Obama’s April 30 Presser on the ObamaCare “Train Wreck”

By lambert strether of Corrente.

Here’s another color-coded annotation of an Obama transcript (via Kaiser), this one from his news conference right after Senator Max Baucus warned that ObamaCare would be “a huge train wreck”. The contrast between Obama working from a prepared text (Inaugural, 2013; Hamilton Project, 2006) and Obama improvising at the podium is quite remarkable; we see no intricate verbal patterning at all.

Whereas the prepared texts are bright with color coding, Obama’s health care presser — and I know this will come as a shock to you — codes as equivocation (with one neoliberal code word, “market,” a little nonsense, and few lies). No secular religion or flights of populism whatever. Nevertheless, for all its banality and woodenness, the presser contains some remarkable passages.

I’m going to color code the transcript using the same scheme I used for the Hamilton Project speech:



Secular religion

A mish-mash of phrases from the Framer’s, Lincoln and MLK echoes, and so forth


Bathos is an abrupt transition in style from the exalted to the commonplace

Neo-liberal catchphrase

“Free market,” “innovation,” “hard choices” etc.


“Our most vulnerable citizens”

Bipartisan shibboleth

“The troops,” for example

Dead metaphors/cliche

“Ring the changes on,” “take up the cudgel for,” “toe the line,” “ride roughshod over,” etc. (Orwell)

Sheer nonsense

Word salad

Falsehood or truthiness

A terminological inexactitude

Blank screen

Placeholder material onto which the audience may project what they like. The phrase comes from Obama’s famous remark in the preface of the second of his two autobiographies: “I serve as a blank screen on which people of vastly different political stripes project their own views.”


Lawyerly parsing and weasel wording


“Ladies and gentleman,” and so forth.

Here’s the transcript. My comments are footnotes:

CHUCK TODD, NBC NEWS: Max Baucus, Democratic senator, referred to the implementation of your health-care as a potential train wreck. (We’ve had ?) other Democrats been whispering nervousness about the implementation and the impact — (inaudible) — the impact that it might have on their own political campaigns in 2014. Why do you keep — just curious, why does Senator Baucus, somebody who extensively helped write your bill, believe that this is going to be a train wreck?1 And why do you believe he’s wrong?

  1. Your mileage may vary, but I don’t think Obama ever answered Todd’s first question.

PRESIDENT OBAMA: Well, I — you know, I think that any time you’re implementing something big, there is going to be people who are nervous and anxious about is it going to get done until it’s actually done. But — but let’s just step back for a second and — and — and1 make sure the American people understand what it is that we’re doing. The Affordable Care Act, ‘Obamacare,’ has now been with us for three years2. It’s gone through Supreme Court tests. It’s gone through efforts to repeal. A huge chunk of it’s already been implemented.3, 4

  1. The Obama improvising at a presser is not the Obama delivering a speech.
  2. And after three years of picking low-hanging fruit — putting childen on their parents policies, pre-existing conditions, rescission — only now do we arrive at the health insurance exchanges, which are the heart of the plan. LBJ implemented Medicare for all over-65s in one year. And that was back in the days of mainframes and paper checks, when gentlemen still wore hats.
  3. So, “already implemented” for some definition of “huge.”
  4. Obama is, in essence, suggesting that all is well because ObamaCare is settled law. But that’s off point; Baucus is talking about implementatoin.

OBAMA: And for the 85 to 90 percent of Americans who already have health insurance, they’re already experiencing most of the benefits1 of the Affordable Care Act even if they don’t know it.2 Their insurance is more secure. Insurance companies can’t drop them for bad reasons.3 Their kids are able to stay on their health insurance until they’re 26 years old. They’re getting free preventive care.4

  1. “Most of the benefits” if you already have health insurance, that is. That sets the baseline about as low as it can possibly go, and is an almost direct admission that ObamaCare won’t control costs.
  2. The baseline goes even lower. Significant benefits that people don’t even notice?
  3. I assume Obama means rescission. But is there ever a good reason?
  4. Proponents claim 54 million are getting free preventive care, of 195.9 million (2012) with private health insurance.

