Why? Because such a bill, with good reason, will be scored terribly by the CBO. You would definitely have very high premiums and would probably have a bill that was no longer deficit-neutral (the government is on the hook for some of those higher premiums to the extent that it's paying subsidies). Is Ben Nelson going to vote for a bill with a $1.1 trillion price tag that raises premiums by 30 percent?
There is no way that removing the individual mandate from the bill would increase the CBO score for net outlay of federal spending. There is not a single health care policy analyst who would not agree that what Silver said was completely wrong. In fact, I used the quotes from two of the biggest supporters of the individual mandate, Paul Krugman and Jonathan Gruber, to show that even they would admit that removing the individual mandate would decrease the CBO projection of net federal spending.
It should be noted that I purposely did not use analysis from economists friendly to my point of view. I selected economists Silver claimed to follow to prove that even they would tell him he was wrong. This is, perhaps, a finer point of debate technique lost on Silver, who is now trying to back track:
Sometimes, they raise fairly good points or expose legitimately sloppy work on behalf of "consensus" scientists. Sometimes, they are being contrarian for contrarianism's sake. And sometimes, they're just throwing a bunch of sh*t at the wall and seeing what sticks, hoping that the underlying truth or lack thereof is lost in the fog of debate.
(Hmm. . . that sounds like a perfect description of what Nate Silver has been try to do on the issue of health care policy.)
A case in point is Jon Walker at Firedoglake, who today has a post claiming that removing the individual mandate would "reduce" the CBO score. I place "reduce" in square quotes because "reduce" is not the antonym of worsen, which is what I had argued the removal of the mandate would do to the CBO's scoring of the bill. The CBO is scoring the health care bills along a number of different dimensions, the four most important of which are outlays, revenues, coverage, and impact upon premium costs.
As you can see, this statement is complete revisionist history. Silver clearly argued it would increase the CBO price tag on net federal spending, which it would not. He was using an incomplete understanding of health care policy to argue my idea of removing the individual mandate as an assurance that they will "fix it later" would be politically impossible. The truth is Olympia Snowe is opposed to the individual mandate and wants a lower CBO price tag. Removing the individual mandate could end up making it easier not harder to get votes. If he argued it would decrease the expansion of coverage, that would be a legitimate argument. That is clearly not what he was arguing, and if he had, I would have used a different rebuttal to refute the political impact of that change.
For example, 15 million of the newly covered would be in Medicaid/SCHIP. At most, dropping the individual mandate would reduce total coverage expansion to roughly 25 million instead of 31 million. The House bill expands coverage to 36 million people more cost effectively, yet no one seems to care about how many million fewer people the Senate covers. Nor does anyone seem to care that the Senate bill's lack of a real employer mandate creates a greater need to increase federal subsidies for coverage expansion. Dropping the individual mandate but strengthening the employer mandate and easing restrictions on immigrants could led to equal expansion of total coverage.
Of course, the CBO already concluded that the bill would dramatically increase average premiums in the individual market by 10-13%. That did not stop Democrats from wanting to pass the bill. If that were 15-20%, would Senate Democrats have then freaked out? Maybe, maybe not (I don't know). The recent addition of a ban on annual limits will increase average premiums, but, so far, I have seen no Democrats turn against the deal. It seems the general tone of the debate is that Democrats care most about the size of the net federal outlay, and care very little about what average Americans' premiums will be, or how much coverage will be expanded. (It should be noted that the CBO did only one full analysis of premiums throughout the whole market, and it is highly unlikely that they will do another before the final bill reaches Obama's desk.)
Mr. Silver, you were wrong. Your justification for why my idea would not work was incorrect. Now that I have proven you wrong, you are calling my arguments a “bunch of sh*t,” and claiming that what you said is not really what you said. Sometimes the best defense is to simply admit your mistake.
I should conclude by saying I have never argued against the theoretical need for an individual mandate if you want a universal health care system not based on a single payer model. I do not feel the Senate bill will produce a working health care system or cover enough people to be clasified as "universal." I only think people should be required to buy insurance if the government guarantees everyone access to quality affordable health insurance. I don't think the insurance in this bill is quality or affordable. I believe before we give the private insurance companies what they want most (a mandate forcing people to buy their product), we need to get more concessions out of them. I'm not ready to trade that bargaining chip yet, and we don't need to because the individual mandate will not go into effect until 2014 anyway.
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