Responding to an Ezra Klein blog post noting citing relatively good Massachusetts news in defense of Obamacare, Douglas Holtz-Eakin finds himself in the same predicament as everyone else who tries to argue there is some yawning gap between Romneycare and Obamacare.
“Yes, Massachusetts re-directed existing health spending to expand coverage,” Holtz-Eakin writes. This is like saying the military redirected some people to France on D Day. Massachusetts imposed an individual mandate requiring people to buy health insurance, set up government-run exchanges through which they can purchase such insurance, offered subsidies, and expanded Medicaid. This is also the basic framework of Obamacare. Most of the differences Holtz-Eakin later cites have to do with the chicanery required to get Obamacare through the reconciliation process (not relevant to Massachusetts) and the vagueries of the federal government. And as monstrous as IPAB is, it is a theoretical cost control mechanism that Romneycare lacks.
Holtz-Eakin then says, in effect, that if you don’t believe him when he says Romneycare and Obamacare are different, Romneycare isn’t working either. The numbers he cites about the cost curve are important. Peter Suderman also gives us reasons to doubt that the recent Bay State news is as good as it looks. But wouldn’t it be easier to say that the architecture of Obamacare is failing in Massachusetts, which had a low percentage of uninsured residents to start with, than to try to engage in this parsing?