama has provoked a political backlash that will make cost control harder in the future. He’s tried to tackle health care like a grown-up and, at the moment, he’s suffering for it politically.
The long-range political implications of what’s happened on cost control are, as Cohn suggested, pretty troubling. Right now it appears a lot of Americans can’t distinguish between quality-and-cost based second-guessing of doctors’ decisions, and euthanasia. If for years to come, any suggestions for questioning provider costs or treatments are greeted with shrieks of “Rationing!” Rationing!” we’re going to have a real hard time ever getting a grip on health care costs. It’s ironic that Republicans are the ones who have promoted the backlash against cost control, even as they still wail about deficits and costs.