Over the course his town hall meeting last evening, Congressman James Langevin expressed support for healthcare reform goals that would contain costs, expand coverage to the uninsured and prevent monopoly-like behavior from insurance companies. I didn’t get any sense from the Congressman’s responses that any of these goals were most or least important.
But given that an exact mix of policies that is supposed to brings about cost control (as opposed to providing subsidies to help some people pay their costs) has not yet been made clear, people have a reasonable fear of getting caught up in the government two-step, where the government says first we’ll take more control of the healthcare system and then, only after we’re in charge, we’ll tell you how we’re going to cut costs. Whether you like our plans or not.
If the government really knows how to cut costs, why can’t they tell us now (in a way that the Congressional Budget Office would believe) — or even better, why not use their strategies to bring Medicare costs into line?
On the revenue side, Congressman Langevin spoke very decisively in favor of a surtax on upper-income individuals, in order to generate the revenues required by new healthcare programs. But when large revenue is being generated from a narrow base, what is going to happen in the down years? Can we trust government to spend conservatively in the up-years, so there will be something left in the kitty to help bridge the down years — or would it be more reasonable to expect government to follow its recent pattern and blow through everything it’s got in the up-years, forcing big tax increases further down the income spectrum in the down years?