Krugman tries to make healthcare reform case — and doesn't

Paul Krugman argues, primarily from issues of recission, or insurance companies revoking clients' policies, that we need to pass Obamacare.

So what’s the answer? Americans overwhelmingly favor guaranteeing coverage to those with pre-existing conditions — but you can’t do that without pursuing broad-based reform. To make insurance affordable, you have to keep currently healthy people in the risk pool, which means requiring that everyone or almost everyone buy coverage. You can’t do that without financial aid to lower-income Americans so that they can pay the premiums. So you end up with a tripartite policy: elimination of medical discrimination, mandated coverage, and premium subsidies.

So, that's his baseline argument for Obama's program.

That said, is he right that the stool's three legs are interconnected and inseparable? Is he right that these are the three most needed legs?

Krugman offers his answer:

But shouldn’t we be focused on controlling costs rather than extending coverage? Actually, the proposed reform does more to control health care costs than any previous legislation, paying for expanded coverage by reducing the rate at which Medicare costs will grow, substantially improving Medicare’s long-run financing along the way.

And, that's the point at which I disagree with people like him.

Without real, vigorous federal regulation not proposed at all in Obama's bill, while Obamacare may "do more to control health care costs than any previous legislation," that's like saying the House's current climate control bill "may do more to control carbon emissions than any previous legislation."

In other words, it doesn't necessarily say much of anything.

We aren't getting a federal bureau of insurance regulation to regulate rates. The antitrust exemption revocation is not something that is reconcilation passable. So what if we get more people buying insurance, if state insurance agencies are still as weak as tissue paper.

Reducing the rate at which Medicare rates will grow? What if that, in the long term, is more than offset by federal subsidy payments to buy insurance, less "Cadillac taxes" or other fees? That may not at all be likely. But, absent the regulatory environment I just mentioned, with an even more rigged market due to compulsory buying, contra both Krugman and the Congressional Budget Office, there's no guarantee that WON'T be the case, either.

So, let's call this "not proven." Obama's bill, as it now stands, is an existential leap of faith at bottom line.

On the other hand, at least Krugman has the decency, and the brains, NOT to argue for "Obama's legacy." Or, rather, "Obama's political capital."