If I were Ezra Klein

Just to define our terms, I take Ezra Klein to be a guy who believes that a single-payer system is clearly a good idea and that in the meantime government-provided universal health care coverage is far better than the status quo, albeit highly imperfect compared to single-payer systems. 

If I were Ezra Klein, I would love Barack Obama and his willingness to drop the forced mandate idea.  But Ezra doesn’t seem to love Barack Obama for that.

I would think that Americans are a fairly libertarian people in some (selective) regards, and that we need to frame progress as "new and concession-laden, choice-friendly version of national health care."  I would know full well that lack of a mandate has efficiency problems, because otherwise people don’t sign up until they get sick and adverse selection makes it unprofitable to sell insurance.

But then, if I were Ezra Klein, I would think: "Ah, at that point there is no turning back.  Private health insurance companies will have to look to government for further financial aid.  This might even evolve into single payer someday, and that is probably the only way we would ever get there, given American Exceptionalism."  I also would think: "I [President Obama] can change my mind on the mandate later, if need be.  Only policy wonks follow the flip flops on such details.  And perhaps the mandate could be implemented indirectly — maybe at the state level, or framed in some other way — so that my hands are clean of apparent contradiction."  I also would think: "The mandate can’t force everyone to buy health insurance anyway — forced auto insurance mandates don’t always work — so the mandate by no means eliminates the adverse selection problem anyway."

Most of all, I would think that Democrats should not waste their energy fighting — prematurely I might add — intra-party battles over issues of mostly symbolic importance.

If I were Ezra Klein, I would think that only Barack Obama has the calm, reassuring manner required to lead America down a difficult and controversial path.  Only Barack Obama (and not Hillary Clinton) would enjoy a true honeymoon period as President, and maybe that is what is required to push through major health care reform.  Only Barack Obama would be seen as approaching this issue from a fresh start and without biases.

If I were Ezra Klein, I would worship at the shrine of Barack Obama.  I would send Barack Obama random postcards of love, affection, and yes money.

But I am not Ezra Klein, and I am not sending postcards to anybody.  Instead, I am sending you this blog post on "If I were Ezra Klein."

Addendum: If Ezra Klein were Ezra Klein.


This is sad. Look. Ezra debates policy on the merits. This is policy by the gut.

Private health insurance is the root problem of our system. They're old technology Tyler, obsolete. Horse and buggy. They provide no essential function worthwhile for carrying into the future, unless keeping fat people and the poor both unhealthy and short lived is essential to your worldview.

Not to mention this is patronizing to the extreme.

And you leave yourself open to the ridiculous: You are no Ezra Klein.

As I said, sad.

I don't see what, you, Russell are so upset about. I'm entertaining the view that Ezra is right on health care, and asking what my attitude toward Obama's view on mandates should be. I am quasi-defending Obama by saying he is truer to the Democratic worldview than many of his critics indicate, and that perhaps he provides a surer path to Ezra's ends. There is nothing in this post that is trying to defend private health insurance (though that is my view, which I have defended on other grounds elsewhere). I think you are reacting by rehashing the same old same old partisan debates you are used to.


you want to talk about debating the merits? Check out Ezra's latest on this matter and be sure to read the link back to this site that Ezra bases it on.

This is but one example. You talk about "the merits". BTW, no liberal economist would ever defend single-payer or universal health care on the grounds you provided. Even they have some appreciation or Hayek, Kirzner and the best of Schumpeter...even if they don't really like them.


First: What is the "Democratic worldview"?

Second: you write:

"There is nothing in this post that is trying to defend private health insurance"

Exactly why would you explicitly "love Barack Obama and his willingness to drop the forced mandate idea" unless otherwise?

That's a rather interesting implementation detail that I'd love for you to elaborate on... how does that work exactly? Krugman has pointed out the rather simplistic problem with this, you wouldn't be trying to set things up for failure would you? As an economist, you would certainly understand the competing forces.

"I think you are reacting by rehashing the same old same old partisan debates you are used to."

Right. Ok then. That's projection, I'm projecting, everybody ok.

Or how about I turn the tables:

As a tenured member of the class of academic economists who feel (rightly or wrongly) a need to defend the status-quo, you are understandably providing various ad-hoc arguments that miraculously evolve over time to support your cause.


Can we generally agree that all so-called "single-payor" concepts are really "multiple-payor" since they are based on taxpayers through governments or members of groups formed by coercion of governmental legislation (a la Massachusetts)?

