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Uwe Reinhardt and the Elitist Liberal Mindset on Health Reform

Morgen on October 21, 2009 at 5:30 pm

Uwe Reinhardt is a highly-regarded Princeton economist who is one of the nation’s foremost experts on health care policy and economics. While he is unabashedly liberal in his perspective, he is respected in all quarters for his research and empirical analysis, if not all of his opinions. And while he has been a frequent commenter on the health reform process – notably on the Economix blog at The New York Times – he has not been overly partisan, or at least has not always marched in lock-step with the Democrat agenda for reform.

However, as much as there is to commend in Reinhardt’s work, he is an almost-perfect exemplification of the type of liberal, elitist policy experts who have been working with Democrats behind the scenes on health care reform. And while he may not be included among this group directly, his research and views have certainly informed many who have been. A point easily demonstrated by looking at the number of times he has been cited and called to testify before Congress.

Reinhardt was not quite as well known during the Clinton-era effort at health reform, but I found some comments he made in the aftermath of this debacle to be quite enlightening in terms of the current healthcare debate. (emphasis added below)

Do I believe, then, that democracy does not work in this country? If by “democracy” you mean the wonderful images of democracy our children learn about in American Studies in high school, then, yes, I do not believe American democracy works, as advertised. Rather, I believe that our democracy consists in the main of letting a perennially ill-informed, typically distracted, and generally confused plebs choose periodically from a menu of rival policymaking elites, each seeking to cram its particular vision down an otherwise placid plebs’ throat by whatever manner works, even if that entails a promise of the proverbial free lunch.

I do not consider this a grim vision, as Mark [Pauly] and many of you might. My vision of democracy is a distant cousin of Plato’s Republic, really, but one in which the priesthood is less saintly and elevated than is Plato’s and in which there is at least the chance to change priesthoods from time to time through a popular vote. And my vision of our democracy does cast doubt on Mark’s hopeful prescription, namely, to level with the plebs, to inform it fully of the moral trade-offs implied by the quest for universal coverage, and to hope that then instructions for proper policy will flow from the people to the policymaking elites. I do not believe that powerful policy in this country has ever been made that way, and I do not believe the 104th Congress will make powerful health policy that way, if it does try to make powerful health policy.

If there will be powerful policy in this realm—say, on Medicare or on Medicaid—more likely than not it will be a skillfully executed cram-down on a massively confused plebs. Let us wait and see.

From: Looking Back, Looking Forward: “Staying Power” Issues in Health Care Reform (1996)

Reinhardt was responding to a proposition made by another professor, Mark Pauly from the University of Pennsylvania, that the Clinton health reform initiative failed because the Administration was not able to convince middle-class Americans of the moral imperative for reform. In fact, according to Pauly, the central Clinton failure was in not even trying to make this case, but instead trying to convince the middle class that reform would be of financial benefit to them. An assertion which was not supported by any actual data and that the Administration knew to be false but chose to promote anyway using political spin and budget trickery.

And so in the text quoted above, Reinhardt is directly refuting what he views as a naive notion on the part of Pauly that a public which is honestly informed of the moral trade-offs inherent in various policy options, would be capable of supporting a policy which may not be in their own personal interests. Thus, Reinhardt’s position seems to be that the central Clinton Administration failure was not a lack of candor, but rather in not being skillful enough to cram-down their policy on the public, or in creating enough confusion around it.

By now, it’s probably obvious why these comments really resonated with me. The degree of cynicism and elitism expressed by Reinhardt is just utterly appalling. In contrast, the approach advocated by Pauly is no doubt the one which would resonate with most (non-elite) Americans. But what has the so-called “debate” over healthcare reform this year been if not a “skillfully executed cram-down on a massively confused” public? And there is no better example of this than the underhanded strategy liberals have employed to garner support for the public option.

Of course at this point all indications are that the Democrats will be successful in passing their health reform bill. And so in the short term at least, Reinhardt’s words from 13 years ago appear to be prescient. But an “army of Davids” has already begun to rise up against the liberal elitists who seek to gain power by deceiving us. And with an election coming next year, their victory may prove to be short-lived.

Let us wait and see.

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Category: Health & Education, Politics |

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