OBAMA: So there are a whole host of benefits that — for the average American1 out there, for the 85 to 90 percent of Americans who already have health insurance, this thing’s already happened, and their only impact is that their insurance is stronger, better, more secure than it was before. Full stop. That’s it.2 Now they don’t have to worry about anything else.3

  1. Cheerfully tossing the 48.4 million uninsured (2013) under the bus.
  2. Once again, an admission that ObamaCare won’t control costs. The dog that’s not barking here is that Obama is careful never to mention price, or to say that premiums would go down. And if he had any warrant at all for saying that, he surely would.
  3. People will still need to worry about going bankrupt, in addition to all the games insurance companies play besides rescission; see NC commenters here for many examples, including “losing” the paperwork—just like mortgage servicers!

OBAMA: The implementation issues come in for those who don’t have health insurance,1 maybe because they have a pre-existing condition and the only way they can get health insurance is to go out on the individual market and they’re paying 50 percent or a hundred percent more than those of us who are lucky2 enough to have group plans. People who are too poor to get health insurance and the employers don’t offer them. Maybe they work for a small business and that small business can’t afford right now to provide health insurance.3

  1. As such issues indeed would, since health insurance companies have already implemented systems for consumers who (actuarially) will be profitable to them.
  2. A remarkable admission. One would think — in a “moral environment” that is not “pathological” — that the logical next step would be to make insurance universal, so that nobody unlucky could fail to have it. Not Obama.
  3. Small business coverage was dropped, since it faced “operational challenges,” i.e. implementation issues.

So all the implementation issues that are coming up are implementation issues related to that small group of people, 10 to 15 percent of Americans — now, it’s still 30 million Americans,1 but relatively narrow group — who don’t have health insurance right now or are on the individual market and are paying exorbitant amounts for coverage that isn’t that great.2

  1. About 18%, and 48.4 million. Of course, I can’t know whether Obama’s lying about the numbers to further minimize the train wreck, or whether he simply hasn’t mastered the material. Regardless, he thinks or at least says that the uninsured population is ~62% of what it really is.
  2. Remember, ObamaCare’s central innovation — the health insurance exchange (“marketplace”) — was at least ostensibly supposed to help exactly this “small group of people,” who are now marginalized (“relatively narrow”) and who Obama now presents as an implementation problem! It bodes very ill for the health insurance exchange implementation that Obama’s backing away from it like this.

OBAMA: And what we’re doing is we’re setting up a pool so that they can all pool together1 and get a better deal from insurance companies.2 And those who can’t afford it, we’re going to provide them with some subsidies.3That’s it.4 I mean, that’s what’s left to implement because the other stuff’s been implemented and it’s working fine.5

  1. Plans offered will differ by the state. Some states have little competition.
  2. It’s unclear that this will happen, or how much better “better” will be. So far, insurance companies have been reluctant to enter the exchanges. If and when they do, it’s likely they’ll collude to keep prices high.
  3. Leaving them underinsured.
  4. Second use of “that’s it.”
  5. This is breathtaking. Again, “Other than that, Mrs. Lincoln….”

OBAMA: The challenge is that, you know, setting up a market-based system,1 basically an2 online marketplace where you can go on and sign up and figure out what kind of insurance you can afford and figuring out how to get the subsidies, that’s still a big complicated piece of business.

  1. The health insurance system is already “market based.” That is the problem.
  2. No, multiple online marketplaces, plural: 18 State-based Exchanges, seven State Partnership Exchange, 1 Federal Exchange which the remaining 25 states will use. Obama jiggers the numbers to hide the complexity.

OBAMA: And when you’re doing it nationwide, relatively fast,1 and you’ve got half of Congress who is determined to try to block implementation and not adequately funding implementation, and then you’ve got a number of members of — or governors — Republican governors who know that it’s bad politics for them to try to implement this effectively2 — and some even who have decided to implement it and then their Republican-controlled state legislatures say don’t implement and won’t pass enabling legislation — when you have that kind of situation, that makes it harder.

  1. Again, not by LBJ’s standards, who got Medicare up and running in one year. That’s because Medicare is a well-architected single payer system, and ObamaCare is a Rube Goldberg device (illustrated below). Except with more moving parts.
  2. There’s a case to be made that there’s no reason for states to get involved in a “train wreck” by building their own exchanges, implying that ObamaCare will end up making Rick Perry look good. Yikes.

rubegoldberg_photo_gal_4155_photo_1695691461_lrOBAMA: But having said all that, we’ve got a great team in place1. We are pushing very hard2 to make sure that we’re hitting all the deadlines3 and the benchmarks.4 I’ll give you an example — a recent example5. You know, we [CMS] put together initially an application form for signing up for participation in the exchanges that was initially about 216 pages long.

