Paul Krugman’s Shocking, Revisionist, and Obscurantist Views on Single Payer

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. 

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About Lambert Strether

Lambert Strether has been blogging, managing online communities, and doing system administration 24/7 since 2003, in Drupal and WordPress. Besides political economy and the political scene, he blogs about rhetoric, software engineering, permaculture, history, literature, local politics, international travel, food, and fixing stuff around the house. The nom de plume “Lambert Strether” comes from Henry James’s The Ambassadors: “Live all you can. It’s a mistake not to.” You can follow him on Twitter at @lambertstrether.


      1. sue

        Excellent-Lambert dissects linguistic abstraction. (weasel words)

        While our language exemplifies abstraction, it is necessary to hold accountable-document, both history and misuse of language.

        1. Lee A. Arnold

          The main reasons why single payer was ruled out are the same reasons why a national public option was not possible, either: Joe Lieberman and Ben Nelson (Nebraska) were publicly opposed. And there were no (zero) Republicans on board, so why don’t we blame it on them, too?

          What these discussions (including Krugman’s column) fail to acknowledge is that Obamacare must lead rather directly to a single-payer system within a few years, for other reasons which will become obvious to everyone. And everybody in the Senate probably already realizes this.

          1. NotTimothyGeithner

            Why don’t we blame it on a minority with no power? Hmmmm…before you say filibuster, lets review what the filibuster is. The filibuster is an organizational rule of the Senate, but the filibuster is not a substitute for the 50+the VP requirement of the Constitution. Yes, this has already been ruled on the by the Supreme Court. If you weren’t paying attention to the Bill Frist “nuclear option” of 2006, all Frist would be doing would be bringing bills directly to the floor (actually they could meet at a McDonalds with a mere quorum) for a vote in keeping with the Constitutional requirement.

            From my count, the Democrats even without Lieberman, Baucus, and the GOP had sufficient votes for a much better bill, and the subsequent question is why given GOP public GOP oppostion and strategy* for dealing with Democrats why did the Democrats continue with a Jim Crow era policy designed to keep the Dixiecrats and Democrats together? Is it so they could conveniently maintain a rotating villain strategy where each Senator takes a lump but has a good record overall while not actually accomplishing anything to con nitwits such as yourself? DING DING DING the answer is YES.

            *Anyone who claims they thought would be more reasonable should be banned from voting for being a moron.

  1. Dan Kervick

    … a complicated system that in the end is supposed to 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.

    To my mind, this is the worst part of the Krugman piece. Nobody can believe that’s true – especially not an economist like Krugman. The “results” of single payer are widely supposed to include a drastic reduction in overall health care costs by creating a monopsony market for health care. Nobody can seriously believe that the current reform is some kind of rough free market approximation of the single payer system. The current system continues to permit an army of market-based exploiters to feed at the trough of the huge fortunes that the vulnerable sick and dying are willing to hand over in their times of urgent and desperate need.

    1. Cynthia

      And thanks to all of the bean-counting, paper-pushing bureaucratic waste being generated by the Death Star, ObamaCare, my guess is that the medical-industrial complex scarfed down most of that GDP number and then quickly vomited it up, leaving the cosmic taxpayers to pay for the massive cleanup.

    2. okie farmer

      I think it’s important to remember before the financial crisis, Krugman was a neoliberal cheerleader. I tired of reading his columns, basically gave him up as hopeless. True, he did have a come-to-Keynes moment after the neoliberal project blew up, but I recommend always taking him with a grain of salt.

      1. Cynthia

        My issue with Krugman is that during the heady days of Robert Rubin’s ill-advised (for the US) but excellent strong dollar policy (for CITI, GS, JPM and anyone else with Asian investments), he had numerous screeds defending the “free global markets.” Apparently, no one realized that Asian countries declared mercantilist war against US manufacturers. So when both the AFL-CIO and the national Association of Manufacturers petitioned Congress for relief from this idiotic policy, the answer was something like: “Just wait, we are entering the New Economy.” Now he’s having second thoughts, perhaps because he realizes future economic history grad students will use him as a poster boy for the Grand Delusion of the 90’s. Meanwhile, given the corruption in the US banking system at the highest levels, any capital controls put in place would only apply to the “99%.” And so it goes.

        1. Dan Kervick

          Right, Krugman has always been a middle-of-the-road economist whose work on trade theory was a part of the neoliberal turn.

          1. Deconstructing Political Spin [Alexa]

            Exactly, Dan Kervick.

            But even more to the point, most of the corporatist (DLC/Third Way/No Labels) Democrats have NEVER supported MFA, or anything even close to it. (at least not for many years)

            Here’s a “blurb” from the (DLC) Hyde Park Declaration on “Health Care”:

            3. Promote Universal Access and Quality in Health Care

            That more than 40 million Americans lack health insurance is one of our society’s most glaring inequities.

            Lack of insurance jeopardizes the health of disadvantaged Americans and also imposes high costs on everyone else when the uninsured lack preventive care and get treatment from emergency rooms.

            Washington provides a tax subsidy for insurance for Americans who get coverage from their employers but offers nothing to workers who don’t have job-based coverage.

            Markets alone cannot assure universal access to health coverage.

            Government should enable all low-income families to buy health insurance.

            Individuals must take responsibility for insuring themselves and their families whether or not they qualify for public assistance.

            Finally, to help promote higher quality in health care for all Americans, we need reliable information on the quality of health care delivered by health plans and providers; a “patient’s bill of rights” that ensures access to medically necessary care; and a system in which private health plans compete on the basis of quality as well as cost.

            Goals for 2010

            Reduce the number of uninsured Americans by two-thirds through tax credits, purchasing pools, and other means.

            Create a system of reliable “report cards” on the quality of care delivered by health plans and providers.

            And excellent post, Lambert–thanks!

            Object Lesson: As long as ‘progressives’ continue to reelect “corporatist” Dems, expect “market-based solutions.”

            BTW, didn’t Paul Krugman serve in the Reagan Administration, right along side of Larry Summers? [I’ve never understood why he is considered to be “a liberal,” frankly.]

            I agree with a previous commenter–take Krugman with a MAJOR grain of salt!


        2. digi_owl

          The history of Economics is filled with euphoric economists that do a 180 when the bull turns bear. And like clockwork the next cycles euphoric economists will use the uptick writings of the last cycle’s to justify that “this time it is truly different and sustainable”.

      2. sue

        Krugman’s books appear written by very different voices-some (intentionally?) unintelligible, and others more accessible, in comparison. Confusing.

    3. Westcoastliberal

      And as Karl Denniger points out in his column today, there is virtually no “out of network” provision in Obamacare, which is geographically configured county by county. Therefore even if you have Obamacare, if you get sick somewhere else, it’s all “out of pocket”.
      It’s such a sorry excuse when we could have done so much better. If only money wasn’t a factor in politics.

        1. Ned Ludd

          I believe this is the article: “Two Other GIGANTIC ‘Screw You’ Parts Of Obamacare”.

          When I looked at BCBS plans on the exchange in my state, out-of-network coverage was 50%. This is far worse than the old high-deductible BCBS plans for individuals, which covered out-of-network care the same as in-network care. On the old plans, for out-of-network care, you had to pay the bills yourself and submit the bills to BCBS; but these were then applied to your deductible or, if you had met your deductible, you were repaid up to the allowed in-network amount. The only drawback was the paperwork and the fact that out-of-network providers might charge more than in-network providers, leaving you responsible for the difference.

  2. s spade

    Nice job. Democratic economists like Krugman establish the utter intellectual bankruptcy of both the economics establishment and the Democratic Party. Why anybody listens to the former or votes for the latter remains a mystery for which both remain eternally grateful.

  3. Crazy Horse

    Of course Obomacare has nothing to do with health care. It is and always has been about extortion.

    It bears the same resemblance to health care as Homeland Security bears to the defense of freedom.

    The solution in both cases is the same. Round up the perps and send them to prison for life in the prisons they have built to house dissenters and drug “criminals.”

  4. middle seaman

    The post epitomizes the eternal wars with the left were the not completely religious, the ones that don’t bravo intensely enough and the once who dare to smile are considered beyond the pale. First, Krugman is an economist and a political hack. Second, following Krugman makes you easily detect that he gives Obama a lot of slack, way more than Krugman’s support of Hillary in 2008 would indicate. Third, no one knows whether a single payer system was possible. Stating otherwise is flat wrong and irresponsible.

    How can we ignore the fact the Obama, and many Democrats, are intent on cutting social security and if possible Medicare. Do you really expect that crowd to vote for single payer?

    How about turning the gun from our head and point it to the right?

    1. ifthethunderdontgetya™³²®©

      How about explaining how “turning the gun to the right” will help get us better policy outcomes or better candidates?

      Obama has done more to further the plutocracy’s interests than any Republican could have gotten away with, in the wake of the Bush-Cheney debacle.

      And he’s still working on it: See the Trans-Pacific Partnership and his efforts to cut Social Security.

    2. Dan Kervick

      Personally, I don’t think Obama could have gotten a single payer plan through, despite his temporary charisma. For one thing, Obama did not campaign on single payer or anything even close to it. He campaigned on a plan not much different that what he then pushed through – but with a public option and without the individual mandate. If he had tried to pivot to single payer, the centrist health-care reform coalition he had built would have fragmented.

      But what he could have gotten through was the public option. And the public option would have been the key stepping-stone to single payer, since it could have expanded over time as a result of its market power and cost savings.

      1. from Mexico

        Dan Kervick says:

        Personally, I don’t think Obama could have gotten a single payer plan through, despite his temporary charisma.

        Of course we will never know, will we? And the reason is because Obama never tried.

        But as an object lesson of how a president can get legislation passed which is unpopular with one’s own party, there’s the history of how Lyndon Johnson got Civil Rights legislation passed, which is told in the PBS special beginning at minute 104:00

        So I’m inclined to thow my lot in with Lambert here, and not with the naysayers.

        1. Dan Kervick

          Johnson benefited from the fact that there was a significant tradition of liberal Republicanism back in those days that supported civil rights legislation, and so Johnson had crossover votes. The percentage of contemporary Congressional Republicans who favor single payer is close to zero.

          It’s hardly surprising that Obama didn’t try to get single payer passed, since he didn’t campaign on single payer.

          1. curlydan

            LBJ knew how to whip for votes. He browbeat, cajoled, begged, and damn near cried for every vote he got. Obama simply let Baucus and Fowler do all the work while and sat passively as the holdouts (Ben Nelson) do all the work.

            Basically, Obama’s limited time in the U.S. Senate and Illinois Legislature pale in comparison to LBJ’s long and hard work in Congress. LBJ knew how to get things passed and didn’t just “ask Congres to do” this and “work with Congress to do” that. If you want a freaking bill passed, you get on the phone and work it. But Prez “Cool as Ice” wants no part of that heavy lifting.

            If LBJ could spin in his grave, he’d have made it halfway to China in Obama’s term watching the lack of effort made to pass these bills.

          2. Brooklin Bridge

            The only thing that rendered Single Payer moot was Obama himself; that which Obama wanted, that which he embraces ideologically, not the opposition and not even his campaign promises (if he could break them for a conservative bait and switch he could have broken them for a liberal one).