"Why on earth would Democrats vote for Clinton instead of Obama?"

Because so many of them are so irrationally angry at bush and the GOP that they are more concerned with having their anger and partisanship voiced than having their goals accomplished.



Mike Huben, when you quoted me you left out the phrase "in some (selective) regards" from my sentence, which makes all the difference in the world for your point.

Oh, goody, if the linked article is representative, this is another journalist proposing ad-hoc subsidies for his ideological whims. "Don't subsidize soy." "Do subsidize fruits and vegetables". Farm subsidies aren't bad because the distort the market, they just don't choose the "right" green things that would make us all healthier? Why does this guy deserve any serious respect? More Crooked Timber and Rosser and less Krugman and Klein.

Thehova has got my thinking down. I'm not sure why thehova thinks that only moderates or conservatives would use this logic - lots of liberal Obama supporters think this way as well. We have someone who looks like a strong candidate with progressive positions and very considerable appeal to independent / centrist voters (note that this isn't a very typical combination). Plus he is intellegent and appears intellectually serious (particularly in comparison to most politicians). Obviously supporting any candidate involves some risk because nobody really knows how things will play out. But from what we know now, what is not to like from the Dems point of view. Especially compared to someone (Clinton) who already has 45% unfavorables and will unite the opposition all while being, if anything, to Obama's right.

A lot of Clinton support is probably explained by residual Clinton loyalty on the part of many Dems, not any sort of thoughtful calculation of the pros and cons. Another part is based on the (to my mind questionable) belief that Clinton is the least likely to make mistakes in the campaign or in government and most likely to be a tough fighter on both fronts.

As an aside, here are some thoughts on Obama vs. Clinton from a moderate (me), since a few commenters can't believe anyone would vote for Clinton. I actually like the fact that Clinton is less liberal than Obama, particularly because I worry about what Obama might do in areas like trade. I also think Clinton's experience really does show through, most notably in her ability in the Senate to work with Republicans who couldn't stand her but having grudgingly given her some respect. Finally, some of Obama's talk sounds like a lot of hot air to me, and I'm skeptical of anyone's ability to get bipartisan support through "can't we all get along" politics. I see the "honeymoon period" as a myth regardless. At some point it boils down to horse trading, and I'm more confident in Hillary's abilities in that area.

Having said that, I like Obama ok as a counterweight to eight years of Bush. And I am concerned about Clinton's negatives. And handicapping political ability is very difficult. Obama may have the right combination of intelligence, ambition, and charisma to be an extremely effective president. I'm just not sold on it given his limited experience, airy talk, and soft approach.

Ok, now back to the main topic. Isn't a multiple payer government sponsored plan a hopeless muddle regardless of the mandate? Lack of a mandate presumably results in rampant adverse selection, but even having a mandate doesn't eliminate that issue. And all of the state attempts to implement similar plans (MA with Romney, VT with Dean, and a host of others) have failed to budge uninsured rates largely because of high prices. I tend to think that any plan built on the complexity of the current healthcare provider and insurance system results in continued high costs and prices.

I agree that the "If I were" hook is a less than ideal one, but I also think some of the commenters should be less eager to assume bad intentions. Try to take people's writings as honestly intentioned, and they'll be more likely to do the same for you.

Regarding the comment above: Medicaid and Medicare are payors not providers. The VA is both. There has been some press lately that the VA might be the best health care system in the world.

I fail to see exactly what innovation insurers provide, aside from fine print and 20% premium increases per year.

And having good insurance is no guarantee that you will actually get coverage. My wife's oncology surgeon dropped our insurer just prior to surgery. The lab also dropped the insurer, the largest in the state.

Ask your GP how much staff and time devotes to jacking with private insurers. My GP says about 50% of his staff's time is spent haggling over coverage. Even he also has to spend time on the phone with insurers.

I really fail to see what insurers add to the actual delivery of care.

And 'If I Were Ezra Klein' conceit makes you seem like a jerk. It needs some work.


Your argument makes no sense. Obviously, universal coverage is not the only "meaningful" kind of health care reform. Health care could be reformed in ways that would expand coverage without guaranteeing universal coverage. And a mandate would not necessarily be either necessary or sufficient to guarantee universal coverage anyway. The problem of non-compliance may preclude universal coverage via mandate, and a penalty mechanism could be used to achieve the same level of subsidy as a mandate in order to make community rating and guaranteed issue workable.

