Tom Church

…I believe it.https://twitter.com/adamjwhitedc/status/1223375629397250048 …

Good line!https://twitter.com/GarettJones/status/1223285515140698119 …

This is a thought-provoking post by John on diversity statements.https://twitter.com/JohnHCochrane/status/1222933998889914369 …

10/ Expanding access to quality, affordable health care is critically important. But if people are going to vote on the public option, then they should be aware of what it could actually cost them. History tells us that it will not be free.

9/ There are many other critiques of the public option. Our paper adds to the debate by providing the first score of how much it would cost if Congress were to subsidize enrollees, doctors, and hospitals like it has in other federal healthcare programs.

8/ We also score the unlikely possibility of charging actuarially fair premiums over the long run. While deficit-reducing, the premiums charged to those on the public option would grow much faster than incomes and far exceed ACA’s 9.78% income limit for subsidies up to 400% FPL.

7/ We score actuarially fair premiums and wage-indexed premiums too. And for reimbursements, we make baseline estimates that stay at Medicare-level rates. No matter the reimbursement level, subsidizing premiums to rise at wage or price inflation leads to long-term deficits.

6/ The > $700 billion 10-year deficit estimate is for what we call the politically realistic public option. Big-group employers can join, premiums are limited to increases in price inflation, and reimbursements to hospitals and doctors rise to private levels in 5 years.

5/ We use the experience of Medicare Part B premiums, the SGR, the repeal of the Medicare Catastrophic Coverage Act, Medicaid FMAPs, and public options in Washington and Colorado to demonstrate the historical failure to charge actuarially fair premiums or reimburse at low rates.

4/ Our paper does what CBO unfortunately can’t, which is to ask, what if that doesn’t happen? What if Congress subsidizes premiums to purchase the public option? What if doctors and hospitals don’t participate unless they’re reimbursed at higher rates? What would that cost?

3/ This is important because the public option is often billed as a deficit-reducing or a deficit-neutral policy. Proponents say that they will 1) charge premiums that cover 100% of costs and 2) reimburse doctors and hospitals at Medicare-level rates.

2/ In short, we find that if Congress were to treat the public option like it has treated past federal healthcare programs, it would add >$700 billion to the deficit in 10 years. In 30 years it would grow to be the third-largest govt program after Medicare and Social Security.