David Leonhardt makes the case that Obama’s health reform is more “centrist’ than Bill Clinton’s proposal. The quotation marks are there because I’m not sure exactly what Leonhardt means by the term — I assume he’s suggesting that it is further to the right, as suggested by the notion that the Senate and House bills are “substantively bipartisan.” Can I argue that opposition is “substantively bipartisan,” as many on the left oppose the Obama approach on the grounds that it channels vast resources to private insurers? Somehow I don’t think so. But moving along:

The current versions of health reform are the product of decades of debate between Republicans and Democrats. The bills are more conservative than Bill Clinton’s 1993 proposal. For that matter, they’re more conservative than Richard Nixon’s 1971 plan, which would have had the federal government provide insurance to people who didn’t get it through their job.

I’m very happy to acknowledge that there are parallels between the Nixon approach and the Obama approach. Somehow I don’t think that this will make it onto Obama for America bumper stickers come 2012. So how is the Obama proposal more conservative than the Clinton proposal? The following is Leonhardt’s interpretation.

In 1993, Mr. Clinton pushed for putting a cap on the growth of insurance premiums — an idea similar to having a national health budget, which conservative governments in other countries have done. Today’s Democrats saw that move as too radical. Instead, they have borrowed Nixon’s old push for prepaid group practices, which are now called accountable care organizations. Together, the cost-control measures are serious enough that the Congressional Budget Office estimates they would save the government $1 trillion in the next 20 years, over and above the cost of covering the uninsured. Some experts remain doubtful of these projections. Others, though, think the budget office is underestimating the savings, as it has with past Medicare changes.

That is one reading of the shift. Another reading, at least equally plausible, is advanced by Michael Cannon of the Cato Institute.

My read of the CBO’s score of the Clinton health plan is that the private-sector mandates accounted for around 60 percent of the Clinton health plan’s total cost, the remainder being (traditional) government spending. So how is it that the CBO made the full cost of the Clinton health plan apparent to the public in 1994, but may now be revealing only 40 percent of the cost of the Obama health plan? For some time, I’ve suspected the answer is that congressional Democrats have very carefully tailored their individual and employer mandates to avoid CBO’s definition of what shall be counted in the federal budget. Democrats are still smarting over the CBO’s decision in 1994. By revealing the full cost of the Clinton plan, the CBO helped to kill the bill.

That is, the decision to tweak the legislation so the CBO won’t count insurance premiums to heavily regulated insurers as taxes made it look far less expensive than the Clinton proposal. This could have been a substantive concession, yet Cannon suggests otherwise.

Proposals that would result in a complete cost estimate — such as the proposal by Sen. Rockefeller discussed in the Medical Loss Ratios memo — are dropped. Because we can’t let the public see how much this thing really costs.

More centrist is one way of putting this. Learning from experience how to create the appearance of centrism is another. It’s possible that Cannon is being unfair. I’d love to see a reform advocate at the Times seriously address his contention.

I wish that I had the same trust in the wisdom of our public officials as many of my colleagues. But I lived through the Bush years, when many conservatives weren’t nearly skeptical enough of expansions of federal power. The fact that members of the Obama administration are said to be smarter, hipper, and nicer is interesting, but that doesn’t have much bearing on the dysfunctions that derive from the extreme centralization of power.