Yet Another Shoddy Democratic Hack Job from Paul Krugman on ObamaCare

By Lambert Strether of Corrente.

I know, I know. Film at 11! But let us sorrowfully pull on our waders and look at Krugman’s latest. From the lead paragraph:

The current state of public opinion on health reform is really peculiar. If you’ve been following the issue at all closely, you know that the Affordable Care Act [ACA; ObamaCare] is one of the great comeback stories of public policy: after a terrible start, it has dramatically exceeded expectations. But hardly anyone seems to know that.

Let’s parse this out. Tellingly, Krugman conflates a public relations narrative (“comeback story”) with actual public policy success, and by what metric? ObamaCare  “dramatically” (narrative again) “exceeded expectations.” What expectations? Whose expectations? Krugman does not yet say. Be that as it may, if “you’ve been following” electoral tactics “at all closely” over the years, you’ll recognize the hollow triumphalism of the expectations game successfully played. (In this case, the comeback was so extraordinarily successful that the coach, Sebelius, fell on her sword to protect the owner, Obama, by resigning to spend more time with her family, but never mind that.) And if “nobody knows,” it’s not because the Democratic nomenklatura hasn’t been taking not so much a victory lap, as a victory tongue bath.

So in the second paragraph comes the reveal: Krugman’s metric for success is signups; the famous lowballed 6 million that turned into 7 million and change. (Never mind the oddity of taking a metric from horse race journalism and applying it to health care policy; we’ll get to that.) And in some way this makes sense: Numbers are obviously important, as Krugman himself points out when critiquing the Ryan budget: “[P]eople who actually know how to read budget numbers weighed in, revealing it as a piece of mean-spirited junk.” The problem here is that the ObamaCare numbers are soft, as this blog has consistently pointed out, and about to get softer.

First, and remarkably, much of the ObamaCare sign-up coverage is based on privatized data; people writing the “comeback story” aren’t relying on direct numbers of signups from either the insurance companies or the famously re-engineered ObamaCare website (whose backend is still broken); they are relying on surveys done at one remove, from the RAND corporation and Gallup. Not that there’s anything wrong with using private polling data to write the narrative for public policy; it’s just that the administration has earned a measure of skepticism in this regard:

The administration has always gamed the ObamaCare numbers, from the first day when they scammed us with unique visitors to the Federal website instead of actual sign-ups. Then they gave us counts of people who’d pressed Submit buttons for enrollment on the website, but hadn’t actually paid for their policies (which many did not (20%), and never mind the errors. Or whether they will continue to pay. Or have cancelled, since the system can’t remove cancellees yet). Then too, there’s the issue of how many ObamaCare enrollees already had insurance, as opposed to those who actually increased the net number of those covered. To be fair, some Democrats just… make the numbers up!

To be fair, sign-ups are hard to measure, because of Obama’s intrinsic (and needless) complexity as a Rube Goldberg device, as Charles Gaba points out in his labor of love (which shouldn’t even need to exist). However, even assuming RAND and Gallup did their work totally at arm’s length from the White House, it would be nice to know that they took all these factors into account in their survey methodology. (There’s no possibility of getting the number of the newly insured from the ObamaCare database itself, because oddly, or not, they have two different and incommensurable surveys on that question, one for the website, one for paper signups.) The bottom line is that ObamaCare met, or slightly overshot, the original goal for signups that CBO set back in 2010; and that goal is preposterously low when set against people’s need for care. Another such great comeback story and we are undone.

Anyhow, the signup numbers are soft, and they’re about to get softer:

The Census Bureau, the authoritative source of health insurance data for more than three decades, is changing its annual survey so thoroughly that it will be difficult to measure the effects of President Obama’s health care law in the next report, due this fall, census officials said.

The changes are intended to improve the accuracy of the survey, being conducted this month in interviews with tens of thousands of households around the country. But the new questions are so different that the findings will not be comparable, the officials said.

An internal Census Bureau document said that the new questionnaire included a “total revision to health insurance questions” and, in a test last year, produced lower estimates of the uninsured. Thus, officials said, it will be difficult to say how much of any change is attributable to the Affordable Care Act and how much to the use of a new survey instrument.[1]

(Sarah Kliff argues the changes will make the Census a more accurate measure of who has insurance; Megan McArdle argues that trend lines will be obscured. And where’s the triumph in churn?)

The bottom line is that Krugman’s metric for “one of the great comeback stories of public policy” is soft, and Krugman the economist — the scholar — has to know that; but, sadly, Krugman the hack doesn’t care.[2] 

Of course, it’s not enough just to have a metric, and Krugman the economist surely knows this; you’ve got to have a metric that’s fit for the purpose as well. So why on earth is ObamaCare signups the right metric? (Aside from the public relations aspects of winning the expectations game, of course.) The Affordable Care Act is the Affordable Care Act, after all; one would think that the key metric would be people who get care that didn’t get it before, even more than people getting insurance that didn’t have it before. It’s as if Krugman measured the success of D-Day by how many troops went ashore, as opposed to whether they were able to dig in and hold ground. But no; in the crazy pants neo-liberal world that Krugman lives in, along with the entire political class, sick people getting care are a problem labelled adverse selection. So much for “public policy,” eh?

From triumphalism, Krugman shifts to pop sociology. He’s perplexed:

Over the weekend I had dinner in NYC with some very smart, sophisticated people [among them, apparently, none of Thomas Friedman’s cab drivers]; yes, all of them liberals. And almost everyone in the group was under the impression that Obamacare is still going badly — they wanted me to tell them whether it could still be turned around.

But anyway, back to the mystery: here we have smart, pro-reform people living in a state where reform is going really well. And they don’t know it!

In part this may reflect the Obama administration’s lackluster job so far in getting the word out. But it also, I think, reflects a persistent anti-ACA tilt in news coverage.

Come now. Is it really likely that the “smart, sophisticated” people round Krugman’s table are tuned into FOX or Limbaugh all day? I don’t think so. In fact, they’re probably reading Krugman’s column religiously; most “liberals” do. I’d like to proffer an alternative explanation.

