Can We Please Stop Hyping Death and Taxes?

(Photo: Thinkstock)

But economists don’t know with any precision what would happen to the ranks of uninsured people if the mandate were repealed. Because a mandate to buy health insurance is such an unusual feature of public policy — and because so much else in health policy changed when the mandate took effect in 2014 — it is hard to empirically estimate its effects.

This uncertainty has been illustrated by the CBO itself. Last month, it concluded that it had been overestimating the mandate’s effectiveness, and therefore reduced its estimate by nearly 20%. My guess is that the CBO is still overestimating the mandate’s effectiveness, and that many fewer than 13 million people will move into the ranks of the uninsured if the mandate is eliminated. The available evidence on the individual mandate seems to point in that direction, and the CBO’s initial analysis that obtaining health insurance would become a social norm as a consequence of the mandate strikes me as off the mark.

Rather than engaging in rhetorical excess about the GOP tax overhaul causing thousands to die, it would be better to discuss how to move health policy forward when Republicans succeed — as they almost certainly will — in repealing the individual mandate while leaving the rest of the ACA largely intact.

Republicans should not simply eliminate the mandate and call it a day. Doing so could increase premiums, ultimately adding to the burden faced by taxpayers. And in some parts of the country it could disrupt the individual market for health insurance. It would also be a missed opportunity to improve health policy.

They should enact real health care reform, with universal coverage against catastrophic medical events as their ultimate goal. As part of this effort, subsidies should be offered to those who can’t afford coverage, people with pre-existing conditions should be protected, and individuals should be encouraged to purchase coverage through means less heavy-handed, and potentially more effective, than the ACA’s mandate. In addition, Republicans should inject market discipline into the system as a way to control costs and encourage innovation and productivity. Democrats will have a different approach, with many arguing for a single-payer, Medicare-for-all system. Let’s have that debate.

A problem with exaggerated rhetoric is that it inhibits productive debate. Back in 2009, some conservatives, notably Sarah Palin, argued that Obamacare would create “death panels.” This rhetoric was irresponsible, and it short-circuited an important national conversation about end-of-life counseling.

It’s disheartening to hear that type of rhetorical excess return — especially from those who know better.

— For more columns from Bloomberg View, visit http://www.bloomberg.com/view.