Great post — I am getting more interested in connecting up historical analysis with contemporary politics, so I am always inspired by people who can do this naturally! Glad you enjoyed my book and Happy New Year from –Liz Borgwardt

The important thing to understand is that this excise tax only applies to health insurance plans that are way too expensive. You call them “high-quality” plans, but it’s not clear that these plans actually provide better care. They are “high-cost” plans, and the people who receive them are the health care rich. These plans should be taxed to raise money to provide health care to people who can’t afford it.

If, as a result of this excise tax, the employers who offer these super-expensive plans decide to offer their workers cheaper plans instead, that’s a big step in the right direction isn’t it? Or are you arguing that union workers cannot afford or accept the very health-care plans the rest of us consider adequate?

Individuals are willing to pay huge amounts of money out of pocket for medical treatment, and the massive bureaucracies surrounding insurers and providers will not disappear. Providers want to squeeze every cent they can out of private insurers, and private insurers would rather pay a bureaucrat to contest a bill than simply pay the bill.

All the general-inflation-indexed excise tax will do is gut employer-provided plans (which tend for complex reasons to overwhelmingly affect unionized workers). Once a company has decided to provide high-deductible, high-copay insurance, why would removing the excise tax cause that company to reverse course and provide what it removed? The negotiated health plans will be gone, and unions are weaker today than they’ve ever been. It seems plausible to me that there would be no recovery of the lost high-quality health insurance plans.

Moreover, the excise tax is POPULAR with deficit-hawk centrists and conservatives. They *like* the excise tax, and not because it is supposed to control medical inflation, but because it makes the bill more “budget neutral.” Why wouldn’t they filibuster any attempt to remove it, or make removing it conditional on gutting other positive aspects of HCR.

I think Jon Walker at FDL is correct: During the conference committee, the White House should push to eliminate the excise tax — using the House’s deficit-reduction scheme instead — or index the tax to medical inflation, so it really only punishes those plans that are “excessive” relative to the industry mean.

The problem to be solved is medical inflation. This version of the excise tax doesn’t solve the problem except — as far as I can tell — by arguably irreversibly reducing the quality of existing health care over the long term.

Here’s what Keil wrote in a blog post from Dec. 11, 2009:

“This week, the administration has been trumpeting the news that the $700 billion TARP is likely to ultimately cost much less than early estimates. That’s true, but far from the whole story.

The government’s best estimate, released Wednesday, is that the bailouts of AIG and the auto companies will ultimately cost taxpayers about $61 billion. It also forecast that other parts of the TARP will end up making taxpayers money. Put it all together, and the final estimated loss from the bailout’s first full year (thru September 2009) is about $41.6 billion. (See our table below.)

Projected Income ($ Bn)
Est. income from bank investments $15.033
Est. income from extra aid to BoA and Citi $4.128
Est. income from TALF $0.339
Projected Income $19.5
Projected Losses
Est. loss from AIG investments $-30.427
Est. loss from auto company bailouts $-30.477
2009 costs from foreclosure prevention program $-0.002
Administrative costs $-0.167
Projected Loss $-61.073
Est. Total Net Loss $-41.573

The projections reflect only spending through September of this year.

It’s certainly true that the picture has brightened in the past year. When the Congressional Budget Office took a look in January at the TARP’s main bank bailout program, it estimated that the government was about $32 billion in the hole from those investments. With the freshening of the economy and recent reimbursements by the major banks (Bank of America in particular), the Treasury now forecasts that the program will end up making the taxpayer about $15 billion.

But the Treasury’s numbers aren’t the whole story. The latest estimate accounts for only the first year of spending, and the TARP’s spending isn’t done. Treasury says it expects the ultimate cost to be higher. Treasury Secretary Tim Geithner extended the TARP thru Oct. 3, 2010, the TARP’s second birthday, earlier this week. He said, though, that Treasury didn’t expect to deploy more than $550 billion of the $700 billion available. As of today, Treasury has committed a total of about $407.3 billion (that’s excluding companies that have refunded their bailout money).

Because the latest estimate deals only with the TARP’s first year, it doesn’t include two big programs that recently ramped up. The foreclosure prevention program, in terms of spending, is just getting started. It’s unclear how much of the $50 billion set aside for that program will ultimately be spent, because of the program’s difficulties [10]: As of the end of October, Treasury had paid only $2.3 million in incentives to servicers. But whatever Treasury ultimately spends, none of that money will come back, since the program involves subsidies, not investments.

The $30 billion toxic asset purchase program also got started only in the past couple months. That program involves investments and loans, but it’s hard at this point to forecast how it will fare.

The second thing to keep in mind is that the Treasury has also sunk more than $110 billion into Fannie Mae and Freddie Mac. That spending wasn’t part of the administration’s estimates, because it wasn’t done via the TARP.