  1. Henry Chao, the HHS official who’s overseeing the technology for the health insurance exchange launch, set the following baseline: “Let’s just make sure it’s not a third-world experience.”
  2. Partly by dropping requirements (small business coverage), a sure sign of a project in trouble.
  3. So far (“October 1 might get pushed”). HHS has contingency plans in place in case deadlines slip.
  4. ~70% of all IT projects fail.
  5. There are others less recent?
  6. The condensed paper version was 21 pages. The online version was 60, and included about 1000 discrete queries (PDF).

OBAMA: And immediately everybody sat around the table and said: ‘Well, this is too long, especially, you know, in this age of the Internet. People aren’t going to have the patience to sit there for hours on end. Let’s streamline this thing.’

So we cut what was a 21-page form now down to a form that’s about three pages for an individual, a little more than that for a family,1 well below the industry average.2 So those kinds of refinements, we’re going to continue to be working on.3, 4

  1. And because of Obama’s public relations push, families with more than two members are going to end up xeroxing extra copies of the forms.
  2. And because of Obama’s public relations push, states that were furthest ahead on their implementations are penalized by having to go back and recode for the new form.
  3. In other words, top management is going to keep changing the requirements up until the very last minute. At least in some software development methodologies, that is not a recipe for success. (Readers, do any of you know what methodology the developers of the Federal Exchange are using?)
  4. The revised form is also simplified, in that many of the eligibility questions asked on the first version are now calculated from data supplied from outside the health exchange system. (For example, data can be grabbed from IRS computers instead of making the applicant fill in a blank.) However, that means that the simplified form is a gamble on a fully functional back-end system.

OBAMA: But I think the main message I want to give to the American people here is despite all the hue and cry and, you know, sky-is-falling predictions about this stuff,1 if you’ve already got health insurance, then that part of "Obamacare" that affects you, it’s pretty much already in place. And that’s about 85 percent of the country.2

  1. Predictions made by people like Max Baucus, the putative author of the bill! (It was actually drafted by Liz Fowler, a Wellpoint VP on secondment to Baucus as his chief of staff.)
  2. More minimization, and in the same terms as earlier. We’ll see if, come 2014, this looks like denial.

OBAMA: What is left to be implemented is those provisions to help the 10 to 15 percent of the American public that is unlucky enough that they don’t have health insurance.1 And by the way, you know, some of you who have health insurance right now, at some point you may lose your health insurance, and if you’ve got a pre-existing condition, this structure will make sure that you are not left vulnerable.

  1. More minimization, and in the same terms as earlier, including “unlucky”!
  2. No. Only a system that guarantees health care can do that. In any case, what about people who don’t have pre-existing conditions?

OBAMA: But it’s still a big undertaking. And what we’re doing is making sure that every single day we are constantly trying to hit our marks so that it will be in place.

And — and the last point I’ll make, even if we do everything perfectly, there’ll still be, you know, glitches and bumps, and there’ll be stories that can be written that says, oh, look, this thing’s, you know, not working the way it’s supposed to, and this happened and that happened. And that’s pretty much true of every government program that’s ever been set up.1

  1. Pre-positioning the alibi is always useful. Anyhow, it’s only people’s health that’s at stake.

OBAMA: But if we stay with it and we understand what our long-term objective is, which is making sure that in a country as wealthy as ours, nobody should go bankrupt if they get sick and that we would rather have people getting regular checkups than going to the emergency room because they don’t have health care1 — if — if we keep that in mind, then we’re going to be able to drive down costs, we’re going to be able to improve efficiencies in the system, we’re going to be able to see people benefit from better health care, and that will save the country money as a whole over the long term.2

  1. Again, a remarkable lowering of the baseline. Here’s Obama on health care in run-up to the 2008 campaign:

"Every American should have health care coverage within six years, Democratic Sen. Barack Obama said Thursday as he set an ambitious goal soon after jumping into the 2008 presidential race:

"The time has come for universal health care in America," Obama said at a conference of Families USA, a health care advocacy group.

"I am absolutely determined that by the end of the first term of the next president, we should have universal health care in this country," the Illinois senator said.