            Obama, as Lambert points out, really had the wind at his back. It was far more than simply temporary charisma. He had just won the Presidency by a strong margin. He had the charisma you speak of in doubles with a whole country proud of what it had just accomplished. The Republicans meanwhile, openly had to admit piloting the country into a catastrophic financial wall of rocks. With a few frank fireside chats about what was actually going on with the Banks, Obama could have wiped the floor with the opposition pretty much any way he wanted. If his recent Vichy show of spine regarding the shutdown was a success, standing firm for single payer might well have been the stuff of history and dreams combined unfolding before our eyes. And even if he hadn’t gotten single payer, it would have cost him little as he would have come across as a man of uncommon strength. He could have easily used that position to get a stronger health care bill passed than would otherwise have been possible.

            In Washington nothing is possible until suddenly it’s perfectly possible and everyone is wondering why they hadn’t thought of it.

            Doug Terpstra in comments has a beautiful analogy with Poe’s Telltale Heart. Whether or not Single Payer, or some equivalent, ever makes it through Obama’s breath taking Corporatist treachery, it will nonetheless keep on beating the word, Shame over and over until long after his name is forgotten as the assassin of the Democratic party.

            1. Crazy Horse

              You are exactly right, Bridge.

              Obama came to office at a historical moment such as we haven’t see since 1929. A president who had the personal character to become a true leader could have conceivably led the country onto a path that at least gave it a chance to face the tide of change that is beginning to wash over our shores. (or more likely he would have simply been assassinated)

              Hoping that Obama would become the leader the country needed was not entirely delusional at the beginning of his presidency, (at least until after his first cabinet appointments were announced.) Instead he as done the impossible— become a far worse president for the vast majority of the country than George bush every was. In comparison bush was a relatively honest ex-alcoholic frat boy who never pretended to do anything but try to feather the nests of his fellow ruling class mates and stand back while Dick Cheney and his fellow Neo-Con criminals devised false flag excuses for wars of aggression.

              Obama’s great crime is not just being a charlatan and loyal servant for his owners— most politicians fall into that category. No, his great crime was that he happened to be the president in charge of directing traffic over the cliff of ecological and financial disaster as the American Empire begins to collapse.

            2. Dan Kervick

              Obama didn’t assassinate the Democratic Party. The Democratic Party is the party of the Clintons and Obama – a centrist party, run by the Rubinites, Silicon Valley, Third Wayers and other powerful economic constituencies. It’s been that way for a few decades now. Obama didn’t kill it: there was nothing left to kill.

              Obama didn’t “betray” anyone – at least not in the economic sphere. He pursued almost exactly the economic policies he campaigned on. None of the major Democratic Party primary contenders ran on a single payer plan – not even close. Obama ran on a plan very close to the one that got passed. He also ran on deficit reduction; he ran on the privatization of education. Sadly, enough, this stuff was all mainstream Democratic Party policy.

              Of course, someone who was less of a corporate tool and someone with more imagination would have used the economic crisis of 2008 to overhaul his agenda after getting into office. Not Obama. He things the recession was just a bump in the road, and after quickly doing a stimulus went right back to the original plan.

              I can’t believe how many people are convinced that Obama stabbed them in the back because he pursued the kind of centrist health plan he actually campaigned on, rather than pulling off some incredible bait-and-switch and suddenly rolling out a surprise left-wing plan following his election.

              1. Lambert Strether Post author

                FDR ran on balancing the budget in 1932, and then did no such thing. So I don’t think it’s such a stretch, and certainly from the perspective of early 2009, to imagine that Obama might well have done the same. Remember all that crap about how transformative he was?

                However, as the post documents, the Democrats not only did not propose single payer, they actively suppressed it, making it that much harder to get it back “on the table” when ObamaCare started to be revealed for the mess that it is.

              2. Doug Terpstra

                Please don’t excuse Obama’s blatant treachery and deceit. From the mandate to the public option, to NAFTA, to Gitmo, FISA, war, WS fat cats, wars, Patriot Act II, NDAA, billionaire tax cuts, rule of law, Palestine, etc., Obama has done a 180 and tripled down on Bush Neoconism to such a degree that his entire persona is one ginormous lie. Who are you, and what have you done with Dan Kervick?

      2. Banger

        First of all, Obama’s campaign was 100% PR and marketing all the way, every day. Someone said that Obama was very intelligent and I had to hear him talk etc. So I turned on an interview he had with Charlie Rose. Well, that’s all I needed to hear the guy was a real pro at saying absolutely nothing. To put it another way, the guy was then and is now completely full of sh!t.

        Having said that no, he was never interested in any progressive reform of anything–though I do believe he wanted to wind down the war in Iraq, but so did everyone else–that has been decided well before the election.

        If Obama was interested in the economy, health care and the welfare of the country he could have put through, in stages, a rational HC system rather than what we see now. As I said upstream, all he had to do was to insist that we have a dialogue a real debate based on facts and reason. That’s it–just that. If he insisted that we would design some kind of system that resembled what every single even slightly advanced industrial country had then the American people would have, over time, agreed. Instead everyone on all sides obscured the real issues. Our system is not just bad it is the worst in the world and all you have to do is say that every day for two months and people will get it. I have stories of people receiving HC in other countries, even Americans abroad–these systems are rational ours is irrational that’s all Obama would have to have said and brought out the plentiful and unambigous evidence to support that. But he didn’t because he was not interested in that–he was interested in mollifying the industry as job 1. We all know that.

        1. Lambert Strether Post author

          ” all he had to do was to insist that we have a dialogue a real debate based on facts and reason. That’s it–just that.”

          Yep. When the focus is on policy, single payer wins hands down. (Of course, on a world-wide Overton Window, it’s centrist, making single payer advocates definitely not purist.)

    3. hunkerdown

      Anything short of tossing the Constitution is within the realm of the possible. The question is only whether the collateral damage is “worth it” for any particular endeavor. Unfortunately, the projected collateral damage (the health insurance industry) was more valuable to the decision-makers than the stated mission.

      As Ian Welsh recently suggested, selling out is always a rational option.

  5. Erik

    I 100% agree with both your political and linguistic analyses. However, I do have some sympathy for Krugman’s meta-conclusion, although on a slightly different level than what he states.

    Even though the Dems technically controlled both houses of Congress and the sandbagging of both discussion of single payer and the offering of a Public Option were futile and foolish attempts to get a bipartisan glow, there were so many Blue Dogs that I do not earnestly think single payer ever had a serious chance. There is no forgiveness, however, for killing the Public Option.

    But back to single payer: if it was, at the time, a political third rail, why talk about it? It would have simply given the Democrats another chance to participate in their favorite activities: infighting and implosion.

    Instead, the hack ACA that we got seems like an old-school GOP play: go little by little over the course of a decade to shift the Overton Window in your favor. They didn’t go STRAIGHT for the Bush tax cuts. They had to start with Reagan to convince us that tax cuts were OK. Then that they were favorable. Then that tax cuts for the wealthy were the ideal activity for humanity. It took 15+ years to get the conservative viewpoint pushed into the mainstream consciousness.

    Now look at ACA, and the entire process has made single payer a more palatable option (and that was happening BEFORE 10/1). While the Tea Party would howl all the more loudly, I have frequent conversations with people in the apolitical middle who now favor the idea of Medicare for All. This is because the ACA process has convinced them that SOMETHING needs to be done and that the current system is unsustainable. ACA has now made it clear that any tweaks of the current system won’t work, either, and will probably only make things worse. Maybe in 10 years, after the Tea Party suffers demographically (and maybe after we unroll some of the GOP redistricting), we will GET single payer.

    To be clear, I am NOT arguing that Obama is playing three dimensional chess. He didn’t foresee this. Neither did his team. But I also don’t think the Karl Roves of the world were ever playing that game, either. They just had a good read on risk and opportunities and when to push and when to play it safe to get what they want in the long term. It’s not a strategy but more like an ear attuned to the vibrations of future political history and sociology. Meanwhile the Democrats have never had anything but a deaf ear in that category. Either they push for nothing or overshoot to the moon. Maybe they fell ass backwards into a lesson.

    1. Dan Kervick

      Yes, the fact that Democrats controlled both houses of Congress isn’t a very compelling fact given that only a portion of Congressional Democrats are on record as supporters of single payer.

      1. Lambert Strether Post author

        There was an opportunity for Obama, who had a lot of degrees of freedom in the 100 days, to look at the best policy choices, and lead. In retrospect, I’m sure that the prospect never crossed his mind; see footnote 2. But that is the standard he should be held too.

        The Democrats are also highly culpable for (as I show with multiple pieces of evidence) suppressing single payer discussion entirely. How much better off we would be if single payer had been “on the table.” Even if it didn’t get passed as a 100 Days measure, it would still be seen as a legitimate policy choice today. Appallingly, it is not.

        The Republicans are afraid of their right. The Democrats kick their left. That has to change.

      2. Lune

        There was little support for Obamacare among the Democrats either. And yet when it came time to whip votes, Obama did it and got his bill passed. He could have done the same for single payer if he wanted to.

        All this talk about how weak Obama was is just an excuse. He is the President. And he was presiding over 60% majorities in both the Senate and the House, something that no recent President has ever enjoyed. Bush got his tax cuts and his Iraq War while the Dems controlled the Senate. He got Medicare part D over significant objections of his own party. Clinton passed his initial budget with a 50/50 vote in the Senate and Gore casting the deciding vote. Reagan spent most of his Presidency leading a massive change in American policy without a majority in either the House or the Senate.

        This whole meme about Obama not being *able* to deliver for his liberal base is just a lie to cover up the fact that he never *wanted* to deliver for his base. That’s fine. That’s his right. Like you said, he never campaigned for single payer. But Obama is as ruthless in accomplishing his goals as any President is (witness his creation of a massive surveillance state that goes far beyond anything GWB ever fashioned). He and his supporters just need to acknowledge that his goals are not the same as most of us liberals’ goals.

    2. weinerdog43

      Erik, here in Chicagoland, we have a saying that offers a far simpler explanation: “The fix was in.” Neither single payer or a public option were seriously considered. This was a gift to the health insurance political donors. Keep the Liberal rubes quiet by never explicitly denying single payer; just don’t give them a seat at the table.

    3. C

      Yes, those horrible, horrible blue dogs like Blanche Lincoln and Joe Lieberman…who the Dem leaders moved heaven and earth to keep in office in the face of progessive challengers.

      It’s like the Menendez brothers pleading that they were orphans.

    4. Banger

      When the “debate” first started all options that made sense were impossible. Why? Because the American people had no idea how bad this system is compared to the rest of the world and the President could have made that case. How? By hammering away at it day after day with unassailable facts. This system is not just bad it is cartoon-bad and it is only the fact the mainstream media refuses in this and almost any other major issue to tell the American people the truth.

  6. JGordon

    As a youngish disabled veteran with VA care, I am in favor of Obamacare. The next time I go looking for paid employment I plan to put on my resumes that I’m except from Obamacare due to my VA status, and I’m confident that’ll put me ahead of the pack the next time I’m looking for paid work.

    And as an aside I’m interested in how many young people are signing up for Obamacare. My gut feeling is that the answer is nearly none, considering the income constraints of the young people I know vs. the insane costs of insurance under Obamacare (yes, even with subsidies–unless they’re on medicaid). So it should be pretty funny seeing how the fascists deal with only old and unhealthy people signing up for their scheme. I’m thinking that they’ll need a whole lot more of that magic money tree theory free money for all the bailouts that are coming.

