A defense of the fiscal responsibility of the Senate Health bill

Tyler Cowen attacks those of us who support the bill claiming we retreat into the relative.  In short, he doesn’t believe the various automatic cuts will happen and is unsatisfied with our defenses of those cuts.

This fight gets more into political science than economics as such.  The economics of the bill as written are covered by the CBO, the question is whether the politics of the bill are sustainable.

Here’s why I think they are:

1. Assuming no changes to the filibuster as implemented in the 21st century, post-passage it will be possible to defend the fiscal responsibility of the bill with 41 votes rather than the 60 votes otherwise required (or 51 votes and luck of the draw if using reconciliation).
2. People with expensive health plans are elite, but they lack the organizational infrastructure and natural ties held by the doctors and elderly who have blocked automatic Medicare cuts.  Their negotiating clout is undercut by the fact that the group contains natural enemies: union workers and corporate execs.  Further, their numbers will be decreased by many companies choosing to simply avoid the health care excise by giving more taxable income.
3. Democrats, under the prior Democratic president, managed to balance the budget.  The good economic times of the 90s were certainly critical to that happening, but we managed it nonetheless largely due to the revenue raising that helped lose us the Congress.  Why would we do it again after losing the Congress the last time?  I don’t believe in politician fiscal hawks, but I do believe that your average Democratic Representative and Senator faces more elite pressure to do something about the deficit than expand health benefits.  Universal Healthcare does address a core middle class concern, but things like the level of subsidies and the benefits of the bronze plan are going to be lower priority for Democratic leadership than being described by the media as fiscally responsible.  If this wasn’t the case, then why did the Reid bill come it at $856B rather than maxing out the $900B the President suggested.  Liberal bloggers, such as myself, won’t get their in a better world cost reductions but we also won’t get our better world benefits for the poor.
4. This will make it easier to raise the eligibility age for Medicare once universal healthcare is in place.  We can do something sensible like index it to the expected lifespan.  Obviously this will be grandfathered in due to the political clout of the elderly, but those who aren’t that near receiving benefits are a larger group that won’t be as motivated.
5. Some of the bloggers Tyler is critiquing are willing to say that the new mammogram guidelines could well be a good idea and that critics should provide counter arguments based on science.  There may well be strong counterarguments, I’d be curious if the false positive downsides still outweighed the detection upsides if we’re talking African American and/or lower income women, but I need to see that data before I go along with the critique. Furthermore, when it comes to things like mammograms, many people are averse to getting tests in the first place, stopping government encouragement for those under 50 without special risk factors, even if coverage is maintained, should make a difference in usage.  I will concede that this up roar and HHS concessions does bad for us, but the strength of the response on breast cancer is the exception as advocates for breast cancer patients are highly organized and feminist groups are on edge after being backstabbed in the House.  There was not a political response of the same magnitude of recommendations on prostate cancer screens.  Interestingly enough, the American Cancer Society didn’t object to those, so I think their critique on changing mammogram standards should certainly get a fair hearing.  Also, I’ll note the fact that the timing of this release shows the scientific independence of the review process, the timing was awful.