Q and A-1

I am going to answer some questions sent by readers about my book Balancing the Budget is a Progressive Priority.

The title of your book is "Balancing the Budget is a Progressive Priority". I consider myself a Conservative. Does this mean that there is not a message in the book for me?

No, of course not. In fact, I note that what the country most needs to respond to health care costs (ch. 7) is a political deal that allows people of all political stripes to both get some "credit" for health reform, but most importantly to have "some responsibility" for doing the hard work of addressing health care costs. Currently, health reform is a political football and there is no hope of moving ahead so long as every new study, finding, etc. is first and foremost the next "projectile" is a political war about health reform. It will take every "side" if we are going to truly address health care costs.

Why include Progressive in the title then? Basically, the book is written to Progressives who have traditionally focused on protection of key programs such as Medicare, Social Security, and Medicaid. In that sense, I am addressing my arguments to people with whom I generally agree politically and in policy terms. I think we have been slow to respond to the need to change our budget to achieve long term sustainability. It is true that I do not generally prefer the policy solutions often espoused by "Conservatives" but that is not always the case. And I fully realize that there is no way I would ever get I want in terms of the way forward. It will take compromise.

A word on labels. I would define a Progressive as believing that collective action (government) has an important and active role to play in improving the lives of people. However, resources are limited. In that sense, I would call myself a cautious Progressive. If people who call themselves different things identify or agree with some of the themes/ideas of the book then great! We will be on our way to practically solving some problems. I wouldn't expect anyone to agree with me about everything.

The Monkey Cage on My Book

John Sides at The Monkey Cage has a post about Balancing the Budget is a Progressive Priority and my experiment with self publishing the book in order to get it out in the midst of the debate this Fall around what the deficit reduction plans of the Super Committee will look like.

The past few days have brought about some interesting conversations with my colleagues in the Sanford School of Public Policy at Duke where I teach about the publishing avenue I have taken.

Kelleher--You Need a Third Law

Paul Kelleher, a great blogger at Something Not Unlike Research, has provided some thoughtful comments about the second of the "two laws" that I say govern all health care systems at the beginning of Chapter 3 in my book Balancing the Budget is a Progressive Priority:

• Everyone dies
• Before that, the healthy subsidize the sick

Paul is a philosopher by training and says:

I am interested in the moral and conceptual issues connected to Taylor's Second Law and its corollary that health policy is fundamentally about how the healthy will subsidize the sick.

Go and read Paul's post as it is a very thoughtful explication of what underlies what I call the second law. He is correct that I mostly think of the second law as a statement of fact, but reading his post lets me know I need to think a bit more about this, especially since it is stated as a "law." The challenge of stating a third law strikes me as important, especially given that our country needs to learn to talk more explicitly about the difficult public policy decisions and trade-offs inherent with health care reform.

My Book is Available on Amazon

My adventure in self-publishing has gone live, and Balancing the Budget is a Progressive Priority is available on Amazon. There are some formatting issues with the book that are being addressed and the revised version (hopefully within 24 hours or so) will be delivered to anyone buying it when you sync in the future. It turns out that the technical details of self-publishing a book are more difficult than I thought....but the text that is out now is the text. UPDATE: These are fixed as of ~7pm 8/17/11.

I started writing this book about 14 months ago thinking that the goal would be to try and put discussion of the balanced budget onto the national agenda. I had planned to start seeking a traditional publisher now, but the timing of such a book (next Summer at best) would likely have come much too late for the coming policy discussions this Fall and Winter, especially with the creation of the super committee. Hence, I decided to put out a pared-down version of my argument in a self-published e book.

Many say that we need to be supporting the economy now, instead of focusing on the budget deficit. I think we need to do both, and that the lack of a long range plan for a balanced budget actually crowds out the ability to undertake short term policies that might support our sluggish economy.

From the prologue of the book:

The decision by Standard and Poor’s to downgrade the long term U.S. debt to AA+ from AAA status seems to have been triggered by the political theater we just witnessed, as well as the policy “no man’s land” into which we have arrived. For all the bluster about the deficit, the debt ceiling deal did not address the primary drivers of our long term problem: a tax code that cannot raise the revenue necessary to pay for any plausible level of overall spending, and health care costs.

We have plenty of short term problems that are going unaddressed as well. A quick look at the employment reports of the past year show that if we hadn’t lost government jobs the unemployment rate would be a percentage point lower, there is growing evidence that some sort of mortgage relief will be required to unstick the housing market, and unmet infrastructure needs to enable our economy to thrive in the 21^st Century abound. Any short term economic intervention and investment seems crowded out by the noise of the debt ceiling debate and the quietness of the action so far undertaken to address the nature of the long term problem. We need to be able to walk and chew gum at the same time, but now we appear unable to do either.

As the super committee gets underway, this book is really my version of what the "grand bargain" should look like. Perhaps movement toward one will enable short term policies to support the economy.

Book Out Next Week

My book, Balancing the Budget is a Progressive Priority will be out next week via Amazon Kindle. At the heart of the book are my suggested next steps for health care reform, because there is no hope of a balanced budget without a means of dealing with health care costs. The 10 year deficit reduction needs as far as the work of the super committee goes is only a part of the story. In the "out years" the impact of health care costs absent more reform are unimaginable. So, if you want a balanced budget ever again, you need a health reform plan.

Everyone is buzzing today about the 11th Circuit Court of Appeals ruling that the individual mandate in the ACA is unconstitutional, but severable, meaning the remainder of the law could remain even if the mandate is invalidated. There are a variety of policy remedies that could be used to try and reduce adverse selection in the absence of an individual mandate. In policy terms, all would not be lost, and the mandate is quite weak in any event. Politically, I think it is a different story.

The Supreme Court will now almost certainly hear the case, and perhaps rule next Summer just as the Presidential campaign hits full boil. The "losing side" be it President Obama and the Democratss or the Republican party will receive quite a political blow.

I don't believe there is any perfect health system and certainly no perfect health reform plan. What our country most needs is a way forward in health reform that provides both "sides" with some credit, and most importantly, which makes both sides responsible for the next, harder steps in addressing health care costs. Currently, every health policy study, finding or news items is first and foremost the next salvo in a political war that is being waged over the ACA. We have no hope of doing the hardest things in health reform as long as it remains politically toxic.

Democrats do not want to see their major policy achievement lose a key aspect, and Republicans, if they are smart will realize they do not have a coherent health reform plan and that they need one if they are serious about achieving a balanced budget some day.

Both sides have an incentive to remove the uncertainty that a Presidential-year court ruling on the mandate might bring and strike a deal. The book suggests the outlines of such a deal that would have at its heart guaranteed, catastrophic insurance that would render the individual mandate unneeded, and render the court cases moving toward the Supreme Court, irrelevant.

More next week.