  7. Bunk McNulty

    Whoa steady, big guy.

    “…the assault on Medicare is really about an ideology that is fundamentally hostile to the notion of the government helping people, and tries to make whatever help is given as limited and indirect as possible, restricting its scope and running it through private corporations. And this ideology, at a fundamental level — more fundamental, even, than vested interests — is why Obamacare ended up being a big kludge.

    In saying this I don’t mean to excuse the officials and contractors who made such a mess of health reform’s first month. Nor, on the other side, am I suggesting that health reform should have waited until the political system was ready for single-payer. For now, the priority is to get this kludge working, and once that’s done, America will become a better place.

    In the longer run, however, we have to tackle that ideology. A society committed to the notion that government is always bad will have bad government. And it doesn’t have to be that way.”

    1. Banger

      But we have to understand why this kludge was built. It is not simply a matter of government being good or bad. It is a question of making pragmatism, reason, and science something that should be in the mix in evaluating something this important.

      The facts of HC are virtually unknown in this country by nearly all Americans and even most of the intelligentsia. If people knew we were spending nearly twice as much for much less than other countries are getting they would be furious–but the mainstream keeps these facts away from public discourse because unless a prominent politician says that the world is round, it is flat according to the presstitutes that misinform us everyday. This is easy, since Americans generally don’t travel outside of tour buses. But guess, what, there are dozens of excellent systems out there that have one thing in common–they are reasonable systems–ours was insane and Obamacare makes it crazy in a different way but still insane.

    2. AbyNormal

      “A society committed to the notion that government is always bad will have bad government.”

      Pseudo-intellectuals differ from real intellectuals in that they make bubbles of complex phrases.
      Ilkin Santak

      1. from Mexico

        These two points from a recent post by Ian Welsh are germane:

        30) Government is either your worst enemy, or you best friend, depending on whether it is controlled by the public, by private interests or running rogue. But government is also the only major organization which can work for ordinary people. Every other organization has another purpose. As such, you must control government if you want prosperity.

        31) Government, under whatever name, is needed to do things we must do together for the greater good. When it does not exist, you get Somalia. Great cell phone service, but your daughters get pulled out shacks at 2 am and raped, or you buy your safety by submitting to an oppressive set of relgous laws.

    3. from Mexico

      Bunk McNulty says:

      For now, the priority is to get this kludge working, and once that’s done, America will become a better place.

      How’s that working out for the Greek, or the Spanish, great unwahsed, who are trying to get their own kludge — the European Monetary System, which was so meticulously designed by neoliberal/neoclassical engineers — to work?

      Making something work which was designed by neoliberals/neoclassicists is like trying to drive a car that is equipped with only a gas pedal but no brake or steering wheel.

  8. Banger

    Thanks for this Lambert–but Krugman was reflecting Washington conventional wisdom at the time which said that once single-payer became a possibility the medical industry would trot out its old Hilarycare ads and overwhelm the public with fear and loathing for Soviet-style health-care. And, indeed, that is what would have happened. What is also not so well known is how much money drug and insurance companies threw at certain Democratic Party activists/ex-officials in the 00’s.

    I maybe differ just a bit with you on this obsession with single-payer. If you go around the developed world you see fairly sand HC systems most of which are not single-payer but all of which have significant government guarantees and subsidies like Obamacare–but unlike Obamacare they mainly keep profit out of the equation. What struck me most about the “debate” during that time was how fact-free, science-free, and reason-free the arguments at the time were. All the left had to do is forget single-payer, just bring out the salient facts which, to put it simply, tell us that the United States’ system is running on a wheel design that is square and the rest of the world uses various types of round wheels with some interesting variety of rims. This, to me, was the great sin of the media and the left of not insisting on a fact-based critique. F!ck single-payer we’re not even at the point of making reasonable arguments about anything. Start with trying to get agreement that maybe, we ought to look at pragmatic solutions to the problem.

    My pragmatic solution would have been pretty simple. First acknowledge that the insurance companies are very powerful and tell them that, if they stay out of the way, and allow a rational system to be instituted, they will get a fixed sum of money every year for, say, five years, to do nothing. They can fire all their employees or not but all they have to do is live in the manner they are accustomed to live in for five years while they either start an honest business or spend it on whores and cocaine–we shouldn’t care–maybe give them a party island or a cruise ship and they can party for five years–why not?

    My point is that unless we argue for facts, science, reason we can’t begin to argue for single-payer or anything else that makes sense. And Krugman should be attacked even more vehemently for refusing to face that fact. Although, imagine, if any major mainstream columnist were to come out for pragmatism, science and reason he or she would be out on their asses in five minutes. All of these operators are deeply political–to become a prominent anything in this day and age you have to be politically savvy–understand whose ass you kiss and whose ass you kick according to the the balance of power in your particular field.

    1. from Mexico

      Banger says:

      …but Krugman was reflecting Washington conventional wisdom at the time which said that once single-payer became a possibility the medical industry would trot out its old Hilarycare ads and overwhelm the public with fear and loathing for Soviet-style health-care. And, indeed, that is what would have happened.

      Well lo and behold, once again what we have is pure speculation being proclaimed as if it were sure truth.

      1. James Levy

        Banger could be wrong, but he does have an historical precedent in what happened under Clinton when the “specter” of any system that didn’t overwhelmingly favor the insurance and medical industries reared its head. So his speculation is based on a fact, not a vacuum.

        1. from Mexico

          A lot of water flowed under the bridge between 1993 and 2010.

          Some people are capable of changing their positions to fit changing realities. A handful of people may even be able to effect change. But most people just continue to relive yesterday as if nothing ever changes or ever could.

          An almost unbelievable thing happened last week. Zbigniew Brzezinski, one of the most died-in-the-wool superhawks in all of American history, acknowledged that the days of US world hegemony, and even hegemony in the Middle East, are over.

          What one of the panelists said is germane to our conversation:

          What struck me…was the contrast between Zbig and many people serving government…whose views of the world get frozen in the era in which they served, and no matter how much longer they live after that, what they write and say seems crystalized in that moment.

            1. Optimader


              He is smarter than the average bear and understands the concept of reevaluation based on new information, like him or not.

    2. Montanamaven

      If Baucus had allowed Dr. Margaret Flowers and others to testify before the Finance committee instead of arresting them, people would have heard about how she was advocating for a “national health care plan” not necessarily a single payer system. If Margaret Flowers, Kevin Zeese, the Mad as Hell Docs, Stephanie Woolhandler, Dr. Himelstein, etc had been on national news shows, we could have got more facts out about other systems. There was some discussion of the Swiss system of using non profit private insurance, but not much. In town halls here in Montana, SEIU actively thwarted any discussion of alternatives to the ACA by not allowing proponents of non profit national health care to talk. Krugman is rewriting history and I have long ago had enough of him.

    3. Yves Smith

      Saying health care systems in other countries are “like Obamacare” in ANY meaningful manner verges on dishonest. How can you write stuff like that?

      1. The only role insurers have is to provide supplemental insurance. Basic coverage (typically very extensive) is paid by the government via taxes, not “subsidized”. ALL schemes in other countries have the basic layer for ALL citizens paid for through taxation.

      2. I am pretty sure all regimes have the government buying drugs. The one I know, Australia’s, does a damn fine job of that. They pick one drug in each major category based on extensive research and bargain like hell.

      1. Banger

        You didn’t read what I wrote and it’s kind of humorous that you reduce what I said so something I did not say and do not think. I did not say that Obamacare was like HC in other countries–if you actually read what I said it was that other countries ALL have reasonable systems and the ACA is not reasonable. The subsidies are minor and full of catches and the usual nasty BS that Washington puts in bills. But they are subsidies nonetheless.

        No one addressed by central point which is we need to stop dicking around with silly details and political correctness and understand that the issue here is not just health care but using pragmatism and reason to debate public policy. Whether we have a market-driven or single-payer or a mixture my point is that it has to be REASONABLE. If we critique Obamacare it ought to be because it doesn’t make any sense!

  9. denim

    What, me worry?
    “For people with insurance, the only impact of the health-care law is that their insurance is stronger, better, and more secure than it was before. Full stop. That’s it. They don’t have to worry about anything else.” Obama, April 2013.

    Obama needs to “make it so”

    BTW, Medicare out of pocket is not free: Part B =$100/month, Part D = $75/month, Medi-gap private insurance to fill in the coverage gaps = $220/month. Do the math before you think you are getting a freebie at retirement.

    1. Thorstein

      But leave out the medi-gap and the Part D for drugs that are effective in fraudulent studies, and Medicare gives you catastrophic insurance for $1200/yr.–not a bad deal.

      The uninsured who are moving to Obamacare are going to get catastrophic “insurance” too, but with a predatory twist: Many, possibly most of them, won’t be able to use their “insurance” until they are bankrupted by premiums and high deductibles.

      Medicare is free in the sense of freedom from want and fear. Obamacare is not.

      1. Cynthia

        I was just wondering what they are going to do if most people just ignore this law en mass, which looks highly likely. Certainly, I can see no benefit for the younger folk. Massive civil disobedience looks like the way to go here, with jury nullification for anyone charged.

          1. Malmo

            The penalty for someone who is single is under $100, right?. I’m certain most singles under 40 will be taking the penalty option.

              1. Cynthia

                The only way you’ll pay a penalty for being uninsured is if you pay too much in income taxes. The IRS will simply deduce the penalty from your refund check. So just make sure you don’t overpay your taxes. Even if you have unpaid taxes owed to the IRS, the IRS can’t add the penalty to your tax bill. At least that how I understand it.

              2. Malmo

                I think most will pay the penalty at $600 too. That’s still only a fraction of the monthly premium for the shitty plan– you know, the plan that will make one go broke even if covered.

          2. Lambert Strether Post author

            Wrong in the sense that if you don’t pay the penalty the IRS can’t put a lien or a levey on you to collect it. (I don’t know if they can grab your refund.)

            I don’t know why the Republicans haven’t organized massive tax resistance based on it; they just aren’t as feral as they were back in Rove’s day.

      2. diptherio

        The premiums for me, as a poor single male, actually seem reasonable (~$50/mo), although for some, even finding an extra $50 at the end of the month is hard. But it’s the deductibles and co-pays that really make the plans unusable.

        So, of course, we hear lots about low premiums (thanks to gov’t subsidies provided by the same taxpayers who are getting the lower premiums, but I digress) but almost nothing about deductibles and co-pays, i.e. how much it will cost you when you actually have to go in for care.

        The premiums for the Bronze plans are especially low but, predictably, the deductibles are higher to maintain actuarial soundness. So, if you’re too poor to afford the low-deductible plans, you’re health care, when you actually need it, will cost you more. Thank you Mr. Baucus and Mr. Obama…

        1. Ed S.

          The premiums for me, as a poor single male, actually seem reasonable (~$50/mo)….

          That’s the idea.

          Don’t know what level plan you’re considering (bronze, silver, etc) but most of them don’t start until you’ve spent a great deal of $$$ (I think the bronze deductible is $5k).

          So it’s really “catastrophic” insurance — which is OK but not how most individuals define “medical insurance”. Nor is the “silver” plan — around a $2k deductible and $45 -$65 copays.

