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!

Here we go; more GOP money grubbing

HEALTH CARE

The Repeal Campaign

Last Tuesday, President Obama signed his landmark health care overhaul -- the Patient Protection and Affordable Care Act -- into law, making it the most extensive social legislation enacted in decades. The President said that with his signature, the law provides "the core principle that everybody should have some basic security when it comes to their health care." "Today we are affirming that essential truth, a truth every generation is called to rediscover for itself, that we are not a nation that scales back its aspirations," Obama said. However, shortly after this monumental event, political grandstanding from Republicans in both federal and state governments began to take shape. Within minutes of Obama's signature, Virginia Attorney General Ken Cuccinelli (R) filed suit in federal court challenging the law and on the same day, 13 other Republican state attorneys general filed a separate federal lawsuit against the new law, arguing that certain provisions violate the Constitution. And in Congress, Rep. Steve King (R-IA) and Sen. Jim DeMint (R-SC) introduced legislation to repeal the President's signature agenda item. Yesterday, the President invited congressional Republicans to try repealing the law. "Go for it," he challenged them. Indeed, Obama has reason to be confident because Republicans in Congress are unlikely to succeed in repealing the Affordable Care Act, and the lawsuits filed by the states' attorneys general have little legal backing.

GOP REPEAL EFFORT 'A SYMBOL': Not only did King and DeMint introduce legislation to repeal the health care overhaul, but many Republicans have also said that repealing the law should be part of the Party's campaign platform for this year's midterm elections. (And of course, Fox News has been eager to promote it.) "Repeal and replace will be the slogan for the fall," Senate Minority Leader Mitch McConnell (R-KY) said this week. While some Republicans like Sen. John Cornyn (R-TX) have favored only a partial repeal, many others, like Rep. Pete Hoekstra (R-MI), want to revoke "the whole thing." However, neither of those two scenarios have any chance of panning out. In fact, some key players in the GOP are candidly acknowledging that their colleagues' new big agenda is mere political gamesmanship. "What you have to do is be politically honest," said former House Speaker Newt Gingrich. "If the Republicans win a majority in the House and Senate next year, they will not be able to repeal the bill. The president would veto it," he said. Sen. Jon Kyl (R-AZ) said the repeal effort "is more of a symbol." "[Obama] would never sign a repeal law," Kyl said, adding, "We don't have the votes to get it passed right now. We're not going to waste our time on that." Seeming to recognize this reality, other conservatives such as former Tennessee senator Bill Frist, former New York City mayor Rudy Guiliani, and former Bush speech writer David Frum have all cautioned against the repeal campaign.

NO CHANCE FOR STATES' CASE: In their lawsuit, the attorneys general claim that the requirement in the new law that all Americans purchase health insurance "'represents an unprecedented encroachment on the liberty of individuals' and violates several parts of the Constitution, including the taxing power and the clause allowing Congress to regulate interstate commerce." Cuccinelli argued that the insurance mandate violates the Constitution because "at no time in our history has the government mandated its citizens buy a good or service." However, this claim is false. As Center for American Progress Policy Analyst Ian Millhiser noted, "President George Washington signed the Second Militia Act of 1792, which required a significant percentage of the U.S. civilian population to purchase -- at their own expense -- 'a good musket or firelock, a sufficient bayonet and belt, two spare flints, and a knapsack'" in case the President ever called them to serve. Other legal experts have said that the states' lawsuits don't stand a chance in court. "It would be surprising if the (Supreme Court) says Congress can't regulate people who are participating in the $1 trillion health-care market," said Stanford University Law School professor David Freeman Engstrom. "The lawsuit probably doesn't have legs both as a matter of precedent and as a matter of common sense." Speaking of the penalties for not carrying health insurance, University of Texas Law School professor Sanford Levinson said that "[a]s a technical matter, it's been set up as a tax. ... The argument about constitutionality is, if not frivolous, close to it."

A WEAK ARGUMENT: To support their argument, the attorneys general cite two cases as examples of the Supreme Court striking down a law for going beyond Congress' power to regulate commerce: United States v. Lopez -- where the Court struck down a law banning the act of bringing a firearm in a school area -- and United States v. Morrison -- where the Court stuck down a portion of the Violence Against Women Act. But as Millhiser has noted, "What these cases have in common is that the laws at issue involved activity that was far less economic in nature than the purchase of health insurance. Neither carrying a gun nor committing an act of violence involves a sale, a market, or an exchange of something of value." Indeed, other state officials appear to recognize the lawsuit's thin grounding. Gov. Jim Doyle (D-WI) told his attorney general in a letter that his request to sue would be denied. "The lawsuit you suggest is a frivolous and political attempt to thwart the actions of Congress and the law of the country," he wrote. As the Wonk Room's Igor Volsky noted, "At least 4 of the 13 AGs are running for higher office (either Governor or Senator) and the rest are up for re-election. Their suits are designed to rally political support, not lay down new legal doctrine." "I will not waste taxpayer dollars on a political stunt," said Kentucky Attorney General Jack Conway, who added that this "gimmick may be good 'tea party' politics, but it's based on questionable legal principles." Georgia's attorney general has also refused to file suit, but Republican Gov. Sonny Purdue plans to sidestep his AG, claiming that "Georgia's state constitution allows the governor to act as attorney general if the elected attorney general fails to carry out the wishes of the governor." And in Nevada, GOP Gov. Jim Gibbons has asked Attorney General Catherine Cortez-Masto to join the lawsuit, but Cortez-Masto's office "said she was waiting to see what kind of changes the reconciliation bill makes before settling on a final decision."
There is nothing civil about civil wars!

McCain More Like The Old Man In The Antic Everyday.

He's is really losing it this badly? Guess so.

And now that the Fix Bills go to the Senate, he will have another chance to flap his gums about this very this very important fix to the senate bill which was passed by the House last night.

WASHINGTON – Sen. John McCain says Democrats who championed the historic health care bill that passed the House haven't heard the last of the issue, predicting reprisals at the polls and in the courts.

Interviewed Monday on ABC's "Good Morning America," McCain repeated House Republican assertions that the transformative legislation amounts to a "government takeover" of health care.

The Arizona Republican declared that Republicans "will challenge it every place we can," and called the measure, approved on a 219-212 vote, "terribly wrong for America." He said he was repulsed by "all this euphoria going on" and argued that "outside the Beltway, the American people are very angry. They don't like it and we're going to repeal this."

There is nothing civil about civil wars!