Austin we have a problem.
Austin Frakt very very politely argues that Daniel Kessler's premium support program is optimal policy for cloud cuckoo land.
Needless to say, I am less polite in comments.
Great post. I was sent here by @ezraklein so I guess I have lots of company. Like Klein I am wildly enthusiastic about the sausage factory observation. A premium support proposal only vaguely resembles any premium support program which would actually be enacted by Congress.
You know what else vaguely (very vaguely) resembles premium support*. Medicare advantage. Which turned out to be a gigantic boondoggle which massively increased costs.
Why is the mega Medicare advantage boondoggle discussed in your post as an argument against current post ACA Medicare and for premium support ?
Premium support seems to me to be Medicare advantage on steroids. The argument that it will lead to competition and reduced costs is exactly the argument made when Medicare Advantage was enacted.
I am ignorant (no need to say that). I'm sure that existing premium support proposals differ from pre ACA Medicare advantage in obscure boring hugely important ways. The claim is that questions about which the general public is uninformed** will be answered in ways that serve the general interest and not concentrated interests represented by well paid well informed lobbyists.
To me this doesn't pass the laugh test. Any argument that premium support will be different from Medicare Advantage in important ways has to include an explanation of why Medicare Advantage is what it is (and was what it was). "This time it's different" just doesn't cut it in policy making any more than it should in finance.
* Note the sentence ends with a period not a question mark. I confidently assert that you have noticed the vague similarities between premium support and Medicare Advantage because you are very smart (it would be enough that you are not an idiot but you are, in fact, very smart, as even an uniformed guy who hasn't followed the debate like mehas noticed).
**and will remain uninformed so long as the USA is a free society since the only way to inform people would be the Clockwork Orange approach of o chaining us to chairs and forcing us to listen with our eyelids propped open so we had to see the power point slides).