I fairly often receive mail pleading with me to take a more even tone, to have a respectful discussion with people on the other side rather than calling them fools and knaves. And you know, I do when I can. But the truth is that on most of the big issues confronting us, there just isn’t anyone to have a serious discussion with. Ezra Klein offers a nice illustration of this point today, in his takedown of Avik Roy on Obamacare in California.
reformist conservative, not to mention a health policy wonk. So what does this reform-minded wonk have to say about Obamacare?
Klein tries really hard to keep his temper even; too hard, I think, because I wonder how many readers will stay with him all the way through. But to cut to the chase, Roy claims that Obamacare will cause soaring insurance rates, using a comparison that is completely fraudulent — and I say fraudulent, not wrong, because he is indeed enough of a policy wonk here to know that he is pulling a fast one.
So here’s the comparison Roy uses: he points out that the insurance premiums that will apparently be charged on the California exchange will be higher than the lowest rates being offered by some insurers in California right now.
As Klein says, this isn’t just comparing apples and oranges; it’s comparing apples with oranges you can’t even buy.
Right now, California has a basically unregulated individual market, in which insurers are free to reject whoever they choose, and charge whatever rates they choose. This means that a few young, healthy people with no record of prior medical problems can get cheap plans; these are, of course, precisely the people who need insurance least, and these plans are cheap not just because they’re only available to the very healthy but because they don’t provide much insurance. If you’re not healthy or wealthy enough to get by with this kind of insurance, too bad.
So looking at these rates tells you nothing at all about the success of a program that offers insurance to everyone, regardless of medical history, and sets fairly high minimum standards for the quality of that insurance.
What’s more, this isn’t some obscure issue. When people try to explain the logic of ObamaRomneyCare — certainly when I try to explain it — they often start from precisely this point, pointing out that unregulated insurance markets give the healthy and wealthy a pretty good deal but leave everyone else out in the cold, then work from that point toward the “three-legged stool” of community rating, mandates,and subsidies that supports reform. So Roy has to know that he’s making an essentially fraudulent argument — and does it anyway.
And Roy is about as good as you get in this stuff: his tone is even, he actually knows something. Nonetheless, he goes for the cheap, misleading shot.
I know that a lot of people wish we lived in a country where debates about things like health care policy were serious, honest discussions of debatable points. I like to hope that by the time I retire I’ll actually live in a country like that. But right now, and surely for years to come, it’s basically facts versus fraud.