Most people who, like Krugman, are in the political class, will never encounter ObamaCare (let alone Medicaid). Krugman’s dinner companions get their health insurance through their employers; it’s part of being on the inside, as a tenured professor, a think tank “fellow,” a top-tier newspaper reporter, or a highly valued new media person at a startup. However, I’m guessing that Krugman’s companions also have family, relatives, friends, or acquaintances who are not so lucky, and in consequence they are sensing vague rumblings of discontent in the zeitgeist, a disturbance in the farce. Like this, from Pennsylvania:

I recently attended a younger cousin’s birthday party. My relatives sat around and compared plans. This group was a mix of ages, employment situations, number of dependents, personal wealth. The bad news for the Democrats is that no one likes Obamacare. Not one of them…. It turns out that I have the worst plan at the highest price. One cousin had to change her doctors completely. Another cousin has a serious heart condition but hasn’t landed any work yet, so, no coverage. When his prescription from another state expires in August, he’s screwed. Another cousin just lost his job. He’d been working for 6 months but just when his health benefits were supposed to kick in, he was laid off. How conveeeeenient. Ironically, it is my self-employed cousins who have the best policy. We share the same insurance carrier but, for some mysterious reason we can’t figure out, he pays something like $450/month for 4 people and has a low deductible. It makes me wonder how the rates are determined.

How do we know this isn’t just a blip, an anecdote? Well, we could look at another metric. Follow the money in the Financial Times:

In its latest projections, the Congressional Budget Office cut its estimate for the cost of the US president’s signature law in 2014 by $5bn to $36bn, saying the government would pay fewer subsidies than expected to people buying insurance.

The cut was mainly due to lower government subsidies for private insurance bought on the exchanges, because the insurance plans available were not as generous as the CBO had assumed.

The budget office had expected the plans available through exchanges to be similar to those that companies provide to their employees. But it said they appeared to have “lower payment rates for providers, narrower networks of [healthcare] providers, and tighter management of their subscribers’ use of healthcare than employment-based plans do”.

In a word: Crapification. I’d argue that enough people have encountered enough crapified ObamaCare policies for word to spread. Even as far as Krugman’s dinner table.

So, to bring matters full circle, Krugman is wrong about everything. His metric for success is not only soft, it’s the wrong metric to begin with. And he’s even wrong in his starting point:

The current state of public opinion on health reform is really peculiar.

No, it’s not peculiar at all. When you force people to purchase a crapified product under penalty of IRS enforcement, it’s entirely natural they’ll resent it, and think ill of the people and the institutions that forced compliance on them. If Krugman were the sort of New Deal Democrat who put all that good will on the Party balance sheet for Obama to piss away, that’s what he’d be focusing on: Not the sign-up metric, but metrics that show whether concrete material benefits are being delivered to citizens by public policy. Instead, he’s epater-ing le Republicans and beating the tribal pom poms.


[1] And then there’s this. From the same Times story:

The White House is always looking for evidence to show the benefits of the health law, which is an issue in many of this year’s midterm elections. The Department of Health and Human Services and the White House Council of Economic Advisers requested several of the new questions, and the White House Office of Management and Budget approved the new questionnaire. But the decision to make fundamental changes in the survey was driven by technical experts at the Census Bureau, and members of Congress have not focused on it or suggested political motives.

Yeah, I’d be shocked (shocked) if “political motives” were involved in any way, especially from the White House and HHS in an election year where the success or failure of ObamaCare was a key issue.

[2] And speaking of hackery, even Josh Marshall gives single payer advocate a shout-out:

The latest polls show the country evenly divided on the ACA. Those numbers do obscure that a small but significant percent of the opponents want more reform, not less. They’re largely single payer advocates, supporters of the ‘public option’ or people who just generally don’t think the law went far enough.

Is it possible that single payer advocates have any impact on public opinion? “Peculiar” though that might be?

NOTE “Shoddy Democrat Hack Job from Paul Krugman” contains multiple redundancies. My bad.

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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. Dan B

    Lambert writes: “No, it’s peculiar at all.” Does he need “not” between it’s and peculiar?

    1. ian

      I keep thinking of my experience with car insurance when I hear this “success story”.
      I’ve seen dirt cheap car insurance that simply allows you to check off the box at the DMV that states that you are insured – just try filing a claim, or getting help dealing with the other guys insurance company when you get rear-ended.
      I’ll be curious to see how many happy customers there are in a year or so.

  2. ArkansasAngie

    Krugman got his Nobel from the same place that Obama got his.

    Peace guy? Right, right … sure, sure.

    1. Carolannie1949

      The Nobel prize in economics is not part of the Alfred Nobel prizes but is funded by the Swedish central bank. It is a “memorial” prize presented at the same time as the others.

      1. NotTimothyGeithner

        Awards like the Nobel prize are given out by the elite of a foreign country determined to grab tourist dollars. Like Catholic saints, for every Mother Teresa of Calcutta, there is a Stephen I of Hungary with a few old updated myths added to the list. The Nobel award is no different.

    2. hunkerdown

      As many times as it’s been pointed out in this very site’s articles that, despite popularly held and widely encouraged misconceptions, they aren’t from the same place, why would you come here and say that?

    1. Ned Ludd

      Megan McArdle, at least, is an obvious hack. Paul Krugman earned his place in the oligarchy by being a much more sophisticated propagandist. He gives his imprimatur to policies that entrench and enrich the elites, he convinces liberals that these policies actually advance liberal policy goals (pragmatically), and then he persuades liberals that the people who criticize these policies are all either daft or venal.

      1. Ronnie Pudding

        Nonsense. McArdle doesn’t become reliable just because she serves your political needs. And in the big picture, she hasn’t been right about ObamaCare sign-ups.

        1. Yves Smith

          This is pure ad hominem. Please address McArdle’s argument in the post cited. The fact that something might be so obviously amiss that McArdle is correct but no one on the left will acknowledge it should be a source of shame about the intellectual honesty of the left, but you’ll apparently use any stick to beat a dog in defending Obamacare.

  3. par4

    I’ll take your word for it, Lambert. Personally I don’t care what any Obama supporter says. Starting with Moore, Maher, Krugman right on down through all of the lesser lights of the blogosphere. They have ZERO credibility on any matter.

