By Kevin D. Williamson
Monday, January 05, 2026
I would write here that “I hate to say, ‘I told you so,’”
but, as everybody who reads this column knows, I
kind of enjoy it. But what I’m trying to get across in the following couple
thousand words is more important than “I told you so,” even if I must—in the
entirely disinterested pursuit of the truth, I assure you!—include a little “I
told you so.”
And, here, I’ll include a note to Ezra Klein: I told you
so.
Back in ye olden days of 2009 and 2010, much of American
politics was consumed by the Barack Obama administration’s attempt to push some
kind of large and ambitious-looking health care reform program through
Congress. The administration had staked its reputation on doing something big
on health care, and, at times, it seemed that the president and his allies did
not much care what was in the reform program so long as he could sign a stack of papers
labeled “health care reform,” an eagerness that was not lost on the
comedians of the time.
I was one of the people engaged in that debate, and I
worked from P.J. O’Rourke’s proverb: “If you think health care is expensive
now, wait until you see what it costs when it’s free.” Of course, “free” wasn’t
a huge part of the conversation most of the time, though there was talk of
“single-payer” models, which people often mistake for “free” health care, and
which Americans progressives seem to believe—wrongly—is the norm in Europe and
in the rest of the developed world. National single-payer programs are, in
fact, pretty rare outside of the Anglosphere, and you won’t find much like the
National Health Service of the United Kingdom in Germany, France, Switzerland,
or Denmark. There are lots of different models in different rich countries,
which are executed with varying degrees of success. One common model is what
the United States tried to create by means of the grievously misnamed Patient
Protection and Affordable Care Act, a.k.a. Obamacare, a settlement based on
private insurance manipulated through a complex system of regulation, price
controls, subsidies, and mandates. In the view of many observers, the apex of
that approach is the generally well-regarded Swiss system, which is what some
of the architects and advocates of PPACA had in mind. If you happen to be a
regular Amtrak rider who has had the opportunity to compare American rail to
its Swiss (or German or Dutch) counterparts, then it should be obvious enough
to you that there are things that work very well in Switzerland that do not
work very well in the United States.
And so it has been with PPACA. The Swiss system has
features that PPACA did not even attempt to replicate, some of which would make
libertarian hearts go pitter-patter (there is no publicly provided health care
in Switzerland) and some of which would have Americans raising their Gadsden
flags (the government specifies a minimum policy and requires that firms offer
it on a nonprofit basis); more important, there was a fundamental aspect of the
Swiss system that originally was part of PPACA but which went almost entirely
unenforced before being effectively repealed in the 2017 Tax Cuts and Jobs Act:
the hated “individual mandate.”
The individual mandate is necessary to the overall
structure of a Swiss-style program because of other mandates: that insurers
offer policies to anybody who wants one, that insurers charge customers the
same rates irrespective of age or health, that insurers cover preexisting
conditions, which itself is a demand that renders the notion of insurance
nonsensical (you cannot place a bet against an event in the past), etc. What an
insurance pool needs to be financially sustainable is a relatively large number
of beneficiaries who are relatively young and healthy and who consume
relatively little medical care, whose insurance premiums subsidize care for the
older and sicker patients. Without the individual mandate penalty, people would
have a strong economic incentive to carry no insurance at all until they
got sick enough or old enough to need it, meaning that the insurance pool would
consist disproportionately of people who are old and sick rather than young and
healthy, which would make private insurance economically unfeasible. The
free-rider problem would wreck the system financially.
Because Switzerland is full of Swiss people, compliance
with the individual mandate there is very high, practically universal—above 99
percent. One reason for that is culture, but another is that the mandate is
ruthlessly enforced: If you fail to sign up for insurance coverage in
Switzerland, you’ll get a notice or two and then the government will simply
sign you up for a policy and force you to pay both your current premiums and
the premiums you would have been liable for (with penalties and interest, of
course) during the period when you had no coverage. PPACA’s individual mandate
was supposed to be enforced by means of a mildly punitive surtax amounting to
2.5 percent of household income. While the United States has higher income tax
compliance than you might imagine (normal to above-average among peer
countries), about 15 percent of taxpayers are noncompliant to one degree or
another (underreporting of income is common), which results in the Treasury
losing something on
the order of a half a trillion dollars a year in revenue owed under law.
Americans are not as hard to tax as Greeks or Spaniards, but we are harder to
tax than Swiss or Germans. This is a thing you know if you know Americans.
At the time of the PPACA debate, I argued (as did other
likeminded critics) that it was going to be very, very expensive, and that our
debt-ridden national government was not well-prepared to accept another
expensive health care entitlement. The retort—which, I will say right here, was
not always exactly intellectually honest—was, basically, “You don’t know what
you’re talking about. Look at the CBO score—this is going to reduce the
debt.” Ezra Klein was a particularly insufferable, sneering, po-faced
trafficker in that line of horsepucky, but President Obama himself was the
biggest offender, famously promising that his program would add “not one dime”
to the national debt. Sen. Jeff Sessions, a rather more prominent critic than
your obedient correspondent, asked the Congressional Budget Office to game out
what would happen if—as seemed likely and as actually happened—future
reformers were to set aside some of the unpopular, revenue-raising parts of
PPACA, such as the so-called Cadillac tax on generous private health care plans
such as those enjoyed by the Democrats’ very energetic union constituents, and
certain unpopular
cost-control measures. The result, of course, was that “not one dime” of
new debt would be many, many dimes. MSNBC pundits thundered that this claim was
“one
of the dumbest health care arguments to date,” Mother Jones’ Kevin
Drum wrote
it off as “so obviously moronic that no one with a room-temperature IQ will
pay attention to it,” etc.
