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FiveThirtyEight

Politics

I’m a little bit reluctant to write about this for a variety of reasons ranging from holiday cheer to the fact that it will feel like kicking salt in the wounds after the Senate’s passage of its health care bill this morning.

I do want to make clear, though, that I should probably have made some finer points of distinction among those who I have lumped under the broad heading of “kill-billers”. There is a healthy debate to be had over the merits of the health care policy, and there’s much to be said from an Overton window perspective about a world in which you’re having two liberals (me and Darcy Burner) square off against one another for nearly 15 minutes on Hardball, or David Sirota writing the opposing viewpoint to USA Today’s editorial position that the health care bill should be passed. Moreover, pressure from the left has been more successful than the pressure-ers might allow. The concessions that liberals won in exchange for giving up the public option are not trivial, and some further improvements will probably be made to the bill in conference.

There have also, however, been people who have been arguing the bill in what I believe to be bad faith — recycling or inventing a grab-bag of misleading and often self-contradictory talking points against the bill’s passage. The progress of the debate over the past week has perhaps been revealing; whereas some advocates, like Markos Moulitsas and Howard Dean, have tended to ratchet down their rhetoric, in some cases even explicitly calling for the bill’s passage, others have tended to become more entrenched. By “others”, I mean in particular two or three of the writers at the blog FireDogLake. I don’t exactly know what’s going on over there; as a group, they’re whip-smart, and they also reflect a diversity of voices, some of which I have had a problem with and others of which I haven’t. But some of the initiatives they’ve launched over the past week, particularly teaming with Grover Norquist to pursue a conspiracy theory about Rahm Emanuel, threatening to primary Bernie Sanders, and attacking Joe Lieberman’s wife, are a little bizarre and not reflective, in my view, of a website that is in the frame of mind right now to have a fact-based debate about the merits of the health care bill.

I don’t have a lot of patience for people who are arguing in bad faith. I have spent many thousands of words explaining why the bill is a good one for progressives and why most of the criticisms do not hold up (see in particular here, here and here). When the people to whom I address those arguments — and again, I’m referring principally to two or three particular people at one particular blog — are unwilling or unable to engage with them, I don’t know how I’m supposed to take their position seriously.

Let me, however, recapitulate three particular sets of arguments that I believe have not been adequately rebutted.

Firstly, I don’t think you can make a credible argument that the bill will leave poor people worse off. The bill provides very impressive subsidies to working-class people, in some cases providing them with in excess of $10,000 worth of assistance per year. Perhaps more importantly, as Jonathan Cohn and Jonathan Gruber have outlined, it radically reduces the downside risk to lower-income families because of annual caps on out-of-pocket expenses. And — something that hasn’t gotten enough attention — the bill increases the Medicaid threshold from 100 percent to 133 percent of poverty; about half of the assistance in the program is devoted to that Medicaid expansion.

Now, you can certainly argue that the bill is not quite generous enough — I wholeheartedly agree with that position, and hope that the subsidy levels can be improved, particularly in the 133-250 percent of poverty range. There have been some efforts, however, to conflate the maximum amount that people might have to pay under the bill with the amount they will usually pay. In a typical year, a family of four making $50,000 will have to pay about $300 per month in premiums to cover the entire family. That compares with a retail cost, before subsidies, of about $1,000 per month. They’ll probably also bear some out-of-pocket expenses. But no matter how bad things get, a family’s exposure is limited to about 20 percent of its annual income. That compares with the status quo, in which even an insured family can bear downside risk of as much as 68 percent of its income, and in which an uninsured family has essentially unlimited downside risk. I don’t mean to suggest that 20 percent of one’s income is pocket change — especially given how little savings the typical American family has — but it’s potentially the difference between having to cut back on vacations, entertainment and meals out versus filing for bankruptcy or losing one’s home.

Secondly, I don’t think you can make a credible argument that reconciliation is a smart strategy. You can certainly argue that reconciliation is possible — meaning, that you might be able to pass something that you call a health care bill via reconciliation. But I’ve not seen a persuasive case — or even really an unpersuasive case — to rebut the argument that what reconciliation would take out of the bill (most notably the exchanges and the protection for people with pre-existing conditions) is better than what it might be able to put back in (a middling public option or Medicare buy-in). Nor have any of the structural problems I’ve pointed out with the more “creative” versions of reconciliation really been addressed; people have just dropped the argument when I’ve pointed out these problems. Although, with the Senate’s passage of the bill this morning, this has probably become a moot point.

Thirdly, I don’t think you can credibly argue that the bill would be improved — policywise — by dropping the individual mandate. You can argue that dropping the mandate makes political sense. You can argue that we can add the mandate later. You can argue that the mandate should be restructured. You can even argue that it’s morally unacceptable. I’d disagree with most of those arguments, but you can make them in good faith. But fundamentally, you can only get (at most) two out of the following three things: a bill without an individual mandate; affordable health insurance; coverage for people with pre-existing conditions. This is Health Care Economics 101. (In the status quo, we sacrifice coverage for people with pre-existing conditions and arguably affordability, especially for those on the individual market.)

If you want to argue that the Senate’s bill is worse than the status quo, or otherwise an unwise choice, without resorting to any of these three arguments, then more power to you; we’re in disagreement, but we’re having a logically coherent discussion based on different preferences and priors. And if you want to argue that the appropriate progressive reaction to the bill is a lukewarm one, and that it would be premature to celebrate while the bill can and should still be improved, I certainly don’t have a problem with that. Implicitly, in fact, that’s what a lot of people — particularly Markos, Howard Dean, the unions, and Darcy Burner but also many others — have been saying all along. The differences I have with those folks are more semantic than substantive, and I apologize to anyone to whom I’ve conveyed the wrong impression.

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