    1. just me

      Michael Moore? I love him! I don’t think he’s a shill. He has huge credibility with me, even when I disagree. And I don’t think he’s satisfied with Obamacare, I think he’s trying to see it as a start to somewhere, let’s pitch in and do something to make something work, pull our socks up.

      Just checked out his website — his top tweet in his sidebar is to Onion story: FBI Uncovers Al-Qaeda Plot To Just Sit Back And Enjoy Collapse Of United States,35788/

      1. just me

        Just saying, Obama hasn’t given him much has given him shit to work with, but I think Michael’s trying with a good heart anyway to find some lemonadeable stuff in there. Still, I haven’t kept up, so salt salt salt, this is just me thinking what I think he’d be thinking and doing.

        1. Jess

          You mean the Michael Moore who did a documentary about how capitalism exploits workers but refused to hire union members for his film crew?

          “Michael Moore used some non-union crewmembers when union workers were available in the production of his latest film “Capitalism: A Love Story,” a documentary that argues the capitalist system allows for greedy corporations to exploit working-class people.”

          Or maybe you’re talking about the Michael Moore who’s worth $50 million?


          “Michael Moore net worth: Michael Moore is a documentary filmmaker and author who has a net worth of $50 million.”

          Or is it the Michael Moore who got to be worth $50 mil by stiffing those union workers he claims to care about so much? Yeah, must be that Michael Moore.

          1. just me

            First I heard of it. I looked at your link:

            “For all of the different jobs on the movie that could have used union labor, he used union labor, except for one job, the stagehands, represented by IATSE,” said a labor source unauthorized to talk about Moore’s decision not to hire members of The International Alliance of Theatrical Stage Employees.

            In a statement issued to, Moore’s agent, Ari Emanuel, said the filmmaker wished the union included more documentary crew people — but he did not deny that IATSE members were snubbed in favor of non-union employees.
            “Nothing would make Michael happier than for documentary filmmaking to get its due respect, and to have unions pursue the documentary film crews with the same energy they give to bringing feature crews into their membership and making it a viable option for them,” he said.

            “This is a Writer’s Guild, Screen Actors Guild and Directors Guild film, as all of Michael’s films are. He is a proud, dues-paying member of all three of these unions,” said Emanuel.
            IATSE, which represents not just stagehands but computer-graphics engineers and hair and makeup professionals, declined to comment.

            A bit more nuanced than your comment indicates, though I would rather hear it from him than his agent.

            I have no problem with Michael’s wealth. He’s earned it, and I respect his work and am grateful to him. And for him, as well, as in I think we’re blessed to have him. I don’t know if I’m saying this well, it’s just that I have this huge depth of years of appreciation for so many, many things. If he stumbles somewhere, I’d rather pick him up than kick him down. And I’m not sure from the above that he did stumble there.

  4. Cocomaan

    Are there any metrics on the number of previously uninsured that have coverage? That, to me, is a major metric. An uninsured person, even with a high deductible plan, should now conceivably have “catastrophic” coverage.

    Haven’t seen that data yet.

    NPR did a story this morning about how we have no idea what the metrics are, and we won’t for a long time. They concluded that story with me shaking my head, because I had even less of a clue about where were were in terms of the data than when the story started.

    There’s apparently a very complicated intersection between private/public/state/fed datas. It is a corollary of having an overly complicated system.

    1. diptherio

      One of the links a few days ago had a chart showing that the ACA had decreased the number of un-insured by…2.4%!. No word yet on whether that 2.4% will actually be able to afford to use their insurance…

    2. RUKidding

      It’s the $50billion question whether those covered by ACA will even have catastophic coverage. Something I think we’ll have to wait & see. Some say the CA Exchanges are good, and that may be the case. Time will tell for that, as well. I can only state that my health care coverage – provided through my employer & probably one of the better plans available – has continued to rise in costs of co-pays, deductibles, etc. while coverage of various procedures needs to be checked & double-checked to make sure it’s within network, etc.

      I am lucky to be very healthy bc it’s a giant pain anymore to do almost anything with the medical/health “care” system. I can’t imagine what people have to go through who are really sick.

      1. NotTimothyGeithner

        Yet the Obots have the gall to call ACA a success which it is for big insurance, pharma, and hmo’s.

    3. jrs

      “There’s apparently a very complicated intersection between private/public/state/fed datas. It is a corollary of having an overly complicated system.”

      They should get the NSA on that.

  5. PWC, Raleigh

    Well and truly said: “In a word: Crapification. I’d argue that enough people have encountered enough crapified ObamaCare policies for word to spread. Even as far as Krugman’s dinner table…When you force people to purchase a crapified product under penalty of IRS enforcement, it’s entirely natural they’ll resent it, and think ill of the people and the institutions that forced compliance on them.”

    See also —- Study: American policy exclusively reflects desires of the rich; citizens’ groups largely irrelevant (

  6. diptherio

    Well, New York has, apparently, made Obamacare work…by requiring narrow networks. Keeps costs down, ya see.

    In an unusual decision that had a strong impact on consumer choices, New York required insurers to offer the same type of coverage on the exchange as off.

    The result was that none of New York’s insurers offered out-of-network coverage for individuals, except in a small part of western New York, because they wanted to hold down costs and avoid being swamped by sick people. So regardless of whether individuals buy their plans on the exchange or off, they cannot get coverage outside a fixed network of doctors and hospitals, even if they are willing to pay more for it.

      1. Mark P

        ‘They are trying to push down the legal “standard of care” to Third World levels and beyond.’


        Here’s a better link.
        ‘The Practical Utility of Gag Clause Legislation’

        ‘State legislatures and the U.S. Congress are currently engaged in efforts to prohibit “gag” clauses in physician contracts.1, 2 These clauses, promulgated by managed care organizations (MCOs) and other such health plans, prohibit physicians from frankly discussing all treatment options, covered or uncovered, expensive or inexpensive, that could be of benefit to the patient. For example, one clause reads: “Do NOT discuss proposed treatments with [health plan] members prior to receiving authorization. Do NOT discuss the [utilization oversight] process with members. Do NOT give out [plan’s oversight] phone number to members.”3

        ‘Because MCOs cover approximately 190 million citizens in the United States,4 these gag clauses have a significant impact on the health care of most individuals in this country….’