I had an exchange with Klein (which seems to have fallen
off the internet) in which I argued that the law was unlikely to be enacted and
executed in its ideal version, and he responded that this view was an error
based on the wrongheaded notion that the government cannot carry out complex
programs effectively. (I am paraphrasing.) And Klein was almost correct about
the source of my reservations: not that no government can carry out any complex
program effectively under any circumstance, but that this government is
not going to carry out this program in the way advertised. And that is
what the for-the-CBO version of PPACA was: advertising. Klein and the
rest of the ladies and gentlemen in the PPACA’s marketing department—which is
what a lot of American journalism was, effectively, for a time—were
wrong about the rest of it, though. The mandate was never enforced, the 40
percent “Cadillac” tax was delayed and delayed and then repealed, etc. These
developments were not just predictable: They
were predicted, by me and by others. Even the authors of some of
that CBO work that the Obama administration and its friends waved around
cautioned that the political incentives were such that the Platonic ideal of
the plan was unlikely to survive much contact with political reality.
The rise of “nerds” as a title of self-aggrandizement was
one of the most predictable social trends of the late 1990s. Equally
predictable was that nerdery was going to be used in dishonest and self-serving
and sometimes
intellectually sloppy ways, as, indeed, empiricism and rationalism
and pragmatism often have—as a cover for ideological and partisan
projects and tendencies. (The observation is, to say the least, not
original to me!) If “unity” is shorthand for “Shut the hell up, peon, and
do what I say!” then “pragmatism” is how politicians say, “I don’t want to hear
about any principled objections to my program or any inconvenient questions
about whether this is the sort of thing we should be trying to do in the first
place.”
And now that it is at last entirely undeniable
that the net effect of PPACA is not going to be to reduce the national
debt—what? Well, it would have worked better if not for Republican meddling.
Maybe—but making policies that work only in a world in which Republicans do not
exist and politics is abolished is not exactly sound program design. Well,
nobody could have seen COVID coming, and that added a lot to health care costs.
True—but making policies for a world in which there are no unexpected events is
not exactly sound program design, either, and rainy days can be anticipated in
general, even if we do not know precisely when and where the rain will fall.
Well, Republicans are worse on the debt: Look
at the $3.4 trillion the Republican tax-and-spending bill will add to the debt!
Donald Trump is a veteran of one game show and three pornographic films and
boasts the mental acuity of something that normally would say “Oscar Mayer” on
the packaging—less dumb and reckless than the GOP circa Anno Domini 2026 is
not a very high bar to clear.
But it is not as though we have not been here before.
When Social Security was being debated, the gentlemen tasked with marketing it
insisted that it would be a self-supporting program, that it would involve “no
money out of the Treasury,” as Franklin Roosevelt put it. The first Social
Security check went out in 1940, and the first Treasury subsidy to Social
Security went out the door in 1947. (It involved expanded benefits for veterans.)
And the pattern repeats: Lyndon Johnson insisted that Medicare would enable
“every citizen ... to insure himself against the ravages of illness in his old
age” and that the expenses would be met by combined employer-employee
contributions, which would be enough to
provide “the funds to pay up to 90 days of hospital care for each illness, plus
diagnostic care, and up to 100 home health visits after you are 65.” Medicare
was created in 1965, and by 1990 its inflation-adjusted costs were about
11 times the original projections. You can go narrow, too, and see that
initiatives such as Medicare Part D have turned out to be more expensive than
had originally been predicted and for obvious reasons—more
generous benefits are generally popular.
It is easy to be credulous when people are telling you
what you want to hear. In 2013, when the U.S. national debt was just under $17
trillion, Ezra
Klein insisted that “the debt disaster that has obsessed the political
class for the last three years is pretty much solved, at least for the next 10
years or so.” And in the next 10 years or so, the debt went to just about twice
that. Klein argued in the same article that the U.S. government was seeing
“probably too much deficit reduction, too quickly.” In September, the debt
stood at just shy of $38 trillion. At the time, Klein cited the authority of
“Washington’s most powerful budget nerds.”
