Tuesday, March 23, 2010

Healthcare for all? Or deficit reduction? Are We Seeing a Case of Quality vs. Quantity?

The Washington Post's Ceci Connolly published a behind-the-scenes look at the healthcare battle over the last two months.

Reading the piece, one is struck by the two strands of thinking that animated the Obama administration to push healthcare through. One the hand, they were clearly in love with the history they were making. On the other hand, they also loved the idea of deficit reduction.

In public, as Connolly notes, Obama was saying grandiloquent things about his bill. When it passed the House, for example, Obama said:

In the end, what this day represents is another stone firmly laid in the foundation of the American dream." He added: "Tonight, we answered the call of history as so many generations of Americans have before us. When faced with crisis, we did not shrink from our challenge -- we overcame it. We did not avoid our responsibility -- we embraced it. We did not fear our future -- we shaped it.

And in private, Obama was, if anything, more sweeping: "It's the greatest thing Congress has done in 50 years."

But at the same time, Obama seemed focused on healthcare as a way of reducing the deficit, telling one Democratic Congressman, "We have to do this. It is essential to bringing down the deficit." According to reporter Connolly, Obama cited estimates by the =Congressional Budget Office would soon show that the measure would reduce the deficit, while by contrast, the status quo "blows the deficit."

So which is it? Is healthcare about putting Obama in the entitlement pantheon, alongside Franklin D. Roosevelt and Lyndon Johnson, or it about reducing red ink?

Obama partisans will say that it's both, of course, at the same time. We shall see.

But one sort of gets the impression that the plan is a give and a take. That is, increasing the quantity of care, spread across 30 million or so more people, while reducing the quality of that care.

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