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Friday, December 18, 2009

Matthew Yglesias has a Memory Lapse

He writes
Something I feel I should point out even though it probably won’t convince anyone, is that a lot of the criticisms being made of a health care bill with no public option and no Medicare buy-in are equally true of a bill with a Medicare buy-in.

I think the idea of letting people 55-64 buy in to Medicare is a great idea. I think it’s better if you drop it to 50 or 45 or 35 or 15. But 55 would be a good start. But obviously a buy-in for the 55-64 demographic doesn’t do anything for people aged 54 and lower. So if it’s really a monumental injustice to enact an individual mandate to purchase subsidized private health insurance on a regulated exchange, then including a Medicare buy-in for people 55-64 doesn’t actually resolve the injustice. Like, at all. On any level. So while I think it makes a ton of sense to be pissed off at Joe Lieberman for getting this very good idea killed, if you think the basic mandate/regulate/subsidize structure is a bad idea then it would have been a bad idea either way and you really don’t have much right to be pissed at Lieberman.

He assumes that the bill currently under debate is the very last change which will ever be made in the US health care system and notes that it is totally unfair to give an option to 55 year olds but not 54 year olds. This is unfair to the un-named people he is criticizing and is even unfair to Lieberman (now that's a challenge).

Yes a 55 year limit is absurd unjust and arbitrary. That's why I liked the idea so much and Lieberman hated it when someone finally explained the issue to him.

Just because a 55 year limit is totally arbitrary, the line couldn't possible be held at 55 years. If it was demonstrated that buying in to Medicare is a great deal both for those who buy in and for the CMS, then the age limit would be lowered and the option to buy in would be extended from individuals on the exchanges to employers.

Lieberman's flip flop is generally considered to be proof that he is against anything that DFHs support. However, he might have changed his mind over night because foolish DFHs explained why we like medicare buy in. We like it exactly because, as proposed, it is such a totally unfair and absurd policy that it won't last.

I blame myself (well I blame Atrios for leaving me off his mailing list) as I made this argument on the web.

I remember long long ago reading that the way to get to single payer was first to allow people over 55 to buy into Medicare, then lower it to 50 then ...

Now who came up with that idea (and left it on the web where Lieberman could see it). He had a funny hispanic name. Oh yeah Yglesias.

The Kaus-Yglesias-Shrum-Kucinich view of health care:

Another resonant point isn't yet CW, though--[Bob Shrum] argued that all the Democratic health care plans are too complicated, that whoever is the Dem candidate should just say he or she plans to let everyone join Medicare and leave it at that. [skip]

I think that's right. And if you don't have the votes for "Medicare for All" then you can take "Medicare for Everyone Over 50." If you don't have the votes for that, you can take "Medicare for Everyone Over 55." Then after the next election you come back and ask for more. And then more. And more. But you give the public a marker -- "Medicare for All." Sure, it's more slogan than program, but it's a good slogan.

Seems to me that in 2007, Yglesias supported Medicare buy in for people over 55 (he chose the number) as all of health care reform. He sure didn't think it was inconsistent with aiming for "Medicare for all." He argued back then that it would eventually lead to Medicare for all.

By the way, it is relatively hard to find old Yglesias posts, since he has had dozens of blogs by now. Never give hostages to fortune or google.

1 comment:

Andy Harless said...

Actually, while the 55-year limit is arbitrary, there is a case to be made that it is fair (compared to some other arbitrary limit). The bill allows insurers to raise premiums with age. Arguably, the case for a public option is weak in the case of younger people, because they will be paying low premiums anyhow (and also because they consume less health care and therefore represent less of the cost containment problem). Even if premiums are too high overall, they will still not be tremendously burdensome for younger people. Where is the cutoff age at which they may become excessively burdensome? I have no idea how to answer that, but 55 sounds like as good an answer as any.

Then again, insurers might start overcharging young people (i.e. flatten their age-premium profile) to make up what they lose to Medicare competition on the older ones. Or they might just raise their overall premium scale and let all the older people go over to Medicare.