And that brings us to the real problem. Analysts such as
those at the CBO do very important and valuable work, and one of the many awful
things about the Trump administration has been its efforts to vandalize federal
data collection and analysis. But if you’ve ever read a CBO report, you know
these are snapshots in time built upon very specific sets of assumptions that
often are not particularly plausible. And non-plausible assumptions can be
useful, too: I don’t think it is likely that the federal government will
radically reform entitlements along the sort of lines I’d prefer any time in
the near future, but I would value careful analysis of what the analysts think
that would be likely to look like at the level of both household economics and
the broader economy. Republicans are going through a dirty hippie phase just at
the moment—captive to a very 1968-ish set of attitudes about medical
care, mental health, law enforcement, religious authority, higher education,
expert knowledge, etc., and the Trump movement is, no surprise, full of
junkies and cultists
and all manner of medical quackery—and
they are full of scorn and contempt for the kind of careful expert analysis
done by organizations such as the CBO. This is the age of “Do Your Own
Research,” after all, advice often heard from people who seem to have done
their own brain surgeries and who often seem to be choosing their own
pharmacological adventures.
But there are other things to consider, too: history,
experience, practical politics, economic incentives, etc. When the CBO comes
out and says, “Yes, PPACA will reduce the debt if it is executed in this highly
unlikely way,” then we probably should ask what the more likely scenario looks
like—and we should pay attention to the answer. My beef with Klein and his ilk
is that what they typically are engaged in is not empirically driven nerdery at
all but simple and generally crude talking-points advocacy. I run into this all
the time when writing about the debt, conversations that go about like this:
XYZ: Fact:
Ronald Reagan drove up the debt as president!
KDW: Presidents
don’t have any direct control over taxes or spending, much less over economic
conditions. Congress controls taxes and spending and has the most direct
near-term responsibility for deficits. Congress was mostly controlled by
Democrats during Reagan’s presidency under the leadership of Speaker of the
House Tip O’Neill. Reagan and those around him actually advocated spending cuts
that would have changed the fiscal outlook, but there was no practical way to
get these through Congress, which was, on the other hand, more open to tax
cuts. In a similar way, it probably makes at least as much sense to talk about
the Newt Gingrich surplus at the turn of the century as the Bill Clinton
surplus.
XYZ: Fact:
Ronald Reagan drove up the debt as president! I guess you don’t care about
facts!
It’s dumb, and it’s tedious. It’s a little like when I
read or hear somebody referring to “X Derangement Syndrome,” whatever X
you like—I just take from that that I am dealing with a dim and boring and
unserious person who can be safely ignored. Or at my previous job, I’d get this
response to some arguments: “Oh, you think that? Well, you write for National
Review, and here are three sentences from an article that someone else
published in National Review 20 years before you were born and 50 years
before you started working there—what about that, huh?”
And I’d think: “Oh, I get it. You’re a schmuck.”
At both the individual level—how we think about policy
proposals in the confines of our own heads—and the social level—how we talk
with one another about policy proposals—it is necessary to be able to proceed
on several parallel tracks at the same time: We generally need all of the
granular quantitative analysis we can get, but we also need to understand and
to appreciate—and, in the political conversation, to concede—the practical
limits of that mode of analysis, particularly when it comes to such complex and
contingent endeavors as mathematically modeling changes in the economy or the
climate, a useful tool but one with a decidedly mixed history. If we could
model economic outcomes the way some enthusiasts seem to think we can, then we
would never have a recession or inflation or a financial crisis—and the reason
we cannot use mathematical models to avoid those has to do mainly with
complexity and epistemic limitations, not, as partisans insist, bad faith.
That is why we need those other modes, too: The lessons of experience are by
nature subjective, and it is difficult to make a nifty chart out of them—but we
need them. And it would be better if the conversation were more open and more
honest.
Writing about media bias provides a good many full-time
jobs for entrepreneurial types on the right, and there is a good reason for
that: The New York Times and Washington Post et al. really are very often in effect
extensions of the Democratic Party. The Times is particularly
perplexing and irritating: One of the world’s great newspapers, but frequently
unreliable when it comes to covering national politics at home. I do not envy
today’s progressive journalists the water-carrying they are going to have to do
for the Democratic Party in the Age of Zohran Mamdani.
(An age that will last about six weeks, I’d guess.)
On the other hand, it is a very interesting and fruitful
time to be a policy- and public-affairs minded writer on the right. Only the
most craven and useless of the so-called conservatives can still cling to the
Republican Party, and those who do are full of shame and self-loathing. For the
rest of us, there is something very liberating about having no rooting interest
in the prospects of either major political party. I don’t know that I ever was
much of a Republican partisan—my first votes were for Libertarian Party
candidates, though I felt more attachment to the GOP after the 1994 election.
That lasted about a decade. I admire George W. Bush, but watching the
Republicans carry (as long as I am rehearsing ancient grievances!) Arlen
Specter’s sorry ass over the finish line against Pat Toomey in the Pennsylvania
Senate primary in 2004 was too much. I believe 2004 saw my last vote for a
Republican. (Also my last vote, as far as I can remember.) I never consciously
shaped my arguments or reporting to favor a political candidate—I have at least
that much self-respect—but there was, to some extent, always that voice in the
back of my head distinguishing our guys from their guys. That is
gone, and I don’t think I’ll miss it.
I even have enjoyed watching the education of Ezra Klein,
who, with his Abundance agenda, seems to have discovered that the way to
have more housing is to build more housing, a gospel he is now preaching to
fellow progressives. I hope they will listen.
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