        1. jrs

          So now what? We’ll have to get all our information on health care options from the internet? Or by getting a second opinion in another country?

          1. Chris S.

            JRS, watch out for the phrase “option” in the US health care context, its a loaded word that being prmoted by insurance companies. If you read the following two documents you’ll see that GATS prohibits mixing public and private so we perhaps (under one interpretation) would have needed to switch to single payer before we signed on to GATS, and by another interpretation we still could but only if we do it NOW before they bring in any more multinationals- this is urgent it coud be next week they do this and Obama of course allows them to “since its a health care emergency” see the problem!

            Suppose we still can, then we MUST do it now, have it be total, which means its not an option, its healthcare for everybody, and for this to work we must make it free, and have it not compete with any commercial entity, in any way, for it to be GATS legal, Read more on this here. GATS and public service systems Please read that its extremely good- it shows how narrow the exemptions are Also read this, Putting Health First.

            while you’re there- look at some of their other stuff – has a LOT of useful information – You can find it by going to Google and typing in “ filetype:pdf and then your search string, for example, “health care” {AND|OR} “GATS” and so on. Also Public Citizen for example.. This is relevant

            That will bring up stuff in PDF format on the GATS trade agreement and its interactions with (Canadian) health care.

      2. just_kate

        holy crap, i had no idea something this insidious was going on. this is beyond sickening and immoral. i’ve also grossly underestimated the number of sociopaths participating in healthcare system in order for this to be an acceptable practice.

    1. jrs

      Of course requiring a narrow network doesn’t seem to apply if you have employer coverage in NY. So it’s still very much a two tired systen, Some poeple argue the ACA means people aren’t as tied to employers as they would be before. That’s true only to the extent that the plans offered outside of an employer aren’t so crappy that getting a job is still the most sensible way for an individual to get health insurance. Through jobs you can still probably get traditional PPOs in New York, and go out of network to the doctors of your choosing.

      Sometimes I wonder if this locking in doctors business isnt’ supported by the AMA, because it’s definitely further cartelization, actual choice of doctors would mean just that and people wouldn’t have to be locked in to doctors that they weren’t happy with.

    2. sleepy

      Obamacare is a trial balloon for the privatization/voucherization of Medicare.

      Ezra Klein pointed that out years ago–approvingly.

      1. sleepy

        I should have added–the real Grand Bargain down the road: repubs agree to lay off Obamacare in exchange for the Obamacare-ization of Medicare, which of course is what repubs have proposed a number of times, and which dems will jump at.

        A win-win!

  7. Jim Haygood

    A federal appeals court considers another case which could overturn Obamacare:

    Before the U.S. Court of Appeals for the District of Columbia Circuit, a group of small business owners says the law authorizes tax credits only for people who buy insurance on exchanges established by the states.

    The case revolves around four words in the law, which says the tax credits are available to people who enrolled through an exchange “established by the state.”

    A judge on the appeals court panel, Thomas Griffith, expressed skepticism over the administration’s argument that the subsidies are available regardless of whether people buy insurance on a state-run or federally facilitated exchange [in 36 states].;_ylt=AwrBJSCFlk5TKAQAYAmTmYlQ


    If the rule of law still existed, this obvious drafting error by the health industry flack who wrote ACA would be fatal. But since the federal judiciary now construes laws on political grounds, any goofball result could emerge.

    After all, they’re going to be loath to overturn the precedent set by Chief Rubber Stamper and Bottle Washer John Roberts, who blessed Obamacare with the solemn invocation that ‘it’s a tax, not a penalty,’ as he waved his hands through clouds of incense smoke in the marble chambers.

    Interpreted liberally, Obamacare may authorize everything from public vomitoria to Soylent Green chambers. Let freedom ring!

    1. different clue

      If that suit reaches the Supreme Court, the Roberts Gang will find a way to rule against the suitbringers. Roberts didn’t do all that pretzel logic to uphold Ocare to have some damn lower court bring it down now.

  8. Chris S.

    There is no overstating their desperation to cover up the “bad free trade agreement – bad healthcare reform connection” by any means they can. Because its such a huge betrayal of the country, and their wasting six MORE years on this scam instead of admitting the problem and saying “we should have done away with this system 25 years ago (the last year when most of us could afford it) only makes it worse.

    So please read this paper: The potential impact of the World Trade Organization’s general agreement on trade in services on health system reform and regulation in the United States by Nicholas Skala keeping in mind that its author’s “worst case scenario” now is coming true.

    I think his death should be investigated.

  9. jfleni

    RE: Democratic Hack Job from Paul Krugman on ObamaCare

    It’s no surprise that the “serious” butt-kissers and highly paid shills (McArdle, WaPo writers, Krugman, and many more) are trying very hard to ignore the stink from the ObamaCare dropping; the truth is that it is an insurance scam designed to LOOK slightly beneficial to beneficiaries, like any propaganda/deception campaign!

    Voters are not being fooled at all by the emphasis on the sizzle instead of the steak! And the shills would be in complete opposition if they had to accept it for themselves! But as the post indicated, that never happens.

    Tentative Prediction: Demo-Hacks could lose the Senate in 2014 , followed two years later by R-nuts winning the White House (Sorry about that Hillary!), with the horror-show (absolute and total ascendancy of Plutocrats) beginning then. Serious Demo-butt-kissers had better think SERIOUSLY about that.

      1. Jess

        He may not but I do: massive civil disobedience with about 50 mil people in the streets and a hundred thousand of them killed by the authorities before the government finally capitulates to real reform.

  10. Steven Greenberg

    I am still not sure why this blog has taken such a dislike for Obamacare. It’s ok if you prefer a single-payer system. I think that if the ACA has a modicum of success, but still has fixable problems, then this might be a step closer to justifying single payer. If ACA is a complete and total failure, health care reform of any kind may be set back by decades. Forget about single payer until the revolution.

    1. Charles LeSeau

      I can’t speak for anyone but myself, but I object to for-profit insurance entirely. I consider the entire business model a scam. I find it especially odious that even on supposedly “liberal” websites and news organizations, absolutely nothing is mentioned of criticism from anyone but the Republicans and Tea Partiers.

