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Another Left-Right Convergence

I’m sorry, but debating the kill-billers on the policy merits of their position has become a bit like debating the global warming denialists. The denalists operate by picking and choosing which evidence they cite and what arguments they respond to. Sometimes, they raise fairly good points or expose legitimately sloppy work on behalf of “consensus” scientists. Sometimes, they are being contrarian for contrarianism’s sake. And sometimes, they’re just throwing a bunch of sh*t at the wall and seeing what sticks, hoping that the underlying truth or lack thereof is lost in the fog of debate.

A case in point is Jon Walker at Firedoglake, who today has a post claiming that removing the individual mandate would “reduce” the CBO score. I place “reduce” in square quotes because “reduce” is not the antonym of worsen, which is what I had argued the removal of the mandate would do to the CBO’s scoring of the bill. The CBO is scoring the health care bills along a number of different dimensions, the four most important of which are outlays, revenues, coverage, and impact upon premium costs. The way that analysts and policymakers will react to the score is based on a combination of all four variables. If a bill slightly reduces the government’s outlays but substantially reduces the number of uninsured people who would be covered, is its CBO score better? If the bill reduces outlays but also reduces revenues, would that improve its score?

In any event, Walker’s claim is questionable on its face. The evidence he cites is from a Paul Krugman column, which I will quote from at some length now:

[M.I.T. economist Jonathan Gruber] finds that a plan without mandates, broadly resembling the Obama plan, would cover 23 million of those currently uninsured, at a taxpayer cost of $102 billion per year. An otherwise identical plan with mandates would cover 45 million of the uninsured — essentially everyone — at a taxpayer cost of $124 billion. Over all, the Obama-type plan would cost $4,400 per newly insured person, the Clinton-type plan only $2,700.

That doesn’t look like a trivial difference to me. One plan achieves more or less universal coverage; the other, although it costs more than 80 percent as much, covers only about half of those currently uninsured.

This evidence is supposed to support Walker’s side of the argument? It says that a bill without an individual mandate costs about 80 percent more per newly insured person. Perhaps, if fewer persons signed up for insurance, the aggregate cost to the government would be lesser. Or perhaps not: as Jon notes, the individual subsidies are structured such that the cost to the taxpayer is roughly fixed, with the government making up the difference in the event of higher premiums. So you’d have to weigh a higher cost per policyholder against fewer policyholders. My impression, precisely because of the way that the individual subsidies are actually structured (as opposed to Gruber’s example of Obama’s campaign trail plan), is that the “higher cost per policyholder” side would win out, and swamp the “savings” from leaving more people uninsured.

This is debatable; what isn’t debatable is that a plan without a mandate is much less cost-effective. We’re not spending $900 billion for the sake of $900 billion; we’re doing it to provide people — a lot of people — with health insurance. A plan that spent $800 billion instead but covered only 60 percent as many people would not receive a “better” CBO score by any reasonable person’s definition. Moreover, the CBO would also score such a policy as substantially increasing premiums for non-subsided taxpayers in the individual market (and perhaps somewhat increasing premiums in the small group market). Is Kent Conrad going to vote for a bill that is scored by the CBO as increasing premiums by, say, 50 percent for these individuals (which will include a lot of farmers in agricultural states like North Dakota)?

But let’s be clear here: the kill-billers are not interested in uncovering the truth about health care policy. They’re interested in motivating partisans and winning debating points. To the extent that I’m making mistakes, they’re honest ones — and I take comfort in the fact that people who really do know what they’re talking about tend to agree with my conclusions, including Gruber, Krugman, and Jacob Hacker (who “invented” the public option). That’s not to say that Walker isn’t knowledgeable about health insurance economics — he is probably more knowledgeable than I am — but he has chosen not to take advantage of that knowledge so as to honestly and objectively evaluate the policy for his readers.

And so long as I’m throwing elbows and casting aspersions, let me point out a few of the arguments that Walker — and the other kill-billers — haven’t really responded to. Firstly, Walker hasn’t responded to my challenge to him to articulate whether he really does think that the Senate’s bill is worse than the status quo. In fact, after he chastised me yesterday for attributing that position to the kill-billers, his colleague, Jane Hamsher, today wrote an article entitled 10 reasons to kill the Senate bill, which did not exactly become any more subtle once you got past the headline.

Secondly, Walker hasn’t responded to the vast majority of my arguments about why his reconciliation strategies wouldn’t work.

Thirdly, he chose to respond to only one or two of the 20 rebuttals that I made to his answers on my “20 questions” post, complaining instead that “Silver’s questions required extremely detailed answers”. Well, damn right they did, because the questions were designed to expose who is really being honest with you about health care reform and who is being a sophist.

It would be one thing if it was just little ol’ me who Walker was arguing against. But instead his arguments fly in the face of the broad consensus established by health care economists (on the policy questions) and procedural and political experts (on the process and politics questions). One of the reasons I consider myself to be a progressive/liberal/whatever is because, more often than not, I’ve found progressives to be on the “right” side of the argument. They’re more empirical, more “scientific”, less dogmatic, less sophistic, less demagogic, less anti-intellectual — not always by any means but at least some majority of the time. After tangling with the kill-billers, however, I’m beginning to have my doubts.

Nate Silver is the founder and editor in chief of FiveThirtyEight.