          Two other minor points:

          1) The “cost” isn’t $50 — it’s $50 plus the subsidy (I’m not being an a-hole TP — just pointing it out)
          2) Your $50/month is for the 1st year; if Lambert is correct the Ocare population will be sicker than the general population — so expect that “cost” to skyrocket.

  10. taunger

    Well, I found Krugman’s piece to be a weak apology, not because of its substance, as you note, but because of the tone. Half-hearted, as if Krugman knows there is little true apologizing possible.

    Perhaps it is right to overlook this and tear the piece apart, but it doesn’t seem worth it to me. He gives all sorts of cues to his tepid feelings about the situation, which you use against him. Fair, but productive?

    Yes its a hack piece, but I read it as clearly so, even to the writer himself. Hopefully your evisceration will lead Krugman to think better of writing such transparently hack pieces again.

    PS – If you think back to early 2009, you will remember Krugman was gallantly writing in favor of a robust stimulus. He’s not all bad, that Krugman guy.

    1. James Levy

      The question at bottom is how much slack you are willing to give someone to stay part of the policy-forming discourse, and how much you want them to step outside and criticize it. Because as far as I can tell, if Krugman said exactly what Lambert wants him to say, his voice would be excised from that discourse and he would cease to effect policy formation at all (assuming that he ever did or could, which are open to debate).

      The cry, “we’ve got to break the boundaries of the discourse” is, well, good, and true, but today only insiders can do that. Screaming from the sidelines doesn’t seem to mean shit to the Washington power establishment, unless you’ve got huge numbers of votes in swing states at your beck and call or boatloads of money.

      I’ll quickly use the British model because it is so easy. Every important nexus of power in Britain (landed wealth, finance, industrial capitalists, the secret police, the Church, the Army, the ancient Universities) are all inherently conservative. So it is easy for Conservatives to rule because they operate in sympathy with all the other power centers of society. Without counterhegemonic centers of power, our only shot in the short run is to get an FDR or a Johnson in there and then put enough pressure on the system for them to make some tentative reforms of the system (Glass-Steagall, Medicaid).

      We wanted Hopey-Changey to be an FDR. What he was from the beginning was a Kennedy-Nixon hybrid. Krugman has been blind to this or simply surrendered to the hope that he and a few more really smart guys, if they didn’t get on Obama’s very touchy bad side, could sway the Emperor with sage advice. Krugman’s greatest crimes, in my opinion, are self-delusion and self-aggrandizement; he really thinks that if he says smart things in a nice way, Obama will listen. In that, he is a fool.

      1. from Mexico

        There are some real problems with your rendition of history, which seem to be custom tailored to fit your defeatism.

        Take this, for instance:

        …if Krugman said exactly what Lambert wants him to say, his voice would be excised from that discourse and he would cease to effect policy formation at all (assuming that he ever did or could, which are open to debate).

        If we look at the experience of the Chicago School, however, what we see is something diametrically different. As Robert H. Nelson explains:

        Traditionally, there has been little effort made by economists to explore the development of ideas and their application to policy as a subject of legitimate economic inquiry in itself. However, in a 1995 book Timur Kuran seeks to develop such an analysis…. Kuran’s analysis may shed some useful light on how Friedman and a few fellow economists in the Chicago school might have had such extraordinary worldwide influence on public opinion and then on government policy over the past quarter of a century.

        Kuran begins with the observation that there are two kinds of opinion, private and public…. The overall result will be that people will commonly tell “public lies” that in fact differ considerably from their “private truths.”

        Kuran also thinks, like Friedman, that the content of public opinion plays a major role in deciding public policy…. Kuran’s model can also help to explain why at some moments there may be surprisingly rapid shifts in public opinion and then in government policy. Once some people start to speak out, and thus the private costs of being honest in public begin to fall, more people will speak out, creating further new private incentives for public truthfulness, and all in all a “virtuous circle” may ensue.

        Indeed, it may be just such a set of forces that can explain why Chicago economics has had so much impact on public opinion. The crucial element here is the strong tradition of public outspokenness at Chicago in the face of conventional wisdom, manifested since the days when Frank Knight made it a trademark of Chicago….

        Tobin on one occasion in the 1960s noted that “many controversies on monetary theory and policy pit Friedman and his followers against the rest of the profession.” Most economists would have lacked the courage or force of will to stand up to the pressures of a virtual professional consensus or opposition to their views. Rose Friedman recently related how her husband required special security guards and otherwise was partially sheltered from normal public exposure….

        The manner in which Friedman’s policy proposals have come to be adopted has often followed the general pattern described by Kuran for rapid shifts of public opinion. There is an initial strong negative reaction to Friedman’s ideas that may persist for some time. Friedman and his Chicago colleagues are likely to be derided for their unrealism and dismissed as out of touch. Other economists and policy makers are likely to keep any private agreement with Friedman to themselves. However, when the tide of public opinion begins to shift, aided by the presence of Friedman and other Chicago economists who have absorbed the heaviest blows at the forefront of controversy, large shifts can seemingly occur almost overnight.

        –ROBERT H. NELSON, Economics as Religion

        Then you tell us this:

        I’ll quickly use the British model because it is so easy. Every important nexus of power in Britain (landed wealth, finance, industrial capitalists, the secret police, the Church, the Army, the ancient Universities) are all inherently conservative. So it is easy for Conservatives to rule because they operate in sympathy with all the other power centers of society.

        Of course you’re omitting one very important “nexus of power,” and that is the people. Remember them? Vox populi vox Dei? “The great gorilla in the political jungle, a beast that must be kept calm,” as Barry Sussman put it? Throughout the 18th century the idea of popular sovereignty gained ground, until it finally overflowed in the American and French revolutions.

        How different your telling of history than Immanuel Wallerstein’s telling of it in After Liberalism. According to Wallerstein, by the late 18th century even conservatives had become resigned to the role popular sovereignty was to play in history. Beginning in the late 18th century, he splits the polity into three groups: Conservatives, who want to retard the growth of popular sovereignty as much as possible; Liberals, who stake out a middle ground; and Socialists, who want to speed the growth of popular sovereignty along as fast as possible. The conservatives held sway in Great Brittain until the second half of the 19th century, and then the socialists became dominant. How do you explain all the progressive legislation adopted in Great Britain after about 1870? Or do you believe in elitist fairytales like noblesse oblige and mos maiorum?

        1. charles sereno

          “The conservatives held sway in Great Brittain until the second half of the 19th century, and then the socialists became dominant.” (from Mexico)

          Now there’s a fairy tale.

          1. from Mexico

            Well I see you and James Levy are both on the same page, such as when he claims that:

            As for the “Socialist becoming dominant” in Britain, that’s a laugh.

            I also notice that neither you nor Levy ever back up your strident and bombastic claims with references, citations or footnotes. Why is that so?

            Anyway, let me show you how that’s done, such as with this:

            What Shaw and all the other publicists who agitated the social question helped to precipitate was the onset of the Great Switch. It was the pressure of Socialist ideas, and mainly the Reformed groups in parliaments and the Fabian outside, that brought it about. By Great Switch I mean the reversal of Liberalism into its opposite. It began quietly in the 1880s in Germany after Bismarck “stole the Socialist thunder” — as observers put it – by enacting old-age pensions and other social legislation. By the turn of the century Liberal opinion generally had come to see the necessity on all counts, economic, social, and political, to pass laws in aid of the many – old or sick or unemployed – who could no longer provide for themselves.

            JACQUES BARZUN, From Dawn to Decadence

            Or this:

            With the extension of the franchise in Britain came demands for higher levels of social spending. The economic historian Eric Hobsbawm has written that “as the working classes got the vote – in 1867, but especially in 1884-5 – it became only too obvious that they would demand – and receive – substantial public intervention for greater welfare” (E.J. Hobsbawm, Industry and Empire). Aware of the potential power of the newly enfranchised masses, and fearful that they might be stirred to support radical causes, mainstream politicians of all stripes competed to offer appealing packages of benefits. In some cases these represented honest efforts to ameliorate the conditions of the working man. In others they were no less sincere attempts to ward off the looming specter of socialism. As Arthur Balfour put it in 1895, “Social legislation…is not merely to be distinguished from Socialist legislation but it is its most direct opposite and its most effective antidote” (D. Fraser, The Evolution of the British Welfare State).

            During the last quarter of the nineteenth century both the effective demand for social services and the willingness of ideologically diverse British governments to supply them grew considerably. The net result was a dramatic expansion in “civil expenditures” (Bernard Mallet, British Budgets: 1887-88 to 1912-13). Of the charges to this account, government assistance to education grew the most rapidly, increasing four times by one official estimate between the mid-1870s and the mid-1890s (Hansard Parliamentary Debates, vol. 39).

            –AARON L. FRIEDBERG, The Weary Titan

            Or this:

            In the wake of the ‘Atlantic Revolution’ and of course in particular the French Revolution new concepts of citizenship developed which gave – in theory at least – the citizens of Western Europe increased political rights, a change that was not really undone by the conservative movement that dominated national and international politics in the decades after 1815. The price paid was that traditional ways of organizing ‘voice’ – through guilds, cities, and other corporations – were suppressed. Again, the rather difficult transformation of political systems occurring in the 1776-1848 period laid the basis for the real progress that was made during the second half of the 19th century.

            Many of the basic patterns of rising intra- and inter-country inequality that we observe in Great Britain and across the continent for the period until 1870 began to be reversed between 1870 and 1914.

            ŞEVKET PAMUK AND JAN LUITEN VAN ZANDEN, “Standards of Living 1700-1870”

            1. charles sereno

              @ Mexico: My earlier reply never got through. Saying “socialists became dominant in the second half of the 19th century is like saying Christians became dominant in the 2nd and early 3rd centuries. In both cases there was repression followed eventually by greater acceptance. To characterize a nascent movement as dominant is projected wishful thinking. IMO, a close reading of your “authorities” does not contradict this view. That’s why I called it a fairy tale.

        2. James Levy

          you seem to have missed this:

          Without counterhegemonic centers of power, our only shot in the short run is to get an FDR or a Johnson in there and then put enough pressure on the system for them to make some tentative reforms of the system (Glass-Steagall, Medicaid).

          Notice the words “in the short run” and “pressure on the system.” Notice I mention reforms like Medicaid and Glass-Steagal. You again turned what I said into a straw man so you can make your own point. Why not just make your point instead of misrepresenting mine to make someone look wrong so you can be right? And quoting Wallerstein is nice but there is no guarantee that he is right and I am wrong.

          As for the “Socialist becoming dominant” in Britain, that’s a laugh. Segments of the working class were bought off from time to time with reforms, and if you check 1867 and 1884, you’ll notice those reforms were initiated by the Conservatives. As for the people, they are mostly preoccupied and unorganized. Perhaps you can overcome poverty, ignorance, State power, and the drug cartels in Mexico, get “the people” all fired up and ready for a socialist revolution, then show us dummies up here how it’s done. Until then, a bit more modesty, please.

  11. DakotabornKansan

    Obamacare as written was designed to leave 25 million people uninsured. CBO estimates that, when the ACA is fully implemented, 31 million people will still remain uninsured. 25 million uninsured is unacceptable, as is 31 million uninsured.