      Insurance is a business that thrives on others’ misfortunes, a business that sells your own money back to you and tries like the dickens to give as paltry a sum as possible, a business where the profiteers don’t themselves do anything in the way of health care – or anything useful; they are merely middlemen who make up actuarial tables designed to enrich themselves while having enough left over to buy our corrupt government.

      So yes, I object very highly to being forced to buy it, and the whole “road to single payer” argument – as far as I can tell – is completely speculative, and considering the country we live in, about as likely as pigs flying.

      1. Chris S.

        Charles LeSeau
        When Reid said that Obamacare might be a stepping stone to single payer, it wasn’t speculative, it was a shameless lie. The reason being the free trade agreements wich the US has been pushing for decades, again and again, work through all the prerequisites which might be involved in a shift to single payer and attempt to ban them one by one or make them impossibly costly. Then the US drug companies and insurance companies use those FTAs as crowbars to force open foreign markets. If you read the Skala paper you’ll see that coming into 2008, the national hunger for health care reform must have seemed exceedingly worrisome for the power elite of both parties who up until then (and now) have basically kept these horrid FTAs out of public view. Also, they have been successful in preventing Americans from knowing much more about single payer than its name. So, they are trying to pretend that “public” is why single payer is better. Actually, public is banned unless its not an option. And it has to be free not “unfairly competing” with for profit entities.

        But, since the US seems to view these FTAs as its tool of choice in coercing its will onto other countries in exchange for access to its markets, these trade agreements have a major problem with blow-back. They ALL apply to us too. Every single one of them. So we have to get the worst deal of all. They are bilateral or multilateral. So, at this point, the reason we are getting such a crappy deal is that we HAVE TO because of these FTAs which are helping a number of multinational corporations make a lot more money of which we get no compensation. But they can’t tell us because we’re getting ripped off in this deal. Which will eventually lead to US jobs being traded away as bargaining chips for tax free money overseas. And its amoral, its making drugs too expensive for sick people (also here and here). Basically, our government is pushing a doctrine of free trade extremism which almost no Americans would agree with if we knew what it was trying to do. Its a completely backwards, amoral system that frames compassion as bad. Public services are bad, market access barriers. So, you’re right, the chances of our doing that without throwing all the FTAs out first is nil. They are trying to confuse people about single payer, single payer cannot exist alongside of insurance companies. Whatever that multi-payer mess is, it has absolutely nothing going for it. It cant save money and in fact will end up to be far more expensive.
        Please read the NAFTA paper I’ve posted a few links to. Pages 8 and 9 which are about Clinton, not Obama, there you’ll see that single payer was arguably blocked since we signed NAFTA in the 90s and that both Clinton and Obama were and are using the same cheap trick to get votes. That paper also has one of the best explanations of how “investor-state” works and it shows how the US often uses it. We should see whats being done in our name. In this case, NAFTA blocked the Canadian province of Ontario from having single payer automobile insurance because it was not in lace already when NAFTA was signed.

    2. NotTimothyGeithner

      If you aren’t sure, you might try reading the articles at your DNC cubicle. ACA is about protecting corporate profits. It has nothing to do with single payer.

    3. Jake Mudrosti

      It’s troubling to see the words “taken such a dislike” in the above comment, and the words “Obamacare haters” in yesterday’s self-satirical Salon headline. In brief, such rhetoric misrepresents any effort at fact-based analysis as a fact-free irrational ‘feeling’ regarding the impact of the law.

    4. scraping_by

      ” If ACA is a complete and total failure, health care reform of any kind may be set back by decades”

      The penny drops.

      The MO of the Right these days is sabotage, not open opposition. Corporate sock puppets have to present as reasonable public servant. The reality would alienate even the most hysterical Blue Hat.

    5. Yves Smith

      The ACA making single payer impossible is a feature, not a bug. This legislation was intended from the get-go to entrench and further enrich Big Pharma and the health care insurers. It was written by industry lobbyists. Pharma and insurances company stocks rose when it was passed. This bill is all about looting, and not about reforms. It was incidentally intended to sap political will for anything resembling reform for decades. Look how long after Hillary’s failed effort in the early 1990s it took to revive this issue.

      1. Fair Economist

        Obamacare very much permits single-payer, on a state-by-state bases (which is how Canada got it), and we’re going to get it in Vermont in 2017. There has been some noise in California too although I’m inclined to guess we’ll have to wait a while.

        1. Chris S.

          “Fair Economist”

          I would direct you to the “Standstill” clauses in the different agreements, which in essence “lock in” the level of privatization which exists when the document is signed and do not allow any increase in nonconforming measures after that date.

          For example, in the GATS “Understanding on Committments in Financial Services”.

          Similar gotchas are in NAFTA, for example, read pages 8 and 9 here.

          The US (in our trade policy) has repeatedly argued that various FTAs prohibit any moves to public healthcare systems in (other) signatory nations.

          You’ll notice that a majority of the states (29) did NOT expand Medicaid, and those states contained a majority of the people who otherwise would have been eligible. (60%)

          Also, as far as I can tell, there are no plans to end the operations of health insurers in Vermont. Are you aware of any? So, I think its total BS at this point. Part of the cover up.

          Please show me how I’m wrong, but I just think its impossible. Everything I’ve read says its impossible.

          The carefree attitude where they just say “we’re starting single payer” and none of the big issues are being looked at tells me that its not single payer. They would NEVER allow real single payer in a US state now because the insurance companies would almost certainly (even if we dont have any multinationals selling insurance yet, not unless they start selling one plan across state lines, which they want to do. Of course thats a trojan horse.. )

          But, even without a legal right, I would expect just because the current political atmosphere is so corrupt and so slanted in their favor that they would demand and probably receive billons of dollars to give Vermont its freedom from insurance companies. Also, what about drug prices. With only a single payer, that means only a single buyer for drugs, a buyer with a lot of clout. PhRMA asked for and GOT assurances from candidate Obama way back in 2007 or early 2008 that he would never do that, then he went out of his way again after he was elected to go through a whole little skit with Billy Tauzin where they pretended to make a deal to take these things off the table, which really never were on the table, because the US had already been arguing in trade agreements to ban for several years- Obviously, they wanted to prevent discussion about them. I think thats what this fake single payer is too. Otherwise we’d be seeing a lot more in the media about issues that come up. There is no single payer in the US now, and there are LOTS of entities working extremely hard to confuse the fact that single payer means single payer. Not many payers, just one. Thats how it saves money.

