On May 23-24, 1865, the victorious Union armies marched through Washington. The columns of troops stretched back 25 miles. They marched as a single mass, clad in blue, their bayonets pointing skyward.
Those lines, dear reader, are the openers of a David Brooks article about the “centralization” of power in Washington via the “Obama health care law” (whose official moniker is “The Patient Protection and Affordable Care Act”). “Obama health care law,” then, in the next sentence or so, becomes just plain “Obamacare.” Another sentence or so later, as Brooks commences a four-step listing of how “Obamacare” has “centralized” Washington’s authority, we are told about how “Obamacare centralizes Medicare decisions — and the power of life and death — within an unelected Independent Payment Advisory Board.”
At this stage, I am eight paragraphs through this seventeen-paragraph missive, and thus far, I’ve been exposed to civil war imagery, Obamacare, and the “death panels” made famous by Sarah Palin.
As far as polemical or rhetorical accomplishment goes, I’d have to say that Brooks got off to a flying start by talking about “Union armies” in Washington, “clad in blue” ready to bayonet any surviving Confederate unfortunates scrounging about in the undergrowth. Civil War? Red versus Blue? Bring it on!
The militarized bluster of this beginning was maintained by his choice of “Obamacare” as a tag for the health care act, but he seemed to have lost some nerve when it came to the “death panels.” Rather than use that term Brooks merely sticks in a coy subclause “and the power of life and death” when talking about the “unelected Independent Advisory Board” that allegedly wields it. This is someone who is dying to soar and swoop in his political engagements but finds himself unable to do so.
Later, Brooks continues his milquetoast rambling by committing to what he terms a “Hamiltonian” position: “centralize the goals, but decentralize the means people take to get there.” I honestly have no idea what it means to “centralize a goal” but I’ll assume in this context that it means deciding to do something, as a legislative authority, as a government, for the nation and its peoples. Which, of course, means that just about any legislation signed to realize ends of national interest (i.e., without regard for a particular region, people or geographic interest) represent the “centralization of goals.” This understanding of “centralization” certainly seems to take some of the possibly threatening totalitarian sheen off it.
Be that as it may, possibly more interesting is Brooks’ decentralized solution:
[G]overnment insists everybody has coverage but then encourages companies, families and Medicare beneficiaries to engage in a regulated process of discovery to find the best care at the lowest cost.
It isn’t clear, of course, how such “encouragement” would work, and it is entirely mysterious, at least at this level of description, how or why such a “regulated process of discovery” would be any more efficient, and conducive to the production of better outcomes than the “centralized” process that Brooks so abhors. And Brooks shouldn’t be happy about the “regulated” nature of the process either; that seems to smack of control and direction, frightening entities for our brave unstructured, decentralized, Hamiltonian warrior.