    The ACA is expected to cause a seismic shift in high deductible health insurance enrollment. The affordability of health insurance is a function of expected out-of-pocket costs, not simply premiums. The low actuarial value of the plans that most people will select – paying only 60 or 70 percent of the medical bills – will create financial hardships for people who need health care. Though lower-income individuals will receive subsidies for out-of-pocket expenses, the costs for which they will be responsible will still be very burdensome for far too many. Thus previously uninsured persons effectively become underinsured.

    Even those with employer-sponsored coverage—the majority of us—will have more difficulties in meeting medical expenses since employers are shifting more costs of care to their employees through higher deductibles and other forms of cost sharing.

    What will be the long-term effects of this major expansion of high deductible health insurance plans on major health outcomes – morbidity and mortality – for the vulnerable and chronically ill, high risk patients with mental illness, cancer, diabetes control, cardiovascular, pulmonary, and renal disease? We don’t know yet. However, high deductible health plans, often considered “blunt instruments, indiscriminately reduce utilization of health care services.

    The “pom pom waving by members of the Democratic nomenklatura, including Krugman” live in a separate economy, on a separate level than the vast majority of people in this nation. They have more choice over their health care. They live in a completely different world than most of us.

    Riverdaughter on Krugman’s unreasonable optimism about Obamacare and his blindness at seeing the needless suffering it will cause for those who are going to get slammed by Obamacare:

    “The left’s willful ignorance and denial of just how bad Obamacare is going to be is doing them no credit. It is BAD policy. All of the potential problems that the left wants to minimize or deny could have been avoided had the policy been carefully crafted by a president who cared about average Americans and by a Congress who wasn’t rushed to make some really bad concessions…If you don’t stand up against unfair propaganda and you allow the bad guys to weaken your side, you should not be surprised if you find that you too are eventually powerless. I don’t expect that the left will every stop rationalizing about why they invited vampires into their house but I really wish they would start putting more of their energy into getting them out. We don’t have time for silly self-delusion. Obamacare is almost upon us and about to take out the Democratic Party and what remains of whatever defense we have left.”

    1. James Levy

      It’s hard to care about things you don’t know about or have forgotten. Men like Obama are present-oriented, power-obsessed, and to overuse a term, narcissistic. The system we have entrenched shares these attributes. Those who wish to “succeed” i.e., advance, in this system have to share, to a greater or lesser extent, those attributes.

      Many on the liberal and Left side of the equation are looking for a deus ex machina because the machine is evil and dysfunctional. Millions saw Obama as a outsider because of his skin color and childhood who could bring new ideas and values to, what for millions, is a dysfunctional system.

      They were all wrong.

      Obama is a man who chose at a very early point in his life to be a creature of the machine. It’s just that the machine will now accept servants of all races, creeds, and colors so long as they will unswervingly serve the machine.

      Our choices: accept the machine as it is, and untold lives and spirits will be broken on its wheels. Smash the system as it is, and count the casualties. Meaningful reform of the system is, in my opinion, no longer an option. Right now, looking out for myself, my wife, and my children’s future, I am frozen in indecision. I can’t tell which is worse. And I’m not ready to be the first martyr for the cause. If others see things more clearly, bless them, and good luck making a better world than the one we inhabit now.

    2. John Yard

      Absolutely. Premiums will stay much the same, while deductibles, co-pays, miscellaneous fees will go out the roof. Appearance is everything.

      This administration is long on rhetoric , and poor to non-existent on execution . The botch-up of the roll-out – after $400m spent ! – is symptomatic of a fixation on image as opposed to results. They can’t – or won’t -execute.

  12. ltr

    This is a very important criticism, but the snide writing makes it almost impossible to reference. Why not write properly, decently so that such a criticism does not immediately lead to dismissal or a reluctance by any fair minded person to refer to?

    1. diptherio

      Don’t know whether I agree or not…is the appropriate tone for taking-down propaganda one of seriousness? You have a point that the tone Lambert employs can be a turn off for some, but others find it refreshing. You can’t please everyone, as they say.

      Perhaps a more “serious” writer will take up Lambert’s critique and phrase it in more acceptable language for those who who deride snide…

    2. ltr

      I agree with much of the criticism by Lambert and with Lambert in general on the Affordable Care Act. What I was complaining about is the tone of the writing that I think makes the criticism harder to take seriously.

      I always read and appreciate Lambert on healthcare, but I hesitate to refer to him when the writing is so sarcastic. I will think again, possibly I am being to proper.

    3. ltr

      After another thorough reading, I am more convinced of the importance of the criticism and I agree with Lambert. So the heck with my complaint.

  13. michaelhudson

    I can personally attest to what Lambert is saying. Dennis Kucinich, the lead advocate for Single Payer within the Democratic party, was not even ALLOWED to bring it up in the party’s meetings or caucus discussions. The House leadership had an outright ban on it.
    the next step therefore is, What does it mean when the party that is SUPPOSED to preserve the New Deal’s philosophy has gone over to the Dark FIRE-sector side?
    Is there any room at all for an alternative view, short of a third party? Given the two-party congressional system in the US — in contrast to parliamentary representation abroad — how can one create a strategy for single payer?
    Not so speak of preserving Social Security for Obama’s coming drive to privatize it and send it into the hands of Goldman Sachs, etc..

    1. Expat

      I am reminded of Lambert’s probably prescient column of a few days ago in which he suggested that Obamacare is the model of social welfare to come in that it is a privatized government program, if you can still call it a government program at all since it is set up along industry lines. After all, Medicare did not start out assuming that citizens’ number one health care consideration should be which insurance company to choose. Obamacare reeks of insurance concerns such as stratification (bronze plan, etc.) not to mention the “pool.” The chief concern of actual citizens, i.e., the best health care providers for their families, isn’t even on the radar.

      If Lambert is right about the abdication of government regarding basic services needed by the majority of people — and I fear that he is — then Obamacare is just a test run and the policymakers don’t really care about any of the substantive objections that are being raised everywhere (even in the mainstream media). The non-sadistic among them will see any improvements in the general welfare as a serendipitous effect not be confused with Obamacare’s central purpose, which is to get the kinks out of privatized service delivery.

    2. just me

      And I remember seeing a hearing on TV early on where the single payer people — doctors, nurses — were not allowed to be seated, not allowed to speak, not allowed to present and be heard. It was sickening.

  14. Doug Terpstra

    Bravo, Lambert, for a definitive, well-documented (if premature*) autopsy of single payer, aborted in-utero by Obama and the DP. This is a key post for the archives, to be referenced every time Opologists claim Odious O did the best he could.

    Clearly, Obama studiously shunned single-payer, the Medicare standard, even though it was the compelling moral imperative and a divine gift to anyone with the highest pulpit and a voice to match. Obama’s legacy is forever tainted by such determined treachery.

    * This is more accurately an autopsy of Obama’s failed presidency. Single-payer was only buried alive, and like Poe’s telltale heart, it will continue scratching and thumping at the coffin cover until the people finally raise leadership with vision and moral conscience to let it out. Single-payer is inevitable; it will rise again.

    1. James Levy

      I hope with all my heart you are right, but if you read James Howard Kunstler’s commentary today at his site, you may come to the conclusion that the whole system will fail before it ever gets reformed. My guess is that ten years out, hospitals in many places will exist only for the rich, with a few aging local practitioners still in business exchanging services for goods more or less in a barter arrangement. These conditions will spread from areas hit by natural disasters that are never rebuilt. I may be too pessimistic, and the decline may be way longer and more steady, but a clean break from the industrial age is possible, and I think it’s more likely than most would imagine.

  15. Benedict@Large

    Finally, people are starting to figure out that Krugman knows as much about health insurance as a grade schooler knows about trigonometry. Maybe you had to have actual EXPERIENCE in the field to see it at the time, but from almost day one, it was obvious to me that Krugman didn’t have a clue on what he was taking about when it came to ObamaCare and health insurance (or for that matter, any insurance at all). And why should he? He’s an economist after all, and NOT an actuary, … although he never seemed to grasp that there is a difference.

  16. Yancey Ward

    Krugman goes through semantic contortions to defend the indefensible- Obamacare, but he is right in one area- it was the headline outlays and the taxes/borrowing that led to Obamacare. Even if I grant that a single payer lowers overall healthcare spending (and I don’t since path dependence does matter), it still requires the government to significantly raise taxes or the deficit to pay for it. The only way to conceal the costs of the expansion of health insurance was to make people pay out of pocket without the government as the middleman- i.e., pretend it isn’t a tax at all.

    1. human

      If wages were increased a la European “socialism”, US minimum wage would offset the necessary increased taxes and we would be that much further along the road to a developed world health care program.

        1. human

          My point being that solutions can be relativey simple. It is not that there is no will, there is no wish to change. The capture is near complete. The oligarchs will not be discomfited in any manner.

          1. human

            It is more accurate to note that the proletariat will not be empowered in any manner. The oligarchs will continue to manuever among themselves.

  17. tinbox

    The argument in this post depends on the ability of single payer/public option advocates to change the filibuster rules because the 60 votes were definitely not there.

    plenty of details here:

    But as Krugman acknowledges, that was never going to happen. Not when Obama didn’t even support a mandate, never mind single-payer. That said, sniping at PK over positions of Joe Lieberman or Harry Reid doesn’t get anyone closer to single-payer.

    1. optimader

      “..The argument in this post depends on the ability of single payer/public option advocates to change the filibuster rules because the 60 votes were definitely not there…”

      And BHO was never going to advocate for it. “The Industry” and Wall St wanted it as much as they want Polio. The sausage mill kept grinding until the sausage was palatable.

      1. tinbox

        That link was just a lot of hot air/speculation. There is nothing in it that shows Dems ever had either the 60 votes to end a filibuster or a concensus to change the Senate rules.

        And what is the point of blaming Democratic Party officeholders when there is no evidence that Democratic voters would support single-payer? Did voters support HRC over Obama when she put forward a more comprehensive health care plan than BO? No. Did voters support John Edwards when he put forward a more progressive plan than BO? No.

        The big obstacle for single-payer is public perception. Sniping at Krugman does not in any way advance that perception. Wrongly sniping at Krugman is flat out destructive.

        1. James Levy

          it’s fair to snipe at Krugmen when he says things that are evasive and illogical. And where was his voice demanding that Obama TRY. The bastards didn’t even try. Johnson faced a lot stiffer opposition in 1964 with the Civil Rights Act and 1965 with the Voting Rights Act, and he won on them, Medicare, and Medicaid. He did it by putting his heart and balls (I’m not sure Johnson had a soul) into winning.

          Yes, it caused a lot of backlash and it cost him a shot at the Presidency in 1968 (because if he was going to be a radical at home, he had to tow the party line in Vietnam or face rebellion on both sides of the aisle). But it is clear that Obama didn’t try, didn’t want single payer, didn’t give a shit about the public option, and has been more interested from day one to getting and keeping his current job than anything else. That’s why he, and apologists like Krugman, deserve a pranging.

          1. optimader

            …it’s fair to snipe at Krugmen when he says things that are evasive and illogical…

            He has a big media pulpit and when he is inaccurate, and obfuscates truth there should be push back or reality goes down the memory hole. It does anyway, don’t need Krugman giving it an extra shove.