        2. lambert strether

          ObamaCare permits single payer if the state is granted a waiver to go ahead with it (thanks, amazingly, to a strange bedfellows alliance between Dennis Kucinich and the Republicans, who took the view this was a state’s rights issue).

          Making the the states wait seven (7) years from the passage of the bill to then only apply for a waiver doesn’t sound very “very much” to me, though of course I’ll be happy if HHS somehow manages to do the right thing and doesn’t sabotage the efforts.

          1. Chris S.

            Where does it say this? I’ll bet you $10 it just says something vague about experimental changes or similar. And in situations like this the devil is really in the details. For single payer to do what it needs to do it needs to be the single payer. Which means the market, needs to get rid of insurance companies. Thy have to go. They can’t be there taking the rich people’s money The only situation which GATS permits public healthcare is if that public healthcare is not competing at all in any way with a private for profit entity. So, it doesn’t matter what the ACA says, in fact, its likely that if its found that the WTO has acquired jusrisdiction from the USA engaging in world trade in that market segment its likely that several parts of the ACA will be struck down. the Supreme Court defers to these international bodies on these matters, seeing it as a contractual matter between the countries and the premise that the markets are a form of property has never been challenged AS A COUNTRY WOULD NEED TO DO THAT. And the chance of the US doing that is basically zero. They want to be told they can’t do it.

            They have been setting this trap for us for 20+ years, ever since the Clinton era.

            I think that its basically some of the same people as engineered the decades long tobacco industry defense who are doing this. They are really smart, they project all of these things out step by step into the future. We would be extremely stupid to underestimate their capacity for evil.

            >ObamaCare permits single payer if the state is granted a waiver to go ahead with it (thanks, amazingly, to a strange bedfellows alliance between Dennis Kucinich and the Republicans, who took the view this was a state’s rights issue).

            As I said, I think the likelihood that you are wrong on this is extremely high. When I say “single payer” I mean, no insurance companies cherry picking any people. I mean the single payer negotiating all prices from a position f strength. I mean everybody in automatically, just by being here legally somebody gets free healthcare. It can’t be tied to spending because then you have to have tiers and it will then also be seen as a business “unfairly competing” with businesses. Read those links, they are authoritative.

      2. Chris S.

        This is totally the way it is.

        A few months ago I realized, those much hyped subsidies which ist claimed willl make “insurance” more affordable for poor people. Those subsidies because of the way the plans are set up – much of the subsidies will go to lowering the remiums of wealthy self employed people (in other parts of the healthcare market) It already has. Why? Medical debt. The poor react to medical debt in the only way they can, they stop going to the doctor, because its the only thing they can do. They are extremely risk averse. The healthcare use patterns of insured people with medical debt are identical to those of the uninsured. Medical debt will cut off the access of the chronically ill poor to the healthcare system. However, the money will I suspect, continue to be paid in their names, and their debt for the unpaid portion of their premiums will continue to rise. This will be a truly diabolical situation because poor sick people absolutely cannot afford to pay money for nothing. This will be part of the deliberately manufactured crisis I talked about in my other post that only their extreme deregulation (don’t look at that Trojan horse too closely now!) will be able to cure. We will be urged to buy or die, or the deal might go away. (We wish!)

        >The ACA making single payer impossible is a feature, not a bug. This legislation was intended from the get-go to entrench and further enrich Big Pharma and the health care insurers. It was written by industry lobbyists. Pharma and insurances company stocks rose when it was passed. This bill is all about looting, and not about reforms. It was incidentally intended to sap political will for anything resembling reform for decades. Look how long after Hillary’s failed effort in the early 1990s it took to revive this issue.

    6. Chris S.

      When he announced during his campaign that he would, and then again at the beginning of his administration said he would take everything that could save money off the table, the fact is, the secretive trade agreements already banned a lot of what he was claiming to give away. So I think Obama’s scheme was a cover up.Maybe Obama himself is a cover up.

      But it was clear to me (because I didn’t know about teh FTAs at that point) that Obama shot his own healthcare plan in the foot right then. The outcome we’re at now was predicttable and I am sure it was intentional. They are creating a fake crisis that only their extreme measures can solve.

      Bluntly, I think its safe to say that it was designed to fail. Because thats all our lame “free trade policy” allowed. Whoever was who they had to take the 2008 victory and turn it into a nullity. Hence Obamacare.

      By the way, you’re wrong, you’re being far too optimistic about the chances for change if we fall into the GATS trap. We have to avoid falling into their trap, because GATS is designed to create a supranational system of permanent corporate entitlements to markets that make politcs and elections and even the most seemingly far reaching changes irrelevant. Permanent mens permanent. One corrupt Administration can do permanent damage thats nearly impossible to reverse, ever.

      Read the following cautionary tale about GATS and the South African government and their National Health Act which was overruled by GATS.

    7. Chris S.

      Steven Greenberg.

      It’s NOT fixable. It never was viable, and they knew it. That’s bad faith. Face reality.

      The worst thing Democrats can do is believe any more of their lies.

      What we’re seeing is almost certainly an act, by actors, tasked with making affordable healthcare impossible, without being too obvious about it, which is what the drug and insurance companies want. (It’s also a crime against humanity, with all that implies.)

      The sooner the American people wise up to this fact, and the curtain is pulled on this dramatic performance, the better.

  11. elboku

    Sigh: personal anecdotes are not proof but if you want one: my son got insurance for 50 a month that includes dental care. He is delighted.

    1. NotTimothyGeithner

      One would think the Obots would spend more time trying to get low info voters to the polls instead of posting absurd stories.

      What is the copay and deductible situation for your son’s insurance that includes dental? Can he use his insurance at a nearby e me regency outfit?

    2. just me

      What does it cover?

      Dental insurance is notorious for basically being insurance in name only.

    3. just_kate

      sincerely curious… for 50 dollars a month and not a penny more what specific services can he receive?

    4. Lambert Strether Post author

      I’m pleased for your son. If only everybody had such good luck. You’d like that to happen, right? So do you support single payer, and if not, why not?

