By Lambert Strether of Corrente.
I hate to chew the ankles of blue America’s favorite quasi-Nobelist, because during the dark early days of Bush the Younger, his was a lonely and desperately needed voice of sanity. Also too, cats. But I read this column (“Why Is ObamaCare Complicated?”) in Conscience of a Liberal, and I was shocked. This is too much. Krugman’s piece contains historical errors, analytical errors, and errors of conscience. Let’s take each in turn:
Krugman’s historical errors:
[P]olitical constraints made [note lack of agency] a straightforward single-payer system unachievable.
But what was the origin of these mysterious “constraints”? Krugman doesn’t say, so let us supply the lacuna. I suggest the real constraints came from three sources, as indicated by their behavior from 2009, when battle for health reform was joined: (1) The Democratic nomenklatura, which censored single payer stories and banned single payer advocates from its sites, and refused even to cover single payer advances in Congress, while simultaneously running a “bait and switch” operation with the so-called “public option,” thereby sucking all the oxygen away from single payer;1 (2) Democratic office holders like Max Baucus, the putative author of ObamaCare — Liz Fowler, a Wellpoint VP, was the actual author — who refused to include single payer advocates in hearings and had protesters arrested and charged; (3) and Obama himself, who set the tone for the entire Democratic food chain by openly mocking single payer advocates (“got the little single payer advocates up here”), and whose White House operation blocked email from single payer advocates, and went so far as to suppress a single payer advocate’s question from the White House live blog of a “Forum on Health Care.” (Granted, the forums were all kayfabe, but even so.) As Jane Hamsher wrote, summing of the debacle: “The problems in the current health care debate became apparent early on, when single payer advocates were excluded [note, again, lack of agency] from participation.”
In short, if single payer was “politically infeasible” — the catchphrase of that time — that’s because Democrats set out to make it so, and succeeded.
But Krugman goes on:
… Single-payer wasn’t going to happen [and why? See above]— partly because of the insurance lobby’s power2, partly because voters wouldn’t have gone for a system that took away their existing coverage and replaced it with the unknown.
“Wasn’t going to happen?” Krugman’s remarkably passive and compliant attitude reminds me of the Obama Fans who kept bleating “He’s only been in office
one two three four five six X months! Give him a chance!” (That, or, “The President is not a dictator!”) Think back. Does you remember the state of play in January, 2009? The Democrats had just won the House, the Senate, and the Presidency. They had just beaten the McCain/Palin ticket like a gong. Thanks to a brilliant, tactically ruthless campaign — and the lingering good will on the Democratic balance sheet for economic issues, perhaps remnants from FDR’s time — Obama’s Democrats had a mandate for “hope and change.” Moreover, the Republicans under Bush had been completely discredited, both in the eyes of a majority of the public and, even more importantly, in the political class of opinion shapers. Obama’s personal charisma was at its height. So too, like all Presidents in their 100 Days, was his power. If Obama had wanted to make single payer the hallmark of his 100 Days, instead of HeritageCare -> RomneyCare -> ObamaCare, he could have done so. And he could have gotten it passed, via reconciliation or ending the filibuster in the Senate if need be. Moreover, Krugman’s absurd claim to the contrary, single payer is both well known, in the form of Medicare, and polls well. (That’s why the TPers don’t want government interfering with their Medicare! They reconcile the cognitive dissonance of a government program actually working to their satisfaction by denying it’s a government program at all.) The 100 Days were there for the taking. Replace “[P]olitical constraints made a single-payer system unachievable” with “Obama and the Democrats decided against a single payer system” and you’ll have something closer to the truth, if that matters these days.3 So much for Krugman’s historical errors.
We turn next to Krugman’s analytical errors:
It’s been clear all along that the Affordable Care Act sets up a sort of Rube Goldberg [hat tip, lambert] device, a complicated system that in the end is supposed to [supposed by whom?] more or less simulate the results of single-payer, but keeping private insurance companies in the mix and holding down the headline amount of government outlays through means-testing.
