the CBO is required to compare the BCRA with current law. For Medicaid, that means it must assume that the financially unsustainable entitlement will continue to swell to cover about 5 million more people, accounting for the bulk of the remaining 7 million uninsured. Not likely. For the individual ACA markets, it means the CBO assumes that enrollment rises by 30 percent over the next 10 years — a sharp contrast to the reality of insurer after insurer walking away.
Some remarks:
1. I have not been following the health care bill at all. Of all the commentators on it, I trust Holtz-Eakin the most. He is for the bill.
2. If the Republicans do not fix Obamacare, then the Democrats will. That means single-payer. That is another reason to be in favor of the bill.
3. My longstanding analysis of health care remains: as individuals, we wish for unlimited access to medical services without having to pay for them. But the more people who are granted our wish, the more that health care spending will soar. What we need is not more people to be granted our wish, but fewer people granted our wish. But pity the politician who runs on the platform of granting fewer people their wish.
4. The libertarian approach to health care is to have people make their own decisions and trade-offs about health care. The bleeding-heart libertarian approach is to give poor people and people with chronic conditions subsidies, but still let individuals make their own decisions and trade-offs. I am not convinced that there are many Americans who want to make choices and trade-offs when it comes to health care. When it comes down to it, they would rather have government make those decisions for them.
5. The CBO’s role in this has been a disgrace. The model that they use to predict consumer insurance choices way over-states the sensitivity to mandates, so it over-estimated how many people would choose Obamacare and it over-estimates how many people will “lose” (i.e., choose not to obtain) insurance without the mandate. The CBO should not be in the business of making this sort of forecast in the first place. The CBO should not be “scoring” the effects of policy, such as the effect of the stimulus on employment. The CBO should be restricted to making budget forecasts and nothing else. When it tries to forecast any other policy impacts, it ends up harming the decision-making process. Holtz-Eakin, a former CBO director, might not agree with me on this point.