      1. nycTerrierist

        He’ll make more in one month than their adjuncts make in a year.
        Income inequality field work!

        1. NotTimothyGeithner

          The worst part is Krugthulu has passed peak credibility, a Reagan apologist who found love for agreeing with half of Americans about iraq. I just don’t see any kind of return.

          1. nycTerrierist

            probably how/why he gets these gigs.

            v. sad. during K’s ‘shrill’ era (the Bush years) I was a fan.
            No more. Turns out he’s just a D tribalist and having written about tribalism, he must be smart enough to know that.
            Conscience of a liberal indeed.

            1. NotTimothyGeithner

              Can a drunk recognize he is a drunk? Of course, Krug man probably has to recognize his audience which is older and limited to self important hipsters and aaron sorkin* devotees who want to be seen working on Mondays crossword, not finishing (I doubt the hipsters can even do monday’s) reading his column after he went all in on Obama.

              His status as a tribal isn’t as important as him holding onto his audience. Without this site and occasional articles at FDL, I haven’t looked at a Krugman column since he started cheerleading Obama health care betrayals. If he were to find jebus tomorrow, would you go back? Lost trust is lost forever. This is his chance at relevancy because low info voters don’t care at all (they have real problems) about Krug man or the NYT, and people who use to read/follow these kinds of outfits who didn’t leave for a financial reason left because they read for their ego or because he used to critique the white house when that was first called treason. Krugman not being fired in 2002 should have been a sign he wasn’t any kind of liberal.

              * Sports night and a few good men were just grand, but the stichk gets old.

  12. Oregoncharles

    It’s an election year and the Democrats are in considerable trouble, so Krugman has suddenly morphed into a party functionary. Personally, I prefer “shill” or “flack” to “hack.” They’re a little more specific.
    As usual, thanks to Lambert for lining up the left-wing objections to the ACA.

  13. MikeW_CA

    I’ve said it once, and will again. If Obamacare is really acceptable, the President should have fought hard for Single Payer, and then accepted Obamacare as we know it when Republicans inevitably offered it as a “compromise”. Then we’d be done with the bickering, and could move on to fixing our still mostly-broken healthcare system.

    1. Chris S.

      I think we’ve all been manipulated into a trap by both parties, a trap where they pretend to argue back and forth and each change they come up with gets progressively worse, kind of like a noose around the American people’s collective necks.

      “the ratchet effect”

  14. Fair Economist

    Obamacare has produced the biggest improvement in insurance access in 45 years (since Medicare) and the lowest increase in health costs in 65 years. It’s a bang-up, clear-cut success. Could something else have succeeded even more? Sure, Hillarycare-style or straight-up single payer would have worked even better. Could they have gotten passed in 2009-10? We’ll never know, but I doubt it. But Obamacare is most definitely a success, and a big one, and the *possibility* that we could have done better doesn’t change that.

      1. Chris S.

        Of course I have no way of knowing what they are about to do, but here is what I am guessing. I think they lied about everything. They don’t know how to be truthful, also they can’t br truthful about anything or the whole thing will unravel.

        So, lets say I’m right, in that case, since they gave us years of pretending to argue, now I am guessing, they will almost certainly pretend to agree. First they had had to create a fake “crisis” – (none of this had to happen because single payer would have worked and not requred any more money) now we will be presented with a “fix” which they will try to get the country to accept without really examining it in detail. That will contain a trojan horse.

        You know the old saying, “beware of Greeks bearing gifts”?

        People should not fall into the trap of thinking they are acting in good faith. They are not, virtually everything about Obamacare was dishonest from the beginning.

        They were setting Obamacare up to fail, so we should not be surprised that in fact, that is happening.

        To me, there is no other plausible explanation other than that they intended to fail.

        They would not have done the things they did if they wanted to succeed.

        If you read this paper you’ll see that the WTO GATS agreement was in all probability a huge unacknowledged factor in their behavior.. To move forward effectively on healthcare we would have had to change a great many of our trade policies and also it would probably come up that it had in fact been that way for many years but the American people were never told so. That would have been a shocker for a lot of people. For example, read pages 8 and 9 of this.

        So in 2006-2007 the impending Democratic victory and the demand of the American people for real affordable health care must have been problematic for a great many of the elite from both parties. A victory that actually led to health care reform threatened their way of doing things if it actually was successful at what it needed to do. But, they had a way out, they could possibly end the ability of the US to enact any meaningful health care reform by means of the WTO GATS agreement’s investor-state provisions. If they could somehow get the US to allow multinationals into the health insurance market, GATS would render that “opening” permanent and not even a revolution could reverse it, making single payer impossible “forever”.

        So, that right there is a good explanation why they might want to fail and then have a crisis and then present some “fixes” which we should not look at in any detail and those fixes are the true payload because they will prevent the nation ever being able to have affordable health care without having really crappy healthcare that isn’t really healthcare. Because thats what they are working with. Thats the kind of people they are. They are rearranging deck chairs on a class segregated Titanic that only has lifeboats for a third of the passengers.

        But, as this unfolds, keep in mind that they knew from the beginning this was going to happen. so it must be what they wanted to happen. It is very basic math. To me, at least, that fact – that they have been playing us – basically – really changes everything.

        If you have time, read the paper linked above. And then check this out. Here is an interesting video from the first few months of the Obama administration.: An interview with Nick Skala : Single Payer compared to “Public Option”

        The speaker is the author of the paper linked above. this is one of the last videos made of him. He died suddenly in August, 2009 of unknown causes.

        1. different clue

          President Clinton was a good lawyer with a fine Oxford/Rhodes Scholar mind. Does anyone think he didn’t know this was in WTO? Does anyone think that stuff like this was not the exACT reason he worked so hard to bring America into WTO?
          Does his support for WTO membership for America have something to do with the 100 million dollars the Clinton family has now?

        2. ian

          “They were setting Obamacare up to fail, so we should not be surprised that in fact, that is happening.”

          I don’t buy this for a few reasons:

          Why would you tout this as a great success, if you secretly want it to fail?

          Why would you trust the folks who f’d it up the first time, to fix it the second?

          It is far, far easier to modify existing legislation (especially legislation of this complexity) than it is to pass something big and new and sweeping.