        2. Lambert Strether Post author

          tinbox, stop trolling. The link documents, extensively, how to change or abolish the filibuster with a majority; the mechanism is well known on the Hill. You either didn’t read it, or you’re lying about it.

          1. tinbox

            Trolling? Because I don’t share your unfounded fantasy that Obama somehow could have made the Senate change their own rules? OK, then, I’m trolling.

            Good luck with the circular firing squad activism.

  18. elboku

    Two points: one, K. is reflecting what was going on then. Almost 70 percent of Americans get employer based health ins. and it is naive to believe that without years of preparation and conditioning they would give that up. Two, I have not seen any realistic scenario posited wherein single payer would have succeeded (and I totally support single payer).

    It will take the collapse of employer based health ins. to bring single payer to the rescue. And that is happening slowly as studies show the rate of employer based health care is going down. It is sad but too many Americans have the attitude that I got mine so eff everyone else. When health ins. is taken away from them, then things might change.

    1. Lambert Strether Post author

      Kennedy had a perfectly realistic scenario: Lower Medicare eligibility by 5 years, every year, until all or covered.

      (Not to say that Medicare is not also suffering from an infestation of neo-liberal rent suckers; it is. But at least it’s built on sound principles.)

  19. optimader

    Good one Lambert

    “..But even worse, the whole tenor of Krugman’s piece reads like he’s trying to gently anesthetize single payer…”

    gently = petechial hemorrhaging in the eyes and goose down in the trachea

  20. JZ

    There is less to this column than meets the eye. So Strether and Krugman read history in a slightly different manner, but I see little substance here. An awful lot of wasted time and electrons for such nit-picking. Go fight your real enemies.

    1. Lambert Strether Post author

      As the post demonstrates, the Democrats made single payer politically infeasible. So why aren’t they (and their enablers, like Krugman) in the class of my “real enemies”?

  21. JEHR

    Thanks, Lambert, for the mention of our great province of Saskatchewan. When CBC listeners were polled about the greatest Canadian in history, they voted for Tommy Douglas who was a democratic socialist from that province. Without his fine work, we would not have the universal single-payer healthcare that we now have.


    Unfortunately, the NDP no longer uses the “socialist” identifier and the conservative government is going to make the health care of Canada dependent on the provinces without the key support of the Federal Government. Harper even refuses to meet with the provinces whether about healthcare or any other topic. We may see defunding next; then people complaining about how the health care system no longer works; then we will be encouraged to “privatize.” Oh, my!

  22. tdraicer

    >Meaningful reform of the system is, in my opinion, no longer an option

    Of course it is an option, at least as long as we don’t accept this form of defeatism. My god, how tired I am of those on the Left who call for either Revolution (despite the historical record of revolutions in the last 100 years, or the fact that the wholesale overthrow of our “system” is as likely to bring a Rightist Revolution as one from the Left) or giving up. Making things better isn’t a battle you win and go home; it is the ongoing process of civilization, and its progress is always uneven, with frequent reverses. And grown-ups accept that and persevere.

    1. James Levy

      I’ll be happy if you are right, but I don’t think so. That’s my considered opinion after watching the system degenerate since Reagan. I could be wrong. I’m not telling you not to try. I’d love to see meaningful reforms. But the system was literally falling to bits in 2007-9 and that did not lead to meaningful change. And the Presidency was stolen in 2000 and that did not lead to meaningful change. So I have some reasons other than being a loser to believe that meaningful change is not realistic under the current system of money=power.

    2. Selenko

      Reforms assume a degree of rationality: that the ruling class will make concessions if it means preserving the superstructure on which its power depends. Do you see any sign of that rationality now? How did the ruling class address the financial crisis beyond shoveling public money at the institutions bearing much of the responsibility? Dodd-Frank? Don’t make me laugh. The state is behaving with all the rationality of a dying animal. Revolution is never pleasant and always uncertain, but right-wing dictatorship is more likely to emerge from a pre-emptive counter-revolution that I fear is already well advanced. Without a revolution I see no other likely outcome except outright collapse.

  23. sherparick

    I am afraid I must be a dissenter her because in no way was Krugman, or Mike Konzal, stating Obamacare was preferable to single payer, or that one should not point out that single payer is the better policy, but that under the political circumstances of 2009, the Affordable Care Act as about as progressive a bill as one could get.

    1. I know he is as hated here as at Red State, but Obama as President cannot enact laws. He can only propose laws and negotiate with enough Congress persons to get it passed.

    2. Obama needed 60 votes to pass a bill through the Senate, and lost that when Scott Brown took advantage of Martha Coakley thinking she was going to coronation and not an election. There was not sixty votes for single payer health insurance in the U.S. Senate in 1935 under FDR, there was not 60 votes for single payer in 1965 under LBJ, and there was certainly not 60 votes for single payer under BHO in 2009-10. If someone could explain where those 60 votes, or even 50 votes, would come from I would like you to name each of the Senators holding office in 2009-10 and how they would have voted. (I think you could safely start with all 40 Republicans voting “No.” Then add Lieberman, Dodd (Conneticut is the HQ Insurance Companies), Lincoln, Pryor, Spector, Nelson (Nebraska), Bayh, Hagan, Feinstein, and Nelson (Florida), and probably Schumer and Gillibrand of New York, and I now have 51 “no” votes. And Sherrod Brown and Bernie Sanders would have been the only for sure “yes” votes.

    3. Pelosi had a Blue Dog caucus of around 40 memebers and New Democrat caucus of aound 40 members. None of these folks would have voted for single payer.

    4. Lambert engages in pure Green Lanternism about how Obama could have gotten single payer passed in the first 100 days. It Would Not Have Happen. As it was both the inadequate stimulus (and I really wish Obama had been a true believing Keynsian rather than an Eisenhower Republican on this issue)and the ACA barely got through the Senate and the House.

    5. But as to style, I do like Lambert’s Left Tea Party touch of going after other progressives as opposed to the organized opposition of the Republican Party and the plutocrats. The Right should not have all the fun.

    1. roadrider

      2. Obama needed 60 votes to pass a bill through the Senate,

      He could have gotten in passed through reconciliation – the same way he got the ACA passed.

      Its obvious that he wouldn’t have proposed or fought for single payer even if he had 100 reliable votes in the Senate. He was dead set against it and wouldn’t even permit it to get a fair hearing or use it as a negotiating position to preserve the public option (which he disingenuously promoted even though he had already sold it out to the pharma and insurance lobbies). Why? Because he fundamentally does not believe in it and neither do corporate whores Pelosi, Reid, Hoyer and the rest of the corrupt, sclerotic leadership of the Democratic Party.

    2. DolleyMadison

      Obama apologists always rebutt any criticism of his betrayals with many variations of the same “he is powerless” theme. Well, if that is true, then why do you continually support him? What good is a powerless leader?

      1. James Levy

        And we all watched a truly limited and rather gauche and ignorant George W. Bush win victory after victory for his policies from 2001-2007. How come Bush could get what he wanted as President but poor Obama is powerless, even after sweeping the field in 2008?

        And, more is the point, what did he try to do in those critical 100 days comparable to the Bush tax cuts or the war against Iraq? Obama was a Not Ready for Prime Time President surrounded by intellectually spent hacks from the Clinton Administration. Obama had the power to appoint advisors who had a clue and could fight for something they believed in. Instead, he surrounded himself with people who would calm the anxieties of Wall Street and kiss his ass.

    3. Doug Terpstra

      The fact remains, Obama never broached SP, pulled its chair from the table and actively shut down any and all voices who wanted it aired — even took Kucinich for a ride, then sat on his hands as the poor chump lost his seat as a result. All your revisionism excusing Obama’s impotence, incompetence, and “realism” ignores the most basic fact: Obama willfully strangled single-payer in-utero. Medicare was the low-hanging fruit that Obama swatted to the ground to rot.

    4. hunkerdown

      3. Pelosi had a Blue Dog caucus of around 40 memebers and New Democrat caucus of aound 40 members. None of these folks would have voted for single payer.

      Well, that was her fault for making committee assignments based on pay-to-play instead of handing them out as rewards for upholding the Democratic vision statement/platform.

      That they got rid of Grayson and Kucinich, big single-payer supporters, after that term suggests that the desires of the party apparatus did not care for single-payer.

  24. Rob Lewis

    I feel your pain and fervently wish single-payer had not been preemptively taken off the table, but Krugman isn’t the only one engaging in a bit of history rewriting. Weren’t the labor unions also fine with dropping single payer?

    And I can’t quite grasp the writer’s definition of politics. He seems to believe that if Republicans do it, it’s “politics”, while if Democrats do it, it’s “cowardice” or “sellout”. Explain to me how Democrats serving the interests of their biggest campaign donors (insurers and drug companies) is not “politics”, as Krugman suggested. It may be touching to believe in the virgin birth of Democratic politicians, but unfortunately it’s not the real world. You go to war with the Congress you have, not the one you wish you had.

  25. Hugh

    Krugman is an Estabishment liberal. An Establishment liberal is one who criticizes aspects of the system which loots us but continues to defend that system because they have received their privileges, position, wealth, recognition from it and they identify with the elites who run it.

    As I am sure others have already pointed out, insurance does not equate to actually receiving healthcare. Even back in 2009, one out of every two dollars spent on healthcare in this country was spent by the government: Medicare, Medicaid, Tricare, and the VA. And lets face it most Americans look forward to being covered by Medicare. So the idea that Americans were inherently opposed to single payer is a flat out lie.

    I am so tired of the argument that the Democrats didn’t fight for something because they didn’t think they could win. This argument was put forward even when as in 2009, and as lambert points out, when the Democrats controlled both Houses of Congress and the Presidency. Well, if the Founders had had this attitude, we would still be an English colony. If Lincoln and the Union had had this attitude, we would be two countries, one free and one slave. If Martin Luther King had had this attitude, Jim Crow would still rule in the South and a lot of other places as well. It was the duty of Democrats to fight for single payer. Instead we saw them seek to suppress any mention of it. Now as cogs in the kleptocratic machine, it is real easy to see why they acted and continue to act as they do. As another small cog, it is equally easy to see why Krugman puts out the bilge he does.

    The point here is that the Democrats are just another corporatist, kleptocratic party. Krugman is one of the elites who serve the kleptocratic order. It is completely wrongheaded to think either is actin in good faith or in our interests. They are not. They never will.

    1. charles sereno

      The Democrats didn’t fight for it because they didn’t think it could win. A true statement. They thought it couldn’t win because they didn’t want it to win. Also a true statement.

    2. Deconstructing Political Spin [Alexa]

      Hear, hear, Hugh!

      You say:

      The point here is that the Democrats are just another corporatist, kleptocratic party.

      Krugman is one of the elites who serve the kleptocratic order. It is completely wrongheaded to think either is actin in good faith or in our interests.

      They are not. They never will.

      As far as I can tell, corporatist Democratic lawmakers have not supported a single-payer health care system for many years.

      The DLC’s “Hyde Park Declaration” states quite explicitly that they are in favor of “market-based” health care solutions.

      Remember, several years ago, Black Agenda Report authored a piece about PBO denouncing his ties with the DLC and its agenda.

      But as far as I can tell–he seems to be quite determined to carry out the Third Way agenda.

      And the Affordable Care Act (PPACA) is just a reflection of this agenda.

