11 Predictions About HCR

Ezra Klein

I'm a little confused by this post Megan McArdle has written saying that I refuse to make testable predictions regarding the eventual impact of health-care reform. As I told her in the e-mail exchange that led to her post, I believe that by 2030 we will have "peer-reviewed research" that will have quantified at least tens of thousands of lives saved. As research tends to take a few years to collect, I expect that will only cover about 10 or 15 years of the bill. To quote again from my part of the e-mail, I believe we will have research showing that this law "prevent[ed] a hundred thousand insurance-amenable deaths within 30 years of full operation."

The point about research is important. If McArdle wants to do testable predictions, let's do them right. That's why I chose 30 years: It takes some time to gather good data on this stuff. But to be more specific, I think that the research will show that the bill did that between 2019 and 2039, if not much sooner. (By the way: an insurance-amenable death is something like a stroke, where we know the insured have much better chances of surviving than the uninsured).

I don't think that's exactly ducking the question. It seems like a testable prediction to me. And I'll make a few more:

1) The excise tax will go into effect on schedule, but it might be indexed to inflation plus one (or even two) percentage points, rather than just inflation.

2) The Medicare cuts will also go into effect with very few, if any, changes.

3) There will be at least one policy in the bill that will be a very effective cost control but that we're not thinking of. One contender for this is the provision penalizing hospitals with high infection rates, which could save quite a lot of money in terms of readmission and recuperation costs if it's effective.

4) There's a very good chance that the difference between the bill's spending and its cost controls/revenues/reforms will prove greater than what the Congressional Budget Office is predicting. To make this a bit clearer, I think there's at least a 60 percent chance that the bill saves in excess of $1.5 trillion between 2020 and 2029.

5) This policy will be very popular in 10 or 15 years. The GOP will not talk of repeal, and will instead argue that they will do a better job administering the health-care system than Democrats.

6) Premiums will grow more slowly inside the exchanges than has been the historical average for the individual and small-business markets.

7) There is a chance -- say, 30 percent -- that the Independent Payment Advisory Board (the Medicare commission) becomes an extremely, extremely important government body.

8) There will be significant supplementary reforms by 2018.

9) Most Americans will not find America to be a substantially more tyrannical, totalitarian or socialist country come 2020. The frenzy over this bill will be something people quote to discredit future frenzies, not to give added weight to tomorrow's hysterical predictions.

10) There will be strong evidence that this bill led to important quality improvements in medical care, particularly in terms of hospital-acquired infections and cost-effectiveness of treatments.

I'm a little confused by this post Megan McArdle has written saying that I refuse to make testable predictions regarding the eventual impact of health-care reform. As I told her in the e-mail exchange that led to her post, I believe that by 2030 we will have "peer-reviewed research" that will have quantified at least tens of thousands of lives saved. As research tends to take a few years to collect, I expect that will only cover about 10 or 15 years of the bill. To quote again from my part of the e-mail, I believe we will have research showing that this law "prevent[ed] a hundred thousand insurance-amenable deaths within 30 years of full operation."

The point about research is important. If McArdle wants to do testable predictions, let's do them right. That's why I chose 30 years: It takes some time to gather good data on this stuff. But to be more specific, I think that the research will show that the bill did that between 2019 and 2039, if not much sooner. (By the way: an insurance-amenable death is something like a stroke, where we know the insured have much better chances of surviving than the uninsured).

I don't think that's exactly ducking the question. It seems like a testable prediction to me. And I'll make a few more:

1) The excise tax will go into effect on schedule, but it might be indexed to inflation plus one (or even two) percentage points, rather than just inflation.

2) The Medicare cuts will also go into effect with very few, if any, changes.

3) There will be at least one policy in the bill that will be a very effective cost control but that we're not thinking of. One contender for this is the provision penalizing hospitals with high infection rates, which could save quite a lot of money in terms of readmission and recuperation costs if it's effective.

4) There's a very good chance that the difference between the bill's spending and its cost controls/revenues/reforms will prove greater than what the Congressional Budget Office is predicting. To make this a bit clearer, I think there's at least a 60 percent chance that the bill saves in excess of $1.5 trillion between 2020 and 2029.

5) This policy will be very popular in 10 or 15 years. The GOP will not talk of repeal, and will instead argue that they will do a better job administering the health-care system than Democrats.

6) Premiums will grow more slowly inside the exchanges than has been the historical average for the individual and small-business markets.

7) There is a chance -- say, 30 percent -- that the Independent Payment Advisory Board (the Medicare commission) becomes an extremely, extremely important government body.

8) There will be significant supplementary reforms by 2018.

9) Most Americans will not find America to be a substantially more tyrannical, totalitarian or socialist country come 2020. The frenzy over this bill will be something people quote to discredit future frenzies, not to give added weight to tomorrow's hysterical predictions.

10) There will be strong evidence that this bill led to important quality improvements in medical care, particularly in terms of hospital-acquired infections and cost-effectiveness of treatments.

There is nothing civil about civil wars!