          1. Chris S.

            Here is some more stuff to mull over. PNHP Research.

            Note on the last link paper that they have already tried this five times when that paper was published and they failed all five times, since then we’ve had Massachusetts and there, medical debt has not fallen, bankruptcies have not fallen.

            Please give me the names of a few real experts in healthcare financing who are on board the “unsinkable” Obama cruise ship SS Titanic.

            Did you read this paper which explains the real reason we’ve been getting crappy health care deals, over and over? Bad, secretive “trade agreements”.

            So in 2008, they couldn’t really do anything without changing the trade agreements OR telling the country they had f-ed it up, neither of which they wanted to do, so they lied and tried to make no real change (Obamacare) look like ‘change’ and are trying to insert traps in it which will block single payer permanently (which is known to work). Meanwhile 100,000 Americans die unnecessarily deaths each year. And nobody’s being brought to justice.

          2. different clue

            If Chris S’s analysis is correct ( and it seems to be so far), then Ocare has been very carefully engineered to collapse in a very particular way to prepare the post Ocare ground for pure Heritage Care
            and all the mini-Single Payers systems to be Ryanized and privatised and collapsed into the Oheritage Care tar pit markets.
            If that was the Ocare secret agenda, why would the Ocrats ever admit to it in progress? They would want to fool their base and string it along. The Opublican role in all this was to pretend to oppose the Ocrats and their Ocare in order to help con the Obase voters into thinking that Ocare must be good if the Opublicans thought it was bad. (Whocouldanode that the Opublicans were merely faking opposition to help the Ocrats con their Ovoter base and string it along?)

        3. Oregoncharles

          ” even a revolution could reverse it” – false. Pulling out of GATS could end it, abruptly. That’s the horror show they’re trying to avoid.

    1. Deb

      I don’t WANT “insurance” access, I want HEALTH CARE access, you bozo. I can’t afford to pay $468/month for the CHEAPEST plan available to me in New Jersey, one that leaves me $12,000/year out of pocket and doesn’t let me use any of the best doctors and hospitals…this is over $150 more/month than I had been paying for an individual plan (that did not include mental health or prescription benefits, so it no longer “qualifies”). A single person gets no subsidy if you make (that is to say, GROSS) a penny over $45,960/year, which is PEANUTS in New Jersey. It is just incredible that this threshold level was not adjusted for the cost of living in the different states. People in the expensive states are getting totally slammed.

      Let’s take a a self-employed person in NJ (which I am) who dares to gross $45,961/year. On that they will pay $7,352 in federal income tax, $1,032 in state income tax, and $5,666 in FICA, making their annual net $31,641, or their monthly net $2,637. The average two-bedroom apartment in NJ rents for $1,420/month, so assuming this individual doesn’t try to live in anything bigger than that (GOD FORBID!), that leaves them with $1,217/month. Now subtract the $468/month that Obama thinks is an “affordable” price for this person to pay for their health insurance premiums (remember, they still haven’t gotten any actual health CARE for this money). That leaves a whopping $749/month left over for food, utilities, car payment and gasoline, other insurance such as auto and tenant’s (highest in the country), clothing, “savings” (what a joke!) and anything else. If you have to service a student loan ($700/month in my case) or actually need health care and end up paying that deductible, you’ll be naked, starving and walking to work real fast to get out of your cold, dark apartment. And don’t even think about having a companion animal or taking a vacation, you fucking loser.

      I just wanna know how anybody did this math and decided this was acceptable. I wanna know how you consider this “most definitely a success.” I guess I just don’t count at all in your little metrics.

      1. Chris S.

        It’s a success in their eyes if it covers this mess up.

        Other goals?


        Preventing the demise of the system regardless of how unaffordable it is

        Preserving US trade policy’s ability to get high drug prices

        Keeping the rich rich and the poor poor

        Making it easier for wealthy kids by eliminating the competition in colleges.

        Preventing innovation

        Forcing poor people to leave the country so they can afford healthcare

        Allowing the export of the “successful” US model to other oligarchies.

    2. Chris S.

      Fair Economist,

      Every time I read your comment I laugh.

      >Obamacare has produced the biggest improvement in insurance access in 45 years (since Medicare) and the lowest increase in health costs in 65 years. It’s a bang-up, clear-cut success.

      1. Lambert Strether Post author

        I would like to see a study of moderating health costs over the post few years that controls for the Great Recession; I would bet people are putting off care. Haven’t seen one, although that doesn’t mean such a study doesn’t exist.

  15. Barmitt O'Bamney

    I’m sorry, but why shouldn’t the government make up the numbers for their patent medicine showhealth insurance program? They make up the unemployment numbers as well as the inflation numbers – and nobody minds.

  16. datadave

    Lost my excellent coverage at a job (which I paid half the premiums). On the week before the individual deadline, to please my mate, I signed up to NY’s version of Obama Care. I couldn’t afford the Blue Cross version (like my two main physicians are on it). And went for the ultra cheap Health Republic one…….. which btw is a ‘start up’ like Oscar is in NYC. Upstate doesn’t have Oscar. Both ‘startups’ are sketchy as most providers aren’t covered. I had to get a new primary care doctor (an unknown entity of Indian ethnicity) and my eye doctor is irreplaceable apparently as no retina specialists are avail. in my locale yet. So I have to pay him his high fees out of pocket.

    Krugman is also a political writer and defending Obama from the Right Wing Wackos so I can understand a little hackery. I do see some minimal benefits from Obamacare… to especially the sick and needy. For one, if I lose my unemployment benefits I can go on Medicaid but the service of these cheap startup insurance companies has so far been dismal..

    Obama will go down in history as wishy-washy and who’s greatest accomplishment is calling the Stock Market Low in March ’09. And yes we all should have bought stocks then as he said we should. Obama will probably beat Calvin Coolidge as the President who inflated the Stock Market the most of all Presidents… and of course shortly after Silent Cal left the WH, all hell broke loose.

    Health Insurance Premiums do Not equate to good health, esp. if the insurance companies are not giving health care except for a mostly useless basic exam once a year.

    1. Yves Smith

      Two hacks defending each other’s back doesn’t make the hackery any the less hackery.

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