Cost-containment shoudn't be wishful thinking

Ezra interviews Jon Gruber, a prominent pro-reform health economist.

Let me start by saying that I have lot of respect for both of them.  Seriously.  That said, I think Ezra pulls out a weak argument at the end:

One of my frustrations with the cost-control discussion is that people set this up like a choice between this bill and a bill with more cost control. In reality, it seems more like a choice between this bill and nothing. And this bill does a lot more cost control than nothing.

Here’s how I think about this: Do you know Pascal’s wager? Why not believe in God? I think of health-care reform similarly. We don’t know if we’ll really bend the cost curve. But if we do this and we don’t do anything, we still go bankrupt in 100 years. We don’t lose much. But if we do it and it works, then it’s a savior.

It also moves the conversation on cost control in a way that’s impossible without this bill. It does real things on cost control, and then it does real things to make cost control more politically viable. It lays the groundwork for doing more. To kill this bill for not doing enough on cost control would be like criticizing the Yankees for not winning the Super Bowl. They won the World Series! They did what they could do!

There’s a third option – passing the bill with real cost control.  No one even tried that.

If Ezra is looking for people who support serious reform and have also called for containing costs, he doesn’t really have to look that far.  Not everyone who recognizes that $2.5 trillion is unsustainable is calling for the bill to fail because it isn’t perfect.  But it’s not also mandatory to pretend a flawed bill is perfect because that’s all the Democrats could deliver.

Every other comparable country covers more people, achieves similar if not better outcomes, and costs much less.

I expect more.  I’m not going to apologize for it.

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