Young Ezra's money quote on cost savings under so-called "public option" plans: "All these are speculative"
There are at least four ideas in the health-care reform debate that have the potential to deliver on long-term savings. Mankiw does not make mention, or even reference an awareness, of any of them.
There's the theory that comparative effectiveness review -- particularly when combined with a new IT infrastructure that could eventually help guide physician decisions -- will cut down on unnecessary treatments and allow us to bring high-spending regions of the country into sync with their low-spending brethren.
That's those assholes from Dartmouth with the study that doesn't control for sickness in the population when looking for variations in cost.
There's the idea that the Independent Medicare Advisory Council will be the locus for a continual process of Medicare reform that will begin to bring down costs in the Medicare program, and also create a sort of "best practices" laboratory where experiments can be attempted and the best efforts can be further developed.
That's the Council that's going to be stacked with health insurance types who define "best practice" in terms of their profit margins.
There's the argument for the public plan, and in particular the public plan with Medicare powers, that implies that a large purchaser in the center of the system could bargain better discounts with providers.
That's the bait and switch plan with only 9 million customers.
There's the argument that the health insurance exchange will grow to become the primary insurance market and that as insurers begin competing on grounds of cost and quality -- as opposed to risk selection -- that efficiencies will emerge and spending will drift downward, and over time, the employer-based market, which is responsible for many of the costly problems in the system, will begin to migrate toward the exchange.
But that depends on the public plan keeping them honest, which it's too weak to do.
All of these are speculative. But that's true for any cost-saving measures that aren't either single-payer or some radical turn toward the free market that rips away subsidies for the poor and benefits for the elderly.
Ezra's still new at the game, isn't he?
Shit like that is why you never, never, NEVER mention single payer!
But we know it works. That's why single payer is the science-based solution.
UPDATE On reflection, what completely blows me away about Ezra's post is that Obama, the Dems, and the Village -- including the "progressives" -- framed the entire health care debate in terms of cost savings. Over and over again. And they labored away -- and were well paid to do so -- and came up with four separate policy options, each of which has been incorporated in their complex, unproven, and Rube Goldberg-esque legislation. And guess what! The result of every single policy option is "speculative." One, two, three, and four. Obama, the Dems, the Village, and the progressives have been painting pictures in the air and waving their hands and can't make their own case using the frame that they themselves fucking chose. This isn't Obama's Waterloo; it's Obama's Charge of the Light Brigade! It's moral and intellectual bankruptcy on a grand scale...