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.