What's the Price of an Acceptable Health Care Bill?

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Ezra asks a question that Peter and I were talking about last night:  what's the price tag after which health care reform's supporters no longer think it's worth passing?  We were discussing the rumors that the administration is going to try to shave the price tag in order to make the thing more politically palatable.  The problem is, what do you cut? 

At this point, all the remaining items on the table:  mandate, guaranteed issue, community rating, subsidies--are pretty much a package deal.  If you take out the mandate, guaranteed issue and community rating will make insurance very expensive, driving all but the very sick, and relatively affluent, out of the market.  If you take out guaranteed issue, the mandate is nonsensical.  Take out community rating, and you lose the main point, which is to have young healthy people pool their premiums with those of the old and sick.  And if you lose the subsidies, you will be in effect commanding people to buy something they can't afford.

You could just sort of trim the subsidies . . . but I think the key sell on health insurance is, as Mickey Kaus has said, the security aspect:  tell people it may be expensive, but for the first time in their lives, they can have total health care piece of mind.  However.  If you cut the subsidies to the middle class, they will freak out about the mandate.  Rather than increasing their security by relieving them of worry that they will end up uninsured, you're suddenly telling folks that they could end up with no employer coverage and a gigantic mandatory bill.   If they wanted to plan on buying health insurance if they lose the coverage they've got, they wouldn't be voting for Democrats.

I will be very interested to see what Obama says next week.


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Megan McArdle is a columnist at Bloomberg View and a former senior editor at The Atlantic. Her new book is The Up Side of Down.

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