SECRET SPECIFICS. I'm not surprised to learn that Ezra disagrees with my view that candidates should not put forward detailed health policy plans. There is one particular part of Ezra's premise that I want to take on strongly. Ezra writes, "I wouldn't be comfortable with candidates concealing their bottom line policy beliefs from me." And, "I need to know if a candidate thinks community rating is essential, if a public insurance option is something they'll fight for, if they'll step beyond universality and make cost control an issue." Here's some news: Candidates don't have "bottom line policy beliefs." They just don't. And it's not because they are evil or deceptive. Very few people -- though Ezra may be one of them -- emerge from the womb with deeply embedded beliefs about community rating, cost control, etc. Sorry. I don't have "bottom line policy beliefs" about those things, so if that's what you want, please, don't vote for me. I understand all these issues, somewhat, but I see them as variables in the huge and complex mess of health care policy and politics, and interdependent with other variables, especially the political. Let's be more concrete about it. Here's a reasonable point of view about health policy: Suppose Candidate X thinks that a single-payer system, perhaps one based on the VA system, makes the most sense as policy -- would be the most economically efficient, fairest, have the greatest ability to control costs, etc. She thinks that such an idea is probably not yet politically viable, and that if she put it forward in the campaign, she and the plan would be savaged by her opponents, and then she would be ripped apart by the Republicans as "the biggest tax increase in history," "you couldn't choose your doctor," etc. X thinks that 90% of the goals could be achieved by a well-structured system that combines an individual mandate with a structured insurance market and generous subsidies. X hopes that the opposition of the insurance industry and some of the business lobby will be muted by such an alternative, making it possible to win over a handful of Senate Republicans and get something passed. So what to do, if you hold such a view? You could describe your preferences exactly -- your first choice and your fallback position -- which is pretty much what Jon Cohn suggests in his reply to my reply, where I think we are converging. Or, you could set some basic goals while leaving the details for later -- but identifying some specific health care models that would meet those goals. And not feel obligated to come up with something diffferent from, say, the Edwards proposal, just to be different on specifics. The fact is, as specific as Edwards is being now, he too will adapt to the politics of 2009 if elected. -- Mark Schmitt