Treasury also forecasts big losses in other parts of the TARP. Approximately $73 billion went to auto companies; Treasury currently expects to lose about $30.5 billion of that. The AIG bailout fares much worse: $43.2 billion had been spent through September and Treasury forecasts losing $30.4 billion (about 70 percent!). And here’s another opportunity to add a caveat: The projected losses on AIG don’t include $2.1 billion that was loaned last month – and the Treasury could loan as much as $24.5 billion more.

Of course, all these are estimates. If the economy continues to improve and the car market booms, then the government might not lose quite so much in its investment in GM, for example. In the meantime, we will continue to post our monthly updates on the bailout, which rely on hard numbers to give you an accurate picture of how the taxpayer is faring.”

So how are you gettingf $3.2 trillion to $12.6 trillion out of any of this? And are you suggesting that we shouldn’t have bailed out the auto companies?

The TARP — which is what people generally refer to when they talk about the bank bailout — will end up costing nothing. If you have complaints about other government programs, what are they?

As for the various bailouts over these last two years, it has by any measure been a pricey debacle. Even assuming every penny of the TARP money gets repaid — and ignoring the opportunity costs — there’s much more taxpayer money sloshing around out there. Reporting for “Newsweek” back in April, Barrett Sheridan wrote:

“Last week, Paul Kiel over at ProPublica’s very good Eye on the Bailout blog surveyed three of the latest estimates of the total bailout “cost” thus far. I put “cost” in quotes because, as the various analyses make clear, the true cost ranges anywhere from $3.2 trillion to $12.8 trillion–leaving a gap of $9.6 trillion.”

It’s true that the bank bailout has restored the status quo and that more reform is needed to make sure another financial crisis doesn’t happen. Criticizing TARP for restoring the “status quo” is like criticizing firefighters for merely putting out the fire instead of renovating the property to make it fire-resistent.

You say “arguing counterfactually about what the bill will or won’t do won’t convince anyone.” You then say you don’t think the bill will do much. But I’ve heard it said in the “mainstream media” that this bill in its latest version will bring health insurance to about 30 million Americans who don’t have it currently. You may be right that this bill won’t provide perfect coverage for everyone — it won’t solve all the problems in our health care system — but isn’t it “counterfactual” to suggest this bill won’t “do much?”

I can respect the fact that you don’t follow leaders. But I’ve been following Obama since early 2008, and I have a hard time believing the he and his fellow Democrats are going to raise taxes, reduce Medicare spending by hundreds of billions over the next decade, spend hundreds of billions on healthcare over the next decade, and the result will be “not much.” What about the subsidies to help poor people afford health insurance? Surely that has to count for something, right?

If this bill turns out to be beneficial for the American people, I’ll be pretty annoyed at Dean and others who tried to spin this historic acheivement as a failure because they were pissed at having to make compromises.

Personally, based on what I’ve read, I don’t think it’ll do much, without significant additional reform, to fix our health care system, and we won’t even be able to assess its effectiveness until Obama’s — possible — second term. I think “coverage” will in many cases be coverage in name only, universal health care with high co-pays, deductibles, unenforced regulations, clever legal work-rounds by means of which powerful health insurance companies will avoid giving coverage, etc.

There is of course a lot that can be done to fix the bill between now and 2013. I don’t think Democrats will do what needs to be done, for the same reason that they didn’t pass a very good bill this time. But that’s partly up to us. If progressives mobilize and organize and eliminate Lieberman-like senators and launch primary challenges against blue dog Democrats and continue to turn red districts blue and put pressure on our elected leaders to keep their promises, we’ll be in a strong position to demand the changes that both sides of this debate — the so-called wonks and activists — both agree they want to see.

As for the progressive “leaders” you mention — I don’t consider them my “leaders,” but I suppose they lead some — they should be listened to when they make sense, and disagreed with when they don’t. (Krugman happens to be in the pro-Senate bill camp, btw, though he like everyone acknowledges its serious flaws.) As for the financial crisis, I believe that we have not addressed the fundamental problems that caused the financial crisis, and that there will be bigger and worse crises to come absent serious reform. What TARP has done is stabilize the banks in the short term, with little upside for the taxpayer, restoring the status quo ante.

TARP (and TALF and all the acronymed uses of our tax dollars) remains a pricey debacle — think of the opportunity costs; what else could that money have been spent on? what would returns have been if we had nationalized/restructured/prereprivatized/whatever the four largest banks in the country? These measures don’t make sense from the perspective of solving the problems we still need solved. The surviving financial companies are larger, more consolidated, more powerful. They remain “too big to fail” and will thus receive taxpayer bailouts next time and every time they fail.