Now all that is gone. Obama does not even bother to pretend that ObamaCare is or will be universal. In fact, ObamaCare will only cover 7 million additional people in its first year, and approximately 30 million when fully rolled out, leaving out 26 million Americans — second-class citizens, simply because, as even Obama admits, they are unlucky — without coverage.

2. Dubious, if the idea is that informed consumers will drive down prices through the marketplace. The career “progressives” are already pre-positioning their alibi, that ObamaCare is “a work in progress,” and that once ObamaCare is in place “we can begin to look at serious problems with the new system.”

QUESTION: Do you think without the cooperation of a handful1 of governors, particularly large states like Florida and Texas, that you can fully implement it?

  1. 25 states is not a “handful.”

PRESIDENT OBAMA: I think it’s harder; there’s no doubt about it.

QUESTION: But can you do it without those?

PRESIDENT OBAMA: We — we will implement it. There will be — we have a backup federal exchange. If states aren’t cooperating, we set up a federal exchange, so that people can access that federal exchange.1

  1. Of course, if there were one Federal system, that would be even easier, right? And if the Federal system were single payer Medicare for All, that would be even easier still, wouldn’t it?

But yes, it puts more of a burden on us. And it’s ironic, since all these folks say that they believe in empowering states, that they’re going to end up having the federal government do something that we’d actually prefer states to do if they were properly cooperating.1

  1. If I’m Rick Perry, I’d be asking Obama how my state is going to be “empowered” by getting involved in a “train wreck.”

* * *

Since the White House has committed itself to a deadline, the deadline must be seen to be met, without fail (“We will implement it”). It only remains to spin whatever system is actually delivered as a success, a process that career “progressives,” and perhaps even our famously free press will be cheerfully complicit in.

Obama, in his presser, began that public relations process, by setting an extraordinarily low baseline for project success, marginalizing those without insurance, pre-positioning alibis, and presenting poor system architecture driven by the requirement to keep private health insurance companies in place as a natural and normal case of TINA (There Is No Alternative).

Obama’s presser is a morally reprehensible though typical effort to encourage a majority of Americans to throw a minority under the bus—even though they, too, may one day be members of that minority if they are “unlucky”!

NOTE Query: ObamaCare subsidies are tax credits. Does anybody know whether student loan defaulters will have their ObamaCare tax credits confiscated? Readers?

NOTE Adding. ObamaCare is extremely complex — indeed, obfuscated. I welcome corrections and emendations in comments. I mean, at some point, a goodly number of us are actually going to have to figure this thing out.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. mmckinl

    Without a Public Option to keep the parties honest Obamacare is just a license for Big Pharma and Health Insurance Companies to print money.

    Look for for companies to drop their group coverage and transfer their employees to Obamacare leaving them open to the vagaries of under-insurance and bankruptcy.

    Great work Ives …

      1. and 1

        Hi Jackass.

        You need to quit whining nobody listened to you, you’re embarassing. Seriosly.

        MUCH better players than you and the we willy winkies of corrente made a different call than you did.

        Let me ask you, jackass, would you rather have a public option, or what they passed?

        I know you can’t answer that.

  2. fiscalliberal

    A lot of people want this to work. Currently health care costs to small employer are continually rising and possibly out of control. It is becoming the norm that free care is available in the emergency ward. All of this is unsustainable and all the Ivy League graduates do not seem to be able to find a solution. Could be they do not have a clue in terms of what the real world is. We saw this in the financial industry. Given free reign with the repeal of Glass Stegle, they brought their system down in 7 years. I view Obama as a person not ready for the job, and Ayn Rand ideologies willing to bring the system down. Only shred of hope is being able to get the exchanges going to get some form of customer base going to allow the insurance industries to formulate a solution. Obama seems to think – put the idea out there and people will come. George Bush used to say it all was hard work, but still did not get anything done. Obama will not put in the hard work. Citizens need to only look in the mirror to see the problem

    1. banger

      There and always were dozens of solutions to the HC problem and they exist all over the world. Most countries have pretty good systems and the vary in detail, but to be simple, the regard health-care as a utility not just a source of profit for the rich–as it is in this country. Our goal is first to provide huge profits and secondarily to serve patients.

      Most Americans don’t really travel–if they do the do so in short stints and just have no clue how other societies carry on day to day so we believe that square wheels will work just fine.

      1. nonclassical

        ..yes-wife is an R.N., Germany…so we know-lived Berlin 4 years. HealthCARE, Germany, costs 20% U.S. healthPROