I like Tyler Cowen a lot, but this is a bit of a bizarre post. If Tyler Cowen were indeed Ezra Klein, he wouldn't actually long for single-payer, as it's not what Ezra Klein longs for. Instead, he'd long for a substantially public health care system in which government provides a guarantee of basic services, heavily regulated private insurers fight to compete against the basic plan, and somewhat less regulated private insurers compete with a public insurer to provide supplementary coverage to those who can afford it (those who cannot would be subsidized into the public insurer). He'd think all this because he believes the profit motive is largely pernicious in the delivery of heath care, but nevertheless takes seriously fears of "no exit," thinks that it's possible insurers will come up with good ideas that it's worth forcing government to adapt against, and believes that folks should be able to spend as much money on health care as they please -- health care should have a floor, but not a ceiling. Additionally, if Tyler Cowen were Ezra Klein, he would be deeply skeptical of Barack Obama. He'd think Obama can give a beautiful, inspiring, speech, but has demonstrated, at various times, a lack of interest, sophistication, and gut commitment to reform. He'd remember the roll-out of Obama's health policy, know who Obama's health policy advisers are, and have concluded that, of the three major Democrats still vying for the nomination, Obama is the least likely to risk his presidency on universal health care reform, and the most likely to spend that capital on other priorities. He'd know that the politics of mandate-less plans don't work out, as they force reformers to bargain away regulation of insurers preemptively, and he'd be fully aware that there's no way you'll pass the bitter pill of a mandate on its own, after the fact. You need the sweetener of universal health care reform. Mindful of the amount of lying and pandering that goes on during campaigns, he'd take the absence of the mandate in Obama's plan as the best information available on Obama's intentions, or lack thereof, on universal health reform, and he'd spend a lot of time attacking on the issue in order to push Obama's people into more concrete commitments, and serious thinking, about reform. But Tyler Cowen is not Ezra Klein. Tyler Cowen is a libertarian economist with a wildly different set of assumptions about human behavior, the policy process, and political change. I am Ezra Klein. And this is what I think.
