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Problems With a Smaller Bill, Cont'd

The Other Jonathan seconds Ezra Klein's warnings that a smaller bill, as currently envisioned, simply won't work. Jon then goes on to question whether the kind of smaller bill Ezra would substitute*, including a large expansion of Medicaid and a Medicare buy-in, would really work politically.

The goal right now, Jon says, is to act quickly and pivot to focusing on the economy. This, more than anything, seems to be what the electorate wants. Crafting a new bill, even a smaller one, would take weeks if not months.

That sounds right to me. The Medicare buy-in is likely to be as controversial as before--popular with the public, but a tough sell in Washngton. It will be the same backroom deal-making all over again. And, unless my math is wrong, most of the money in such an initiative would go into Medicaid--a worthy enterprise, for sure, but not the easiest to sell. Middle-class independents feel health care reform has nothing to offer them. Passing a bill that raises taxes, even somebody else's taxes, primarily to finance health insurance for the very poor probably won't dispel that perception.

None of this is to say the Medicare-Medicaid alternative isn't worthy on policy grounds. A lot of people would be better off! It's clearly better than nothing.

But nobody should be under the illusion that this sort of bill would be easier politically. I remain convinced (as does Ezra, by the way) that the best path forward is to pass the Senate bill, then fix it later.