Even accepting the weasel words, what on earth can “more or less simulate” possibly mean? One can simulate a dynamic process or system, but not a static result. (Strat-O-Matic baseball does not “simulate” a score; it simulates a game!) Forgiving Krugman’s sloppy language, let’s assume Krugman means to say that ObamaCare, as a system, is meant to “simulate” single payer, as a system. If that’s so, it does a remarkably poor job. If I were going to sketch a single payer system on a blackboard, my first step would not be to chalk in multiple payers (“keeping private insurance companies in the mix”). Moreover, single payer has at least the connotation of universality — Medicare is single payer for all over-65s; the VA is single payer for all veterans — and so a single payer simulation that isn’t universal (“means testing”) wouldn’t be my first step either. It’s as if Krugman’s trying to argue that reptiles “simulate” mammals, or fish simulate bicycles.
Considering what “the results” might mean leads us to Krugman’s errors of conscience. He writes:
Yes, Obamacare is a somewhat awkward kludge, but if that’s what it took [note well the past tense] to cover the uninsured, so be it. .. [T]he odds remain high that this will work, and make America a much better place.5
(I get a kick out of “so be it”; it’s a classic example of vacuous, banal pragmatism from Obama’s Amen corner of Democratic hacks.) Forget the weasel word “somewhat”; let’s just unpack the deception in “cover the uninsured,” shall we? Never mind that the “infuriating” #FAIL of the ObamaCare rollout has made it impossible to get a good overall sense, despite anecdotes, of whether the coverage on offer from ObamaCare offers value for money;4 and never mind that, although Obama claims health care is a right, access to that right is delivered capriciously and whimsically, varying by jurisdiction, age, income (especially at the edge cases of 138% and 400% of poverty level), and whether HHS’s marketers think you will make ObamaCare actuarially more sound, or not; and never mind that ObamaCare, given that there are proven health care delivery systems available, is an experiment performed on the American people without their informed consent; no, never mind all that: Krugman surely must know that ObamaCare, when fully implemented, will still leave ~25 million without coverage. How, in good conscience, can anybody say “So be it” to that? And how, in good conscience, could anybody write “cover the uninsured” instead of “cover a large fraction of the uninsured,” when the former is a lie, and the latter is the truth? The mind reels.
But even worse, the whole tenor of Krugman’s piece reads like he’s trying to gently anesthetize single payer, ease it into a coffin, and then nail the coffin lid shut (“what it took“), and all the while with single payer very much alive. Why? Because Krugman can’t even be bothered to mention ongoing single payer efforts, at the state level! Unfortunately — I mean for the citizens of these states, not for the insurance companies — under 42 USC § 18052 of the ACA, states can only apply for “waivers” to set up their own systems by 2017, so four years from now (and X thousands of excess deaths) is the earliest an American Saskatchewan could start setting up single payer. How, in good conscience, and assuming that universal coverage truly matters to him, can Krugman ignore these state efforts? Surely this is rank obscurantism? And why, assuming good conscience, doesn’t Krugman advocate for changing 2017 to, say, 2014, using the admitted complexity and Rube Goldberg-esque nature of ObamaCare as a reason?
Could do better!
1 Hilariously, Obama cut a secret deal with Big Pharma in summer 2009 that there would be no public option in the final health care reform bill. I don’t know which scenario is more appalling: Whether the savvy and pragmatic career “progressives” who shilled for the public option’s ever shifting bullet points and shrinking coverage throughout 2009 did so in full knowledge of Obama’s secret deal, or whether they, too, were betrayed by him. Nobody’s talking.
2 “Power” as expressed in the $20 million from the health care industry that went to the Obama campaign, which outstripped even Obama’s Croesus-like haul of $16 million from the securities and investment industry. Is it so unreasonable to assume that Obama serviced the health insurance companies just as assiduously as he serviced the banksters? I won’t use the word “corruption,” but feel free to think it!
3 Why were Obama’s 100 Days such a bust? It would be irresponsible not to speculate; so see note 2.
4 I’d expect Consumer Reports to cover this issue, since it’s in their remit; so far, such a topic is absent from their coverage.
5 As a troll prophylactic, let me say that I don’t advocate defunding or repealing ObamaCare; despite the debacle of its launch and the perversion of its design, it must end up helping some people who desperately need help, if only because of its sheer scale. However, I regard ObamaCare, and especially its rollout, as a teaching opportunity; a chance to show people that better opportunities exist that could give Americans a health care system that’s up to first-world standards: Single payer. The pom pom waving by members of the Democratic nomenklatura, including Krugman, is meant to suppress that teaching opportunity, exactly as in 2009.