    3. Deconstructing Political Spin [Alexa]

      Hear, hear, Hugh!

      You say:

      The point here is that the Democrats are just another corporatist, kleptocratic party. Krugman is one of the elites who serve the kleptocratic order.

      It is completely wrongheaded to think either is actin in good faith or in our interests.

      They are not. They never will.


      [Please note: I am trying to switch my “username” to match my byline on a “Twitter account.” I have no nefarious purpose. It was my intention to use both names, for just a couple of days. I hope that this is not an infraction of any rule, here.]

    4. Alexa

      Hear, hear, Hugh!

      You say:

      I am so tired of the argument that the Democrats didn’t fight for something because they didn’t think they could win. This argument was put forward even when as in 2009, and as lambert points out, when the Democrats controlled both Houses of Congress and the Presidency. . . .

      The point here is that the Democrats are just another corporatist, kleptocratic party.

      Krugman is one of the elites who serve the kleptocratic order. It is completely wrongheaded to think either is actin in good faith or in our interests. They are not. They never will.

  26. aletheia33

    that paragraph you’ve taken apart, when i read krugman’s whole piece, jumped out at me as different from the rest–it reads like something barry (or whoever writes for him) might have written to paul saying, “if you could just put this in”. i’m probably too tinfoily, but what could suit the administration better than exactly what PK does in this piece–acknowledge all the problems, take it apart, but just so you can put it all back together again and make it sound reassuringly like we’re really still on the right track.
    i do find it odd that krugman would present what sounds like pure white house marketing speak as his own, when that’s not his voice–as if he doesn’t realize how important language really is. (not the many economists really do.) the rest of the piece, though still questionable, sounds more solid to me.

    i do have to question whether, even if all the right things had been done to bring out support for and try to establish single payer, the opposition might still have been able to make it impossible. i mean, given that the whole congress is owned by the insurance industry, when PK says single payer was not “achievable,” even though he’s eliding a great deal that actors with integrity might have done, we’re still dealing with the reality on the ground that there are actors with integrity are rarer than hens’ teeth–correct? he does not mention this, of course, but it remains the case, no?

    please sort me out, someone, if my thinking is just getting tangled up to no constructive purpose here.

  27. aletheia33

    and thanks so much for the excellent language breakdowns you do. always both highly amusing and urgently to the point.

  28. aletheia33

    oh god–wish i could delete my post above. i read lambert’s piece early this morning and thought it was about a paragraph in TODAY’s PK op-ed, which i later read at my local cafe on hard copy. i cannot now recover the op-ed because it’s the end of the month and i’ve used up my free new york times access. i apologize for wasting everyone’s time with my inaccurate comment.

      1. aletheia3

        thanks lambert, yes i can access the blog piece for free, but i could not access today’s op-ed, The Big Kludge, which contains a paragraph that struck me at the cafe this morning as very redolent of obamaspeak–while i thought the rest of the op-ed did not read quite so orwellianly. i now have it and here’s the graf:

        “The proximate answer was politics: Medicare for all just wasn’t going to happen, given both the power of the insurance industry and the reluctance of workers who currently have good insurance through their employers to trade that insurance for something new. Given these political realities, the Affordable Care Act was probably all we could get — and make no mistake, it will vastly improve the lives of tens of millions of Americans.”

        maybe it’s just that “make no mistake.” and the colloquial “just wasn’t going to happen.”

        would love for you to take down the op-ed just as you did the blog post. probably redundant hence not best use of your time. but i so enjoy (and am inspired by) your relentless, fine-grained dissections of the bland, phony (to use a reliable, old-fashioned term) lullabies we cannot close our ears to, this now omnipresent piffle (i borrowed that from russell brand).

        i hope some high school current events/social studies teacher somewhere out there is using these kinds of pieces to teach some young people how to discern the lies. it’s an invaluable work that few are cut out for. keep it up.

      2. aletheia33

        and how about that “proximate answer” and “probably all we could get.” minus the equivocating, what is left? piffle. (“perhaps blend of piddle and trifle”–Webster’s). foam on the sand…

        now for the interesting question: how can the states still trying to work toward single payer and in danger of having no waiver granted them in 2017, when who knows where things will stand, use this moment to extricate themselves from the ACA vampire squid/get waivers before 2017?

        …what if these states were to just go ahead and set up their own health CARE programs and see how that plays out in the courts? they’d have to come up with a way to fund it outside the federal largesse–not likely. and of course, no state gov’t actors have the gumption, but what if they did? could they push forward with this pragmatic action ultimately–say, if they formed a united front?

        aside from this delightful fantasy, what do you think those states can/should do to seize this opening? and what is the plan of action of the single payer advocates, who do recognize the opening? any info very welcome.

  29. Hugh

    As to procedure, spending bills can be sent through the reconciliation process. The finished reconciliation report has a limit (20 hours in the Senate) on debate and requires only a simple majority for passage.

    Every two years, there is a new Congress. No new Congress is bound by the rules of the previous Congress. Regular parliamentary procedure applies. This means there is no filibuster or 60 vote threshold until the new Senate agrees (by simple majority vote) that the old rules apply.

    There are those who also argue that the filibuster can be suspended at any time by a direct appeal to the President of the Senate, i.e. the Vice President.

    As to the composition of Democratic officeholders, it is important to remember that back in 2008 people like Rahm were pushing Blue Dog Democrats even where much more liberal candidates could have won. In 2009 and after, the Democrats then said they couldn’t push for more liberal legislation because of all those Blue Dogs they helped get elected.

    This is why a party platform is important. Candidates should be obligated to accept it and fight for it. If they don’t, they get expelled from the party. As it is, Democratic officeholders are far more in accord with the Republicans than they are with their base. This is the other side of the equation. The base needs to put the platform together. If Democratic officeholders are not fighting for the issues that are important to it, the base should not vote for them. Or to be clearer, Democratic officeholders are not fighting for the issues important to the base, so the base should not be voting for them.

  30. Pedro

    I disagree. Krugman is more or less correct. The ACA is closer to the conservative healthcare dream than to a progressive model, and yet, look at the resistance it has been getting. It’s not as if the Tea Party is arguing that it’s not enough like Medicare. It’s the opposite. They hate that it subsidizes healthcare for poor people and that wealthy healthy people will have to subsidize everyone else. A single payer model would be even more troublesome for conservatives. So how would Obama had fared if he had gotten around filibusters and pushed through a single-payer model?

    As much as we don’t like it he had to play the compromise game. What does make me angry is that he does not at least acknowledge that he sold-out. I would have respected him more and he would be in much better bargaining shape if he were able to tell the Tea Party to shove it because he has already compromised away his base for their sake.

    Krugman is right though that if million of Americans were told they would lose their employer based health insurance and that their taxes would go up to support the system there would be major resistance. Of course, we know this would be overall better for most people and society in general, but that’s a hard sell. Look, we now have people losing their employer based insurance and they are gaining traction with the Teapublicans because they are blaming it on Obama care. And that’s without them even being able to prove their new coverage would be worse or even that Obamacare caused the change in the first place!

    We dislike Obama because he capitulated without admitting it. But that means he lost bargaining power. It’s as if he voluntarily tacked to the right. This may be so. He may be a Manchurian candidate, but I still think he thinks he’s being pragmatic. He still thinks these incremental changes are better than nothing, that it’s better to get re-elected and pass incremental change. But it is getting tiresome. The Dems are getting NO credit for tacking to the right and if you get no credit you get no leverage and you might as well become a Republican.

    1. Alexa

      The Tea Partiers are big defenders of Medicare–remember their signs–“Keep Your Hands Off My Medicare!”

      They consider the “ACA Model” to be a form of welfare, because unlike Medicare, only some folks are subsidized.

      In the Medicare program–with the exception of a Medicare premium surcharge levied on approximately the Top 5% of wage earners–it is NOT means-tested (although the Powers That Be are probably getting ready to destroy Medicare, too, by further means-testing, dipping well into the barely middle class.)

      But as it stands, with the exception of VERY affluent folks, the Medicare premium is the same for all.

      The only thing that has stood between us and the destruction of the social safety net so far–is the Tea Party crowd.

      So odious or not, I am grateful to them for having the backbone to resist the proposed cuts.


  31. jfleni

    The Key sentence in all these links is “Of course it’s corruption”. That’s all you have to know. The fool’s circus with ObamaCare, the obvious preference of the people for a better system, (plus the raving of the Tea Party morons) leaves a small opening for single-payer. Let’s take advantage of it.

    Barry Bubba, the butt-kisser champion, (along with Liz and the rest of the crazy posse) has done what what the Roman proverb said: “Whom the gods would destroy, they first make mad.” Nobody would consider the latest foolishness of DogPatch-DC as anything but insanity. There could be a small chance of sanity taking over, let’s hope so and work for it.

    Krugman apparently believes the Dem/dimwit screams from Harvard Square, and pays no attentoon to anything else.

  32. Deloss

    I think Paul Krugman is entitled to his opinion, like anybody else. But if he actually ran the government, we’d have had more stimuluses and larger ones. I was always under the impression that the person who killed the public option, almost single-handedly, was Olympia Snowe. You can look at the NYT article for yourself:

    I try to be a progressive but I am also a gradualist, and I think beating up Paul Krugman for lack of ideological purity is not helpful to our side.

    1. Hugh

      Lambert was in the middle of this, and I was also part of the debate going on at the time. Both lambert and I were and are single payer advocates. From the beginning, we saw the public option as nothing more than a bait and switch, something to get liberals on board, preempt criticism from them, and then be dumped or reduced to next to nothing when it was all over. So the public option was a dead man walking long before Olympia Snowe played her kabuki part in what was a foreordained conclusion.

      As I wrote back in my Obama scandals list:

      The public option was a concept of Jacob Hacker, a political scientist. He envisioned it as covering 129 million Americans or half of the non-Medicare population. It was to be available on Day One to all and use Medicare rates. His version of the public option did not come close to making it into any of the bills in the House or Senate. Indeed the public option throughout the debate remained nebulous. It became a kind of Rohrschach test reflecting the hopes and fears of supporters and detractors. In keeping with the debate’s focus on money, the content of the public option was left deliberately undefined.

      Who could sign up for the public option was unclear for much of the summer as well. At a July 28, 2009, AARP tele-townhall, Obama seemed to imply that registration in the public option would be open:

      “So you could still choose a private insurer, but we’d also have a public plan that you could choose from”

      and on August 20, 2009 in remarks before the Organizing for America national health care forum:

      “Now, one of the options will be a public option because we think that potentially could be a better deal for consumers. But nobody is going to force you into that option. It will, however, help keep the private insurers honest because if they’re charging a lot more — higher profits, higher overhead, worst deal in terms of insurance — then a lot of people will say, well, I might as well take advantage of the public option. But it will be the choice of the individual.”

      This changed rather radically in Obama’s September 9, 2009 speech to a joint session of Congress:

      “But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. (Applause.) Now, let me be clear. Let me be clear. It would only be an option for those who don’t have insurance.”

      And as Obama continued, it would cover only about a tenth of those in the original Hacker public plan:

      “In fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up.”

