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A World Without an Individual Mandate: Careful What You Wish For GOP

Health economist Jon Gruber runs the numbers on a world in which the individual mandate is struck down and not replaced by anything:

-Repeal of the requirement to buy insurance would mean more people would wait until they get sick to buy insurance in the new nongroup exchanges, which would increase the average premium by 27 percent in 2019.

-Retaining the law’s insurance reforms, but repealing the subsidies as well as the requirement to purchase insurance, would further discourage people from buying insurance when they’re healthy. Premiums in 2019 would cost twice as much as projected under the law as a result.

-Retaining the law but repealing the mandate would newly cover fewer than 7 million people in 2019 rather than the 32 million projected to be newly covered by the law. Federal spending, however, would decline by only about a quarter under this scenario since the sickest and most costly uninsured are the ones most likely to gain coverage.

-Retaining only the insurance reforms in the law — repealing both the mandate and the subsidies — would not increase the number of people with insurance, leaving 55 million people uninsured in 2019.

 

By Ezra Klein  | December 13, 2010;

December 13, 2010 Posted by | Individual Mandate | , , , , , | Leave a comment

Individual Mandate: Cutting Off Your Policies to Spite Your Opponents

To step outside the latest Supreme Court case, it’s worth remarking on the long-term damage conservatives are doing their cause by focusing their fire on the individual mandate.

The political case for their strategy is clear: The individual mandate, like most taxes, is unpopular. In fact, it’s one of the only unpopular elements of the whole bill. But it’s also one of very few ways to have a health-care system where everyone has coverage but private insurers dominate. In the long run, it may be the only way. That’s why Republicans originally thought up the idea, and why it’s mainly been associated with a Republican health-care bill. Mitt Romney, Chuck Grassley, Orrin Hatch, Bob Dole, Judd Gregg and Mike Crapo are just a few of the prominent Republicans who’ve cosponsored legislation with individual mandates.

More internationally, you may have heard of the conservative affection for Singapore’s health-care system. Here’s how the journal of the American Enterprise Institute describes Singapore’s structure in a gushing article: “In Singapore’s system, the primary role of government is to require people to save in order to meet medical expenses they don’t expect.” Another term for the government forcing you to put money into a vehicle that helps protect you from a health-care crisis is, well, an individual mandate.

Switzerland and the Netherlands also use individual mandates to sustain universal health-care systems that are less centralized than single-payer arrangements. It’s a pretty common device. But if Republicans get it ruled unconstitutional in America, they’d be wise to ask themselves what other options they have: After all, the constitutionality of Medicare is not in question, and that’s really the other model we could eventually trend toward. As Matt Miller put it in a column a few months back:

Conservatives, either from confusion, or for the sheer fun of taking a political bite out of Democrats, are fighting the one measure that’s essential if private insurance is to retain its central role in American health care … [But] be careful what you wish for. By fighting the mandate needed to make private insurance solutions work, and doing nothing to ease the health cost burden on everyday Americans, you’ll hasten the day when the public throws up its hands and says, “Just give us single-payer and price controls.” Don’t think the anti-government wave this fall won’t reverse itself on health care if the most private sector-oriented health care system on earth keeps delivering the world’s costliest, most inefficient care.

By Ezra Klein  | December 13, 2010

December 13, 2010 Posted by | Health Reform | , , , | Leave a comment

Charles Krauthammer Is the Fraud

Charles Krauthammer says that Obama has conned Republicans into agreeing to a second stimulus even bigger than the first. Democrats are too stupid to see this (and Republicans are even more stupid, presumably, since they are the victims).

Barack Obama won the great tax-cut showdown of 2010 – and House Democrats don’t have a clue that he did. In the deal struck this week, the president negotiated the biggest stimulus in American history, larger than his $814 billion 2009 stimulus package. It will pump a trillion borrowed Chinese dollars into the U.S. economy over the next two years – which just happen to be the two years of the run-up to the next presidential election. This is a defeat?

He’s right about the Democrats’ stupidity, but this is not Krauthammer at his most lucid.

Yes, Democrats are fools to tear their hair out over this deal, which gives them most of what they wanted: the middle-class tax rates, unemployment benefit extension, payroll-tax cut, and so on. They compound the idiocy by advertising higher taxes on the rich as their core objective. Forget relieving poverty, widening access to health care, improving opportunities for the disadvantaged. What matters more than any of that is sticking it to “millionaires and billionaires” (two-earner households making more than $250,000). You bet, the Democrats are acting like fools.But this stimulus is not bigger than the first, not even close. Two-thirds of its “cost” is keeping tax rates where they currently are. There is no new stimulus in failing to put taxes up–in forgoing a drastic fiscal tightening that nobody wanted and nobody expected. Unlike Krauthammer, I think further short-term stimulus makes sense, so I welcome the $300 billion (over two years) or so of extra stimulus in the deal. Oppose this if you like, but please don’t call it a bigger stimulus than the first.

In any event, the key question is this: does Krauthammer oppose the deal? Having declared Obama guilty of a massive swindle, and recalling that he is opposed to all of Obama’s sinister purposes, Krauthammer is obliged by his own logic to say what a bad thing the agreement must be. So what exactly did he want to happen? Presumably, raise everybody’s taxes next month, with an especially steep rise for $250,000+ households. Has he previously advocated this policy? Maybe he has, and I missed it; if so, I apologize. But if he agrees it makes sense for now to keep taxes where they are, which has been the Republicans’ defensible position, what is so bad about what just happened? Krauthammer is left opposing it because Obama was in favour. It is not every day that Krauthammer is backed into an absurd and dishonest position by his own logic.

What about the long-term deficit? This deal, if temporary, has little effect on that either way, and could easily be deficit-reducing if it avoids a second dip (as Krauthammer seems to concede it might). Obviously, the long-term deficit remains a huge concern. Tackling that requires prolonged Bowles-Simpson-type efforts that were not on the agenda for this deal. They should have been, but they weren’t. Was that a reason for rejecting the deal and letting taxes rise next month? I think not. Again, if that is the outcome Krauthammer wanted, then all right. But if that is not his position, then he is the fraud.

Read David Brooks instead.

BY: Clive Crook, Senior Editor of The Atlantic-December 11, 2010

December 13, 2010 Posted by | Economy | , , , , , , , , | Leave a comment

   

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