David Brooks’ attempt to match the emotional verve of Shout Radio goes something like this:

Forget my wankery the wonkery. Let’s get primeval.

I suggest he keep his day job. Democratic attempts to reform health care are, warns David Brooks, stampeding a herd of rhinos. They will trample the riverfront in River City, the ‘burbs in Baltimore, and the suntanned in San Diego. Unless the Republicants stop them. "Yes, bwana," we are meant to say. "It’s your safari. We are just the bearers hauling your tents and tea sets, your whisky and sodas, and your first draft of the short, happy life of Francis Macomber."

Odds are that the closest Bobo will ever come to a rhinoceros outside the zoo is the horn powder he buys in Chinatown. He resorts to hyperbole because Paul Krugman is holding forth in an adjacent column on health care and the high cost of not reforming it, and he would never win that competition head on.

The rhinos have been roaming unchecked for a generation. We’ve thrown research projects, legislative and corporate reforms at them, all in an effort to tamp down health care inflation. But the rhinos keep coming. They are ubiquitous, powerful, protean and inexorable.

They feed on fuel sources deep in our system: expensive technological progress, the self-interest of the millions of people who make their living off the system, the public’s desire to get the best care for nothing, the fee-for-service payment system and so on.

A few of David Brooks’ parade of horribles are accurate. He and Paul Krugman agree that fee-for-service medical care (built around what insurance contracts will pay for) raises costs without improving outcomes. And both think that giving MedPAC, an expert panel advising Medicare, real power could help significantly lower costs.

Other "horribles" are wildly inaccurate. No one expects to get their health care for free. No one does now. We pay handsomely for it and get poor value for money. What we do want to do is improve that by reducing the profits and power of those "protean, powerful inexorable" forces that David Brooks devotes himself to supporting.

The intellectual honesty of some of Bobo’s recommendations is suspect. Examples are the effects of state vs. federal regulations and the cost impact of George Bush’s 2003 Medicare Part D legislation:

You want to loosen federal regulations so that states have more room to experiment — not tighten them, as the current legislation does.

Republicans advocate state regulation when they want to delay improving fuel economy. They advocate federal regulation when they want to spike local gun control laws or halt regulations that protect consumers instead of banks. Their preference is based on desired outcome, not principle.

So it is with health care reform. Insurers, like credit card companies, are already fully staffed to play off inconsistent state laws and unequally assertive state oversight agencies. It allows them to offer the absolute least coverage possible for the most money. State agencies would fair poorly in negotiating with insurers compared to the federal government. GOP-dominated legislatures would fight reform. State budgets are broken, assuring that even progressive legislatures would be hampered in implementing reforms.

The relative need for improved health care does not stop and start at state boundaries. It is a function of many things. Among them is the frequency of employers who offer health insurance and the number of employers leaving or shutting down plants or cutting jobs that once provided health insurance. The Northeast has many regional economies. Reforms that stopped at state boundaries would enhance discrepancies in access to health care rather than reduce them. The South has many right-to-fire states, whose laws protect companies, not workers. It is home to employers, such as food processing and retail giants that offer no health coverage or whose turnover is so high few stay long enough or are paid enough to use it. As for those auto plants in Alabama and the Carolinas, how long will their benefits remain top notch when their Detroit competitors shutter their plants and and topple their unions?

In short, relying on states to "experiment" with solutions inherently delays reform. It preserves insurer dominated markets where profits would stay high and access to decent health care would stay low. If federal tax dollars are to pay for reform, the benefits should be evenly shared rather than be dependent on whether you live in progressive Massachusetts, the Governator’s nearly bankrupt California or Haley Barbour’s Mississippi.

The Medicare Part D reform has produced impressive reductions by allowing consumers to pocket prescription drug savings.

For a fiscal scold, Bobo is happy saving crumbs. The legislation he cites prohibits the government from negotiating lower prices from drugs companies, a point Paul Krugman makes here:

[T]he 2003 Medicare Modernization Act drove costs up both by preventing bargaining over drug prices and by locking in subsidies to insurance companies.

Which means, Bobo, that consumer savings are coming from recycled tax dollars by way of subsidies to drugs companies, not from cutting costs. Those contradictory observations about identical legislation and its outcomes might be what drives Bobo to see rhinos!:

[T]he point is that you have rhinos at the door! You’ll try anything that works. You want a political class that no longer perpetuates the myth that people can get everything for nothing.

Brooks should tell that to the big banks, big oil, big ag, big pharma and big insurers, who want their protected markets, their bail-outs, their tax breaks and legal immunities, but no unions, no legally empowered workers, not even a labor-sponsored summer parade in Findlay, Ohio.

David Brooks mixes a tasty recipe for insurers. He serves up thin gruel for taxpayers and citizens. Is that his point, or is he just horny for more dinner conversation with Senators and Beltway mavens?