      This raised questions not only about how such a small plan split among 50 state exchanges could keep the larger privates honest but also about whether it would have sufficient market share to negotiate lower prices with health providers. In a word, would such a public option even be viable? These concerns were heightened by moves in both the Congress and the White House. The public option was divorced from the Medicare rating structure meaning that it became even less competitive. It would have to pay more for services and therefore charge higher premiums to its customers. Its startup costs would have to be paid back, again resulting in higher premiums. On top of this, its rollout would be delayed until 2013, ostensibly to make the 10 year cost projections for the overall healthcare plan come in on budget. Any possible expansion of its availability would not come before 2015.

      It was all a recipe for failure, but that was rather the point. As I said, even at the beginning of the debate Obama’s support of the public plan was less than wholehearted. At a June 23, 2009 press conference, when asked if the public option was non-negotiable, Obama replied,

      “we are still early in this process, so we have not drawn lines in the sand”

      He again downplayed it on August 15, 2009 at a townhall in Grand Junction, Colorado,

      “All I’m saying is, though, that the public option, whether we have it or we don’t have it, is not the entirety of health care reform. This is just one sliver of it, one aspect of it.”

      This remark created quite a storm and Obama backed off of it. On August 20, 2009, he was more positive:

      “I continue to support a public option, I think it is important… The only thing that we have said — and this continues to be the truth — and I mean, sometimes you can fault me maybe for being honest to a fault — is that the public option is just one component of a broader plan.”

      However this did not prevent the White House from supporting various efforts, such as co-ops, triggers, and opt-outs to kill the public option entirely. The object here was to do it without the Administration taking the blame for it.

      Back to me in the present. The public option was never more than a political ploy to shut down liberal opposition to Obamacare. Indeed as the debate went on, I and others began calling it the Amazing Shrinking Option. Nobody actually knew what the public option was. Despite Hacker’s work, there were never any solid outline of what it was precisely. This was probably deliberate since its vagueness lent itself to successive reductions in scope. So that over time, we didn’t so much see what it was but we did see increasingly what it wasn’t.

      Obama never bothered to define and declined to fight for it, so yeah, it was only ever for show and dead long before Snowe came along.

    2. Lambert Strether Post author

      I’m not beating up Krugman for lack of ideological purity. I’m beating up Krugman for sloppy writing, getting the history wrong, and failures of conscience. I mean, his own column is named “Consience of a liberal,” and how does suppressing any mention of state single payer programs square with that, in a post that proposes to lay single payer to rest?

  33. DakotabornKansan

    “Progressive defenders of Obamacare may inadvertently be digging the graves of Social Security and Medicare,” says Michael Lind.

    “If Obamacare — built on means-testing, privatizing and decentralization to the states — is treated by progressives as the greatest liberal public policy success in the last half-century, then how will progressives be able to argue against proposals by conservative Republicans and center-right neoliberal Democrats to means-test, privatize and decentralize Social Security and Medicare in the years ahead?”

    Lind predicts that “it is only a matter of time before conservatives and Wall Street-backed “New Democrats” begin to argue that, with Obamacare in place, it makes no sense to have two separate healthcare systems for the middle class — Obamacare for working-age Americans, Medicare for retired Americans. They will suggest, in a great bipartisan chorus: Let’s get rid of Medicare, in favor of Lifelong Obamacare!”

    “Think about it, progressives. The real “suicide caucus” may consist of those on the center-left who, by passionately defending the Affordable Care Act rather than holding their noses, are unwittingly reinforcing the legitimacy of the right’s long-term strategy of repealing the greatest achievements of American liberalism.”

    1. Alexa

      You nailed it, DakotabornKansan!

      You say:

      “Think about it, progressives. The real “suicide caucus” may consist of those on the center-left who, by passionately defending the Affordable Care Act rather than holding their noses, are unwittingly reinforcing the legitimacy of the right’s long-term strategy of repealing the greatest achievements of American liberalism.”

      Which is “why,” IMHO, the ACA should be “repealed and replaced with Expanded [and a more generous version] Medicare-For-All!”

      The Sunday Talk Shows were full of complaints about “private insured consumers” being thrown off their insurance in the past few weeks.

      But “things” will really hit the fan when millions of “group plan participants”–by far the bulk of Americans–also are thrown off their employer-sponsored plans.

      Their numbers make those of the individual market pale, by comparison.

      I believe that the “individual mandate” was the “Nose Under The Camel’s Tent” for many other “mandates,” to follow.

      As is exemplified by Senator Harkin’s half-baked plan for “opt-out” only retirement plans for some Americans.

      And some so-called policy experts have been talking mandatory “long-term health care” insurance(posted a video about this months ago).

      What’s next, for crying’ out loud?


  34. Code Name D

    The biggest caveat I have is that this is a mal-formed question, especially from a political perspective. Instead of asking if it can be done, the real question should be how it can be done. Those who would declare it to be impractical are in essence opponents to the single payer.

    When I make this argument, I am often accused of making a “may way or the highway” argument. Especially given that most people whom I discuses this with declare themselves to be genuine supporters of universal care. To which I point out that Obama and the Blue Dogs opposition to single payer is not imaginary or some rhetorical cliquey – they actually do oppose it and will say so when cornered or when they address a like minded audience. When they declare that single player is “not practical,” they do so with the intent of shutting off further discussion. It’s the “pragmatists” who insist that it’s “my way or the highway”, simply declaring single payer supporters as being unreasonable – a reflection of their true opinion of single payer.

    I add that accepting the argument that single payer or the public option is “unreasonable” is indistinguishable from not supporting the reform. This is not an “are you with us, or are you against us” kind of argument, but rather challenge to weather the apologists actually supports that which they say they do.

    PS: I plan on espanding on this at Old Elm Tree.

  35. Cal Damage

    I always enjoy well-researched pieces intended to prove that the idealist author is actually a knowledgeable realist.

    1) I guess you’re too young to remember how often the insurance industry ran ads in every market (TV, radio, print, national and local) opposing the last Democratic attempt at upgrading America’s health care industry’s availability to Americans. (Note: Republicans have never tried.) Exactly what in 2009 was going to prevent the same onslaught, especially when single-payer upped the ante to “We’re putting you all out of business”?

    2) When discussing the Democratic majorities after the 2006 and 2008 cycles, please include your list of 218 House members and 51 Senators that would have voted for single-payer had it been in a bill.
    2a) I believe it took a reconciliation slight-of-hand to get this thing passed as it was, as it did for the Bush/Cheney/Nelson tax cut of ’03. As for filibuster, I’d like to go back to the rules before the ’79 changes (Mann&Ornstein do a good explanation) but, assuming the Democratic electorates’s demonstrable mid-term lethargy combined with even more racist backlash at a failed attempt for single-payer, did you really want Obama to be the only thing standing between you and Rand Paul’s utopia, with no filibuster left in the Senate to stop the Republican majority that would have resulted?

    3) Yes, Krugman chose the wrong term for the simulation. It seems intended to simulate (at least until Roberts went all Tenther on the ACA) universal coverage.

    I think ACA’s premium support/voucher/price offset will end up being the wedge to single payer, as some areas either go without any insurance company willing to cover them, or with prices so high that the ACA premium offset is more than actual insurance is most places, at which point even the fiscal conservatives (which does not include much of the GOP leadership today, and certainly none of their young guns) will say ‘why the hell are we paying that much money to buy those people private insurance when we can cover them for less by putting them in Medicare” like some permanently disabled get now.

    Between the competition of the actual insurance market the ACA creates (never been one before, where you could compare apples to apples on prices, like you now can compare bronzes to bronzes, etc.,) and the data that must be reported by the insurance companies (prices, locations, number of folks who pay that price) as well as meeting the “must spend 80%/85% of premiums on actual care” requirement, the margins may get so thin that the need for the public option, and then single-payer, become apparent, as insurance companies move out of more and more markets.

    We need idealists to remind us of the goals, and to push us. But others have to show the idealists that only Jesus got to walk straight across the sea. The rest of us gotta build a boat first.

    1. Lambert Strether Post author

      1) Wrong. And since when is “ZOMG, the forces opposed to X ran advertising against it!” proof of anything?

      2) In the conditions of 2009, if the party leadership made it a loyalty issue and whipped for it, of course it would have passed — only 50 votes in the Senate needed.

      3) Sometimes the idealistic thing is the realistic thing, and so-called realists are simply vacuous go-along-to-get-alongers. It’s a nice dichotomy, but like all dichotomies comes down to cases. I mean, what was the New Deal? Idealistic or realistic? Both. What’s ObamaCare? Neither, I would say. It’s purely venal. The suppression of single payer advocates and advocacy is the tell here.

      NOTE On apples to apples, you’re assuming that the services behind the bullet points are comparable. There’s no basis for that assumption. You are confusing identical wording with identical services delivered. They are not the same.

      1. Doug Terpstra

        Well done, Lambert, very well done.

        It can’t be said often enough. Better to have tried and failed than never to have tried at all. Obama and cronies never once made even a halfhearted attempt to get single-payer and in fact went out of their way to stifle, muzzle, and censor its advocates, including O’s own prior personal physician. Calling it disgraceful is much too kind. Venal is the right word.

        Revisionist apologies like Cal’s (it wasn’t worth trying or even introducing) are lame and disingenuous at best; at worst insidious and cynically dishonest.

  36. Yancey Ward

    Yikes. What a thread.

    Single payer requires, literally requires Congress to come up with another trillion dollars in revenue every year at a minimum. You could not have gotten 10 votes in the Senate for such a proposition in 2009, or any other year. This is why you got ACA.

    1. Hugh

      You are forgetting the trillions currently being pumped into the private insurance industry. If that money was redirected into Medicare for All, healthcare would be cheaper for all, available to all, and the outcomes would be better.

      1. Yancey Ward

        Yeah, you gotta redirect via taxation, but the taxation would not fall on the insurance industry, or the health care providers. People here are pretending it is politically easy to redirect the spending so that it goes through the government first- it isn’t any easier than it is to raise any other tax.

        Let’s say you outlaw all private health insurance- then the spending on that insurance becomes the income to capital and labor. To claim that for single payer will require raising taxes on capital and labor. And the payers won’t care one whit that their incomes increased prior to the new rates- the rates are the political hurdle, and pretty much insurmountable today and in the future.

        1. Lambert Strether Post author

          Sure it’s easy. You just have to go to war with the Republicans and beat them to a pulp; conditions were ideal for that in 2009. In other words, do for real the relatively minor pushback that Obama did in the shutdown, and in a timely manner, not 5 years too late, as in Obama’s famous victory over the TP that we’ve already forgotten about.

  37. Whistling in the Dark

    Is there a doctor in the house?

    I remember reading some months back about a doctor (Maine, I think), who was (I think) refusing insurance as payments — only taking cash.

    I know it was a locally-specific kind of situation… but how feasible (and, of course, I know there would be pros and cons…maybe) is it for doctors (and… well, their organizations) going rogue in that sense: Refuse insurance in favor of cash, medicare/caid, and charity.

    Is there an actuary in the house?

    What sort of individual payment would be expected if every man, woman, and child pooled their risks in, say, the state of South Carolina? Would it really be that bad? Where can someone get their hands on these numbers? … Which is to say nothing of who would be receiving the payments, you know, besides health care practitioners/firms, who are part of the community of service and should therefore have no stake in gouging anyone… in addition to, yes, these alien (from community, I mean) entities providing pharms and gadgets …

    You know, do the math, and the people will come.

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