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Ezra Klein’s Wishful Thinking



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Obamacare’s advocates are desperately trying to reverse public opinion, even as the evidence mounts that the voters aren’t buying it — and that they shouldn’t. Ezra Klein fired the latest salvo arguing that (a) the Massachusetts reforms are the same as Obamacare and that (b) evidence from Massachusetts indicates that Obamacare is working.

Wrong on both counts.

The myth that the Massachusetts reforms are the same as Obamacare is built on a shaky foundation of facts.  Yes, Massachusetts re-directed existing health spending to expand coverage. The resemblance ends there. Massachusetts did not have $500 billion in new taxes on investment income, medical devices, health insurance companies, and “Cadillac” health-insurance policies. Massachusetts did not have a dangerous Independent Payment Advisory Board, misguided Patient-Centered Outcomes Research Institute, futile Center for Medicare & Medicaid Innovation, and myriad other agencies, boards and bureaucracies. Massachusetts did not rely on budget gimmicks like the CLASS Act, student loan “savings,” and mythical Medicare cuts to squeeze past the finish line.

Obamacare and the Massachusetts reforms are not even close cousins.

And if advocates wish to cling to the myth of twin reforms, the facts bode poorly for Obamacare. Massachusetts had a relatively low number of uninsured at the time of reform. It can shed no light on the likely success of Obamacare’s massive apparatus of federal and state exchanges, creation of a trillion-dollar new entitlement, and expansion of Medicaid. The early results are not promising, with a growing legacy of missed deadlines.

More importantly, there is no evidence of bending the cost curve in Massachusetts. Health-care spending per capita in Massachusetts is 36 percent higher than in the other 49 states ($9,278 versus $6,815 in 2009). And there is nothing promising about the post-trajectory reforms. From 1991 to 2005, spending per capita grew faster in Massachusetts (5.9 percent) than elsewhere (5.6 percent); post-reform, the difference grew, as Massachusetts grew at 5.1 percent between 2006 and 2009 while the remainder of the states grew at only 4.2 percent annually.

Obamacare is not the same as the Massachusetts reforms. And it is not working.



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