More From the Buy Now, Pay Later Crowd


In an interview with Ezra Klein, MIT economist Jonathan Gruber comes out swinging in favor of what I've previously called the "buy now, pay later" theory of health care reform: First cover (nearly) everyone, then figure out how to pay for it later once everyone is already locked in.

Here's Gruber:

My view is, even if the bill did no cost control it would be an incredible thing for this country. But politically, it sets the stage for cost control in two senses. First, it puts in place all the things we can do now. It does comparative effectiveness and pilots and all the rest. But second, once you get coverage off the table, the conversation gets more focused on cost control.

… People say you can't do coverage without cost control. I think it's the opposite. You can't do cost control before coverage.

Granted, this isn't terribly surprising given that Gruber was a major influence on the Massachusetts plan, which first employed the buy-now-pay-later strategy and has become a model for national reform. And indeed, in the interview, Gruber explicitly compares current reform bills to what was done in Massachusetts.

Problem is, Massachusetts hasn't managed to achieve anything like cost control. Its premiums are the highest in the nation, its health-system commissioners fear it's heading towards bankruptcy, and even those who believe that it's a model for reform admit that, without significant changes, the long term viability of the entire system could be threatened.

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  1. What the hell is “cost control”? Something to do with casualties in the Middle East maybe?

  2. MIT economist Jonathan Gruber

    He’s an economist?

    He’s from MIT?

    Where’s his brain?

    1. MIT economist Jonathan Gruber

      He’s an economist?

      He’s from MIT?

      Where’s his brain?

      Lumped together in the foul belly of the same shaggy beast that consumed Krugmans M.I.T. skull nugget and left the empty volume stuffed with used napkins.

    2. Massachusetts is all right?
      Somebody check his brain.

  3. You can’t do cost control before coverage.

    In other words:

    You can’t clean up a mess before making one.

    1. Of course you can. You allow people to buy insurance across state lines, avoiding expensive state mandates. You allow pharmacists to dispense drugs directly, the way they used to be able to. You reform tort law and reduce defensive medicine and malpractice insurance costs. You reform the FDA so that drug companies don’t have to spend a billion dollars in order to sell a medicine. You reduce the power of the AMA. Etc.

      There are many ways to reduce the cost of medicine, but unfortunately Obama and the Democrats are doing none of them.

  4. Gruber?… Gruber?… Gruber?

  5. John Gruber stands by his work in Massachusetts, and has Ezra Klein to back him up, of course, but his analysis (doc) is shoddy work: He projects figures out to 2016 using computer models with huge assumptions built in. Reminds me of another dismal science…

  6. Old Mexican, you totally stole the words out of my brain. Seriously, Gruber’s plan doesn’t sound like a good idea even to those of us with modest intellects.

  7. So he’s saying we need something and then once we have paid for it with our credit card, then we’ll figure out how to make it less expensive. Wow, he went full retard on that one.

  8. Gruber is half-right. It’s very difficult to extract efficiencies from complex systems until those systems are given time to operate and highlight those inefficiencies.

    Gruber, of course, suffers from the fatal conceit of all central planners who believe that they’d be able to then crack the code all by their lonesome, and that the inefficiencies are a result of a few selectively poor management choices, instead of a flawed underlying architecture.

    1. What MP said.

  9. We could look at the long history of large government bureaucracies that saw steadily diminishing budgets as they worked further to control costs.

    You know, like… uh… one will come to me shortly…

  10. You can’t do Marxism without sealing the borders against emigrants.

    So, he takes Arnold Kling’s concept of “freedom of exit” seriously, by advocating that we eliminate it.

  11. Speaking of Arnold Kling, he recently made much the same point as Gruber did — from the other side of course…

    As I have written before, with a partisan bill, we will get dessert, not spinach. That is, more government subsidies, not efforts to restrain spending.

    Down the road a few years, the Republicans will be invited to join in a statesmanlike effort to control costs. For the spinach, they will be allowed to share credit. Not for the dessert.

  12. It amazes me that otherwise intelligent people can be so stupid. I guess it is arrogance. A normal person would look at the problem and quickly realize that controlling costs like that is impossible or would require such draconian measures to render it impossible. But Gruber and his ilk are so arrogant they think the rules don’t apply to them.

