Rivlin and Galston are Almost There

Matt makes a good point in his last post when he notes that Alice Rivlin in more recent public statements has put the focus on rising health care costs. Similarly, Bill Galston—who, like, Rivlin signed on to the Brookings-Heritage-AEI entitlement crisis proposal—appears to be losing some of that old-time DLC religion. In the current issue of The American Prospect, Galston calls for a federal government that commands "an increased share of gross national product .... to provide new forms of insurance against economic risk and volatility" and notes that "universal health insurance would give us a fighting chance to restrain the rate of growth in medical costs ...."

That said, both Rivlin and Galston have yet to really break with their bad company at AEI and Heritage. At the end of his TAP piece, Galston says that "we will need a new approach toward the large entitlement programs—especially Medicare and Medicaid—that drive so much of the long-term increase in the federal budget" and then goes on to outline the Brookings-Heritage-AEI proposal. Similarly, Rivlin, in her op-ed, still relies too heavily on outdated and ineffectual crisis rhetoric about "entitlements." Instead of saying, as Rivlin does, that "no candidate is facing the fiscal time bomb of health-care entitlements," why not say: "no candidate is proposing adequate solutions to reduce the spiraling costs of health care, costs that reduce our nation's economic competitiveness and growth." The latter more accurately defines the problem, and better points toward the solution. It's also more likely to be heard by a public that is much more concerned about health care (consistently in the top three of issues) than the deficit or "entitlements" (the top issue for a mere 1-2 percent of the population, despite the mighty efforts of political pundits and inside-the-beltway policy mandarins).

The most important piece of proof for me that Galston and Rivlin haven't broken with the old ways is how they misdescribe health care entitlements as consisting solely of Medicare and Medicaid. In fact, the 2nd biggest health care entitlement isn't Medicaid, it's the $200+ billion tax break for employer-sponsored health insurance. The health insurance tax break costs around $30 billion more than Medicaid and, if my recollection is correct, is increasing at a faster rate than either Medicaid or Medicare. It's also, unlike Medicare or Medicaid, a regressive tax subsidy that provides more benefits for the wealthy.