In his most recent post opposing health care reform, Whip Inflation Now, Bobo argues that the most important issue is inflation in health care costs, not reforming health care delivery and the insurance model used to pay for and restrict access to it.

Health care inflation is not some optional side issue that can be left out of reform. It is the core problem that undermines the viability of the health care system, the federal budget and the economy as a whole.

He conflates disagreements over how to pay for reforming access to health care with reforms needed to control the cost of the underlying care. Both are needed, but it will take several rounds of legislating, testing, vetting and revising, over more than one session of Congress to do this. By comparison, Medicare was easy and it took twenty years from Truman’s proposal to Johnson’s legislative victory. We no longer have that kind of time.

Bobo is also upset at the need to raise taxes of the kind that Scarecrow summarizes here. He’s in the highest tax bracket and doesn’t personally need improved health insurance or health care, conflicts he should make explicit. Brooks is correct that,

“The current health care system is hard-wired to be bloated and inefficient,” and health care economists don’t see the current bills doing enough to fix that.

He is not correct that the basic problem is that,

the American people have gotten used to high-tech, all-everything health care, under the illusion that they don’t have to pay for it and that it’s always better for them.

That’s a not too subtle variation on the welfare momma and her Cadillac argument. Even Americans with health insurance know how expensive treatment is, including the cost of documenting a chronic sickness, which destroys the ability to obtain insurance to cover it when jobs change. Like bad credit, it also often destroys the ability to get or keep a job.

Americans have no control over the insurance their employers negotiate, they have no ability to negotiate premiums or coverage and less ability to influence what doctors charge. They can only choose to avoid treatment, with the attendant costs to their health, their family’s well-being and their productivity at work and in their community. Mr. Brooks expresses no concern about those costs.

Among the other disconnects Brooks ignores is that Americans access to health care is dependent on wealth or having health insurance. Insurance is still irrationally tied to a specific employer, and anyone with a documented chronic illness is unable to obtain insurance and often employment. It’s not portable. It doesn’t come along with the average American as s/he changes jobs several times over the course of a routine career. And it’s dependent on finding an employer willing to provide it. Private individual schemes are either wildly expensive or so full of holes, there’s no cheese left.

Brooks remains pessimistic about the lower administrative costs of a publicly run insurer ("even if they materialize"), despite Medicare’s forty-five year record. And he cites the conservative Senate HELP committee’s questionable claim that a public insurer won’t increase the total number of insured Americans “largely because the public plan would pay providers of health care at rates comparable to privately negotiated rates.”

He credibly worries about the secret deals the White House is concocting with big insurers, drugs companies and medical care providers. Then he laughably wonders how good a deal private industry will get from them – when they are at the table and consumer representatives are not. That’s like biting your nails about how good a deal Goldman will get from Tim Geithner.

Reforming health care properly can increase access to it and lower its costs. Doing so needn’t come solely from taxes on the middle class or lower Medicare or Social Security benefits. Those are political choices we needn’t make, nor need we make the wealthy or insurance companies profits pay for all of it. But Brooks would treat the latter as untouchable. That’s his political choice and one three-quarters of Americans would not make.

To remember what life is like NOT down David Brooks’ rabbit hole, read Christy’s post from this morning:

Think about it: in most states, you lose your job, you lose your health care coverage. Think about how many Americans have been laid off, downsized or had their workplace simply vanish the last few years in this economy. And then tell me this isn’t a problem in this country.

Bobo’s arguments are frequently like bread pudding: immediately comforting, but taken routinely, they will send you to the political diabetes ward or the intellectual fat farm. Instead of stale bread, currants, eggs and milk, Bobo’s columns are made of stale arguments, a few dried facts and a bit of goo. The resulting mishmash rarely holds together as well as the pudding.