  13. Oh yeah and I want an airplane too.

  14. @John: That isn’t quite it. For these folks, the whole point isn’t to fix the system. They measure the merit of any proposal by the degree of government control it provides; that’s really all they’re after. It’s just an article of faith that that will fix everything.

    1. I don’t think they’re after government control. The problem is that in order to “make the world a better place”, you have to be able to control it. Ergo, the more control government has, the more tools available to “improve” things. That the improvements either don’t happen or end up causing unintended consequences, doesn’t negate the expansion of government power used to bring them about.

      It’s like … you want to get to the other side of the canyon because the grass look so much greener there. So you build a bridge over it. When you get there, you realize the green shit was all poison ivy. But the bridge is still there long after you’ve wandered off to the next mirage.

  15. People say you can’t do coverage without cost control. I think it’s the opposite. You can’t do cost control before coverage.


    1. I think he meant to say,

      People say you can’t do coverage without cost controlling people. I think it’s the opposite. You can’t do cost control people before coverage.

  16. Gruber? I thought Bruce Willis killed that guy.

    1. Yippie-kiy-ay mother fucker.

  17. My view is, even if the bill did no cost control it would be an incredible thing for this country.

    It won’t control costs. It will cause them to rise faster than they already are. I’ll give this guy points for honesty: First lock people into an entitlement then figure out how much it’ll cost later.

  18. Cost control seems more like a process.

    Let’s be clear that Ezra Klein, as eloquent a writer as he can be, is undeniably in favor of any bill that gets health care to everyone. I’m hearing more and more in the last week or so about this so called cost-control process. Isn’t that just code for “we have no idea how this is going to work economically, so we’ll adjust — i.e., make things up — as we go?”

    Is there a historical case in which (the federal government) plunging into the morally righteous unknown leads to a verifiably successful economic outcome?

    1. Let’s be clear that Ezra Klein, even though he is clinically retarded, is undeniably in favor of any bill that gets health care to everyone.
      There fixed it.

      Don’t refer to Klein as eloquent. The man is a complete and utter moron. And he is a dishonest hack to boot.

      1. Well, in the spectrum of morons, I’ve seen far more “complete” ones than Klein — I suspect you have, too. I haven’t really gotten the dishonesty vibe that you got because I think dishonesty stems from an intent to deceive (oneself or others), and Klein just doesn’t seem that clever. You may have read more of his stuff than I have.

  19. Translation: Use the promise of free unlimited health care to get the public to buy in. Then start rationing after they’re hooked.

    Incidentally, if Ezra Klein seriously thinks that all those pilot programs are going to result in some sort of fair, efficient distribution of health care dollars, he’s either naive or disingenuous.

    1. he’s either naive or disingenuous

      Klein is 24 or so, so it might just be a flip of the coin. Fascinated by the praise he receives for his health-care coverage, I followed his posts closely through RSS for about a month before I could stand it no more. Not so much disingenuous, but definitely naive and perhaps misguided from an unimpressive grasp of facts and history. He’s a good food writer, though, in that yuppie/foodie way.

      1. He is just stupid. But is so stupid he doesn’t even understand what he doesn’t know. He doesn’t know how stupid he is. It is a pretty sad statement on our current situation that anyone listens to him about anything.

      2. Ezra Klein is not naive. A naive person is one who holds stupid ideas because they have not been exposed to criticism of their stupid ideas.

        Ezra Klein is out there in the blogosphere, giving and getting criticism every day. He continues to hold those stupid ideas, and indeed lash out at those who criticize them. That’s not naivete — that’s hubris.

        1. Well, naive about the likelihood of the government behaving in a “socially just” fashion, possibly.

          Pretty much all liberals/progressives are. They seriously believe that if everyone is politically involved enough, that “democracy” will result in a fair, equitable, distribution of the resources the state seizes from the bottomless well of rich people and corporations.

          Anyone who has followed politics long enough will observe that’s not what ever happens, but Klein is to young to remember much before the Bush era.

  20. How have we had a post this long without someone mentioning how punchable Ezra Klein is or what a douche he looks like?

  21. The real problem with the far left is that they really do think universal shitty coverage > 75% good private coverage plus 25% shitty or no coverage.

  22. In 10 years Klein will do a full reversal and become an editor at a major conservative or libertarian publication.

  23. What an A-Hole.

    Let me turn on my A-Hole translator

    “…. Let’s promise the moon now, people will see free and painless stuff and of course want it. Then, once we got the power, we fuck them, take away the goodies.”

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