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Harold Pollack on Sensible Economists Support Health Care Reform


Dog bites man: 270+ health, public finance, and labor economists oppose repeal of health reform: Several of us drafted the economists’ letter. It opposes the repeal of health reform. It also rebuts the “job-killing” charge Republicans are making about the Affordable Care Act. We got more than 270 signatures, and counting. With a tiny number of exceptions, we confined the letter to health, labor, and public finance economists. Had we included other public health and health policy experts and clinicians, we could have easily gotten huge numbers.

It makes an interesting contrast to a similar Republican effort here. I hope that readers look at both letters.

Consider the tone and the quality of the arguments. To take an obvious example, The Republican letter criticizes ACA as “A crushing debt burden,” and writes the weasel words “could potentially [ialics mine] raise the federal deficit by more than $500 billion during the first ten years and by nearly $1.5 trillion in the following decade.” They do not acknowledge that the Congressional Budget Office scores the repeal legislation as raising the deficit by $230 billion.

Less obviously, look at who signed. Andrew Sabl has knocked the Republican letter already for its lack of luminaries. That’s not my point. Their list includes some very accomplished people.

Their list does not include many people at the core of health policy analysis and research. With the exception of Douglas Holtz-Eakin, Joseph Antos, June O’Neill and a very small number of others, their list does not even include many of the standard Republican policy experts I would expect to see. Then look through our 270 names. It includes people like Hank Aaron, Alice Rivlin, Kenneth Arrow, David Cutler, Alan Krueger, Jon Gruber, Uwe Reinhardt, Hal Luft, Charles Schultze, and many more. These are not ideologues. They are not only at the top of the profession. These are pioneers in the fields of public finance and health services research who in many ways provided the intellectual groundwork and the empirical research on which current health policy debate is based.

Partisan noise aside, the overwhelming majority of serious health policy and public finance researchers support the Affordable Care Act and want it to work. Indeed, I believe that most Republican policy wonks who would repeal the provisions that cover the uninsured still support the delivery reforms embodied in the new law. The dirty secret of Washington politics is that policy wonks on both sides have much more in common with each other– say on the new Independent payment Advisory Board, or on overpayments to Medicare Advantage plans–than either side has in common with, say, Congressional committee chairs who want to meddle in Medicare reimbursements for surgeries and medical devices.

I hope, as we move forward, that a responsible, incremental Republican opposition emerges that makes possible improvement and genuine negotiation in the implementation of this new law.

Antos, Holtz-Eakin, and O'Neill ought to know better. Hell, they do know better.