Dayen has this covered fairly well (although I don’t endorse the ad hominem bits), but I still have a some things to say about Jon Chait’s call for a pre-emptive surrender on raising the Medicare eligibility age. First of all, Yglesias is right that it’s impossible to evaluate the concept without knowing what we’re getting in return, and it’s true that to get something in a negotiation you generally have to give something. But this really helps Chait only in the most theoretical sense. Not only because Chait is offering to make what everyone agrees would be a really, really terrible policy concession without explaining what Republicans have to give up for it, but because nothing that’s being discussed would make remotely it worth it. Sure, if you could really substantively strengthen the ACA by trading the eligibility age for a robust public option and more money for Medicaid that would provide greater incentives for recalcitrant states, that might be worth doing. But there’s no plausible scenario in which Republicans will actually offer anything like that. The actual deal apparently being discussed — trading terrible Medicare policy changes for less than you’d get in upper-class tax rate increases if you just did nothing — would be an incredibly bad deal that suggests that Obama hasn’t learned anything about dealing with congressional Republicans. Right, you have to give something to get something — but the expiration of the Bush tax cuts and the defense cuts in the sequester already provide plenty of leverage.
So why on earth are we talking about making a major policy concession on Medicare in exchange for unspecified concessions that Obama can probably get using the leverage derived from the sequester? Chait offers a couple of unconvincing justifications. The first argument is that raising the eligibility age has a “weirdly disproportionate symbolic power, both among Republicans in Congress and establishmentarian fiscal scolds. Mitch McConnell and Erskine Bowles alike would regard raising the retirement age as a sign of serious belt-tightening and the “structural reforms” conservatives say they need.” I don’t really buy it. Bowles might like it, but he doesn’t actually have any meaningful constituency. In terms of congressional Republicans I’m much less convinced. Again, I need to know what I’m getting in exchange for this, and there’s nothing Republicans seem to be offering that wouldn’t be plausibly attainable by offering middle-class tax cuts and restoring some defense spending after January 1. (And I’d rather compromise on tax rates than by weakening the welfare state, particularly since any win on raising the top marginal rates will last until the next time the Republicans control the White House and the House of Representatives simultaneously.)
There’s a second justification, which is essentially a heighten-the-contradictions from the center. The policy change will be so bad that it will be good because people will agitate to make it better:
What’s more, raising the Medicare retirement age would help strengthen the fight to preserve the Affordable Care Act. Republicans may be coming to grips with their lack of leverage over the Bush tax cuts, but their jihad against universal health insurance lives on. Having narrowly lost their wildly tendentious legal argument for striking down health care, they are devising newer and even more implausible ones. Republican governors continue to turn down federal funding to cover their poorest uninsured citizens and refuse to set up private insurance exchanges.
The political basis for the right’s opposition to universal health insurance has always been that the uninsured are politically disorganized and weak. But a side effect of raising the Medicare retirement age would be that a large cohort of 65- and 66-year-olds would suddenly find themselves needing the Affordable Care Act to buy their health insurance. Which is to say, Republicans attacking the Affordable Care Act would no longer be attacking the usual band of very poor or desperate people they can afford to ignore but a significant chunk of middle-class voters who have grown accustomed to the assumption that they will be able to afford health care. Strengthening the political coalition for universal coverage seems like a helpful side benefit — possibly even one conservatives come to regret, and liberals, to feel relief they accepted.
As with most heighten-the-contradictions arguments, this is unconvincing in the extreme. First of all, particularly given that a significant number of states haven’t bought into the Medicaid expansion and aren’t in any hurry to establish functional exchanges, this will create a lot of suffering for people while we wait for 66- and 67- year olds to work their political magic and convince Republicans to strengthen the ACA. (We’re also assuming that seniors in deep-red states will blame Republicans rather than the ACA for losing their insurance, which seems…optimistic.) And second, as Dayen says in his follow-up response, the idea that “that the reliance of those aged 26-64 on insurance exchanges to deliver affordable health care is not enough of a constituency behind the program, but adding in those aged 65 and 66 will simply put it over the top” isn’t well-founded. A leftist who took their own heighten-the-contradictions rhetoric against the PPACA seriously might favor the Ryan voucherization program and would have logically opposed Medicare when it was passed. As we saw during the debates over the PPACA giving everybody over the age of 65 single-payer made assembling a coalition for better heath care policy going forward much more difficult, since a class of people disproportionately likely to vote had nothing to gain and things to fear from universal health care reform. (Fortunately, most lefties making h-t-c arguments don’t really take them seriously, and since Medicare wasn’t signed into law by Barack Obama but by a previous Democratic president whose compromises can be forgiven, the suffering-now-because-magic-ponies-later logic isn’t compelling to anybody.) Even so, this would be a terrible idea because getting European-style health care (whether in hybrid or single-payer form) would be enormously difficult even with more people over 65 on your side; the most likely outcome of not doing Medicare would have been worse coverage for seniors and nothing for everyone else, not Medicare for all. It’s hard to imagine what political power 66- and 67- year olds alone will add to your coalition that could make this kind of concession worth it, and moreover it can “work” only by completely screwing them over in the short-term for benefits that may or may not materialize. I’ll pass, thanks.
…Cohn has more.