But I think the biggest problem with an individual mandate is that most Americans simply won't accept it. People don't like the government telling them how they must spend their hard-earned money, especially when it's something as expensive as health insurance. And assurances from mandate proponents that people won't be forced to spend more than they can afford are likely to be greeted with great skepticism.

The only major health expenditure in my close family has been an organ transplant.

I would argue that at current states of technology, organ transplantation is one of the only good major expenditures anyway.

Cancer treatments are not controversial, they mostly just don't work. Heart bypasses may or may not do much.

Organs are not allowed to be a part of a free market. The bottleneck on supply is controlled by the hospital system. Allow kidneys and other organs to be sold somehow. That's a real reform.

All fair points, Greg. I don't think that Clinton is a terrible candidate all things considered and she certainly could turn out to be a terrific President if elected. I just don't see what progressives are getting in exchange for running someone with such high negatives in a year when the Republicans should be in trouble. If you are really, really centrist, of course, the calculation might be different.

I'm not so worried about trade with Obama. Edwards is the one I see as most likely to embrace protectionism and I don't see either Clinton or Obama matching his rhetoric on this front. Obama spent a while teaching at Chicago - this doesn't necessarily make him more centrist in general, but I would think that it makes him more likely to be a free trade sort of progressive rather than a protectionist. Though perhaps this is still more of an unknown than with Clinton (actually come to think of it her husband's economic team is another point in her favor in my book though I suspect that Obama would have a good team as well). It is possible, of course, that I am projecting my policy preferences onto my favored candidate.

There's a pernicious little assumption here: That Ezra Klein favors single-payer insurance, which he doesn't, or that single payer implies "one-size fits all." No proposal I'm aware of limits a consumer to only UHC. UHC, as Ezra Klein himself stated, puts a floor under coverage, not a ceiling on top of it. There's no reason that someone willing to pay for it can't have supplemental health insurance coverage.

As far as I'm aware, Ezra Klein has been comparing the U.S. health care system unfavorably to various single-payer systems for several years, and has only recently stated clearly that he does not favor a single-payer system in the U.S.

If you have a UHC proposal that allows people to opt out and pay for their health care out-of-pocket, or to purchase only a cheap, catastrophic insurance policy to protect themselves against very large but low risk expenses and pay for routine care out-of-pocket, I'd love to see it.

Considering I read several major news sources a day, I'm surprised I haven't heard more about the mass rioting and political movements to repeal mandatory automotive insurance.

They're not really comparable. We only mandate third party liability auto coverage, and that mandate is part of the contract for owning and operating a motor vehicle. Most people accept that they have an obligation to protect the interests of others they may inadvertently harm by choosing to drive a car. No comparable obligation justifies a mandate for health insurance. It's more a like a poll tax. Health insurance is also likely to be much more expensive than auto insurance for most people, meaning the economic incentive for non-compliance is much greater. Even mandatory auto insurance is estimated to have a non-compliance rate of around 15%.

"I just don't see what progressives are getting in exchange for running someone with such high negatives in a year when the Republicans should be in trouble"

I'm not an economist. So, since this discussion has (d)evolved to politics, I feel better about speaking freely. First, I don't think John Edwards is a "protectionist." He favors protectionist policies because he's trying to garner support from a particular group. Maybe this sounds like semantics, but I think it's important. Most of these pro-pols don't think in terms of policy. They think in terms of quid pro quo. So, thinking about their motivations in terms of policy gets you started on the wrong foot.

The quote above goes along with my theory that the worse an incumbent is, the more extreme the positions and candidates opposition feels they can get away with. I think this can manifest itself in several ways. Hillary isn't radical on a lot of positions, but she is extreme in that she would be a stick in the eye of a large number of Americans who vote for anyone but Hillary. They can run Hillary BECAUSE the Republicans are in trouble. They can run a Black left-winger BECAUSE the Republicans are in trouble.

It wasn't long ago that there were musings about a McCain-Liebermann fusion ticket. Now, a party that is feeling its oats feels no need to water itself down. The Republicans will have to tack to the center to be able to compete (Ron Paul, wouldn't have to tack, but that's another story). This is one of the major results of the Bush betrayal. Because Bush so screwed up, in return for the massive growth of government over his term, we will either get an economic leftist, or a "compassionate conservative." So, the reward for a pro-government Republican will be even more government growth.

By analogy, it's like when my car was stolen. The cops found it but I had to pay $200 to get it from the tow place. I got punished for screwed.

Comments for this post are closed