Ezra Klein has an unusually banal piece in the WaPo in which he presumes to demand that anyone who opposes the current healthc are reform bill, oppose it ways that he approves of. Specifically, he asks that if you use the CBO’s critical assessment you, “must do some combination of the following:”
a) Support, as the CBO says you should, the eradication of the tax exclusion that protects employer-based health-care insurance;
b) Support, as Lewin and Commonwealth say you should, a public insurance option that can bargain at Medicare’s rates;
c) Support, as the Office of Management and Budget and every health-care wonk in town says you should, one of the various policies floating around to give MedPAC authority to continually reform and modernize Medicare;
d) Support some form of aggressive cost-sharing that would make people extremely angry because it will save money by reducing their access to health-care services;
e) Support comparative effectiveness review that can judge not only the effectiveness but also the cost-effectiveness of various treatments, and give the federal government authority to use that data when deciding reimbursement rates.
Well, as it happens, I support a… except that I’d prefer to see the tax break extended to private individuals rather than eradicated. We should make all health care expenses, out-of-pocket expenses as well as insurance premiums, tax-deductible below the line.
Option b is a vile, nasty solution that will drive up costs, reduce the quality of care, and force private insurance out of business. Option c is…. oh, whatever. This is emblematic of how crippled the current health care debate is. Whenever anyone uses the line, “every wonk in town says you should,” without any justification, it means that he’s either a complete idiot, an insufferable gasbag, or in this case, both.
Option e, is of course, the idea that the federal government could decide that some treatments regardless of their efficacy, aren’t worth supporting and will not be covered. It’s essentially giving the government the power to decide that your life isn’t worth quite as much as you might think it is.
Option d also stinks, but is of course, the essence of the current bills (and of option b). Aggressive cost-sharing is all that the government can do, “a public insurance option that can bargain at Medicare’s rates” is the very definition of aggressive cost-sharing. Klein claims he doesn’t support d, but he does support both b and e, which is exactly the same as supporting option d.
What Klein is saying is that if you oppose the current bill, you’re just opposed to increasing taxes and reducing the quality of care.