Politics & Power Quote by Peter Orszag

Orszag is doing something economists rarely get credit for: using a values argument disguised as a technocratic one. The surface claim is clean and commonsensical: doctors should make medical decisions, not politicians or insurers. But the line works because it smuggles in a sharper indictment of how US health care actually functions - as a system where power follows payment, and “decision-making” is code for rationing, gatekeeping, and risk management.

The first move is rhetorical triangulation. “Politicians” signals partisan meddling and bureaucratic mandates; “insurance companies” signals profit and denial letters. By pairing them, Orszag collapses two popular villains into a single obstructive force, then offers “doctors” as the morally legible alternative: trained, proximate, ostensibly apolitical. That’s a strategic simplification. Physicians don’t just practice medicine; they also respond to incentives, liability fears, and institutional protocols. Orszag’s point isn’t that doctors are saints. It’s that the public trusts clinical judgment more than administrative calculus, and trust is a policy asset.

The kicker is the promised outcome: “higher-quality, lower-cost…over time.” That “over time” matters. It acknowledges the paradox that giving clinicians more autonomy can raise costs in the short run (more tests, more treatments), but argues that better decisions upstream prevent expensive disasters downstream. In the context of late-2000s/early-2010s reform debates, this is also a quiet defense of payment reform: shift incentives so that clinical choices align with efficiency. It’s not anti-policy; it’s pro-politics that hides behind the white coat.