Ezra Klein thinks I’m either misinformed or an agent of misinformation. My response:

1. Ezra’s rant about “annexation” is a tiresome exercise in semantics. Ezra’s style (“Look out! I’m about to get wonky!”) is so focused on policy details that he often loses sight of the bigger picture, either by accident or on purpose. When every American citizen is required to buy health insurance, regardless of whether they think it’s in their best interest to do so, then the health-care sector has been brought fully under the thumb of the federal government and there is no way out. It is one thing to subsidize endlessly, through preferential tax arrangements and social insurance and entitlement programs, a system that relies on third-party payers for the first-dollar provision of basic medical care. It is another to add fines and jail time for refusing to comply with this system — for refusing, if you are young and healthy, to subsidize care for the middle-aged, who are at the peak of their earning power.

2. “Spruiell goes on to say a bunch of other things that are not true,” Ezra writes, but he only addresses one of my claims. We’ll get to that. Here are the other things I wrote which he did not address:

The Democrats’ bill maintains private doctors and hospitals — in the sense that they would only be mostly paid by the government: As it stands, federal, state and local spending as a share of all health-care expenditures is 47 percent. The subsidies, Medicaid and S-CHIP expansions in the Democrats’ bill would, over time, easily push that percentage past 50. And its cuts to Medicare would not offset the growth in Medicare spending that will push the government’s share of total expenditures even higher. How is that not true?

It maintains private medical device companies — because somebody has to pay higher taxes to fund this monstrosity: CBO: “The legislation would impose several new fees on firms in the health sector. New fees would be imposed on providers of health insurance and on manufacturers and importers of medical devices. Both of those fees would be largely passed through to consumers in the form of higher premiums for private coverage.” How is that not true?

It makes Medicaid available to childless adults: Well, it does. How is that not true?

It raises marginal tax rates, discouraging work and investment: Again, it just does. If you are below a certain income threshold and your income rises, you lose your health-care subsidies. That would constitute a large marginal tax-rate hike for many families. And high-income families pay higher payroll taxes under the Democrats’ bill. That’s another marginal tax-rate hike. How is that not true?

It increases the cost of hiring new workers: For many employers it certainly does. Employers pay a penalty if the benefits they offer don’t fall within a government-defined range of affordability, meaning they either have to bring contributions up or pay a fine. How is that not true?

It adds to long-term deficits while increasing the size of government: The last part is undoubtedly true, though the first part is subject to some debate. I agree with Paul Ryan’s critique of the Democrats’ budget gimmickry and find Ezra’s counterarguments unpersuasive. The arguments Ezra offers amount to a blanket excuse for removing or delaying any provision of the bill that adds unacceptably to its ten-year budget score — he really says little more than “Republicans do it too” or, with regard to the Doc Fix, “That’s just a separate issue.” The criteria for what constitutes a separate issue appears to be… whether or not it adds unacceptably to the bill’s ten-year budget score! Although maybe Ezra’s analysis runs deeper than that. His metaphor about how the Medicare Sustainable Growth Rate is a leaky roof on your old house, and you’re buying a new house, but you need to fix your old roof, or something like that, was a little too convoluted for me to follow.

The one argument Ezra attempts to refute is my claim that the bill would cause premiums to go up. This was the crux of the dispute that arose between Sen. Lamar Alexander and President Obama at last month’s health-care summit. I think the arguments on both sides have been adequately ventilated, but just a quick rehash: The Democrats’ bill essentially outlaws cheap insurance — premiums will rise because all policies will have to meet some minimum threshold of acceptability to the federal government. Why? Because, as George Will sharply observed on ABC’s This Week Sunday, “There you have the premise of this legislation and the core of today’s liberalism: The American people are such dopes, they can’t be counted upon to buy their own insurance.”

Ezra argues that the government would provide subsidies to offset the higher costs — again, as if the money doesn’t have to be borrowed or taxed from someone first — and that it would only affect the individual market, not the group market, so that most people who get insurance through their employers would not be affected. Of course, the group market is already subject to extensive federal regulation under ERISA, and in this sense Ezra has a point when he objects to words such as “annexation” and phrases like “one-sixth of the American economy”: So much of the sector has been annexed already, we’re probably talking about a smaller percentage than that. But once citizens can be fined or jailed for non-participation in the system, I would argue that it has been fully annexed, and that it would take a monumental effort to reverse course.

3. This brings me to the last point I made in my post, which Ezra did not bother to address: Most important, it is the first (or the latest, if you prefer) step down the road to single-payer. This is debatable, but it is beyond debate that many liberals and Democrats are hoping this is the case. I get the sense that Ezra sympathizes with this goal and realizes that progressives have to work incrementally to get there. He sees this bill as a first step toward something he admits that conservatives would be right to fear, even as he disingenuously argues that we shouldn’t fear this bill.

P.S. My favorite part of that post is when Ezra wishes that the crew around here would adopt the “more-in-sorrow-than-in-anger” tone of David Brooks. Sorry. Not while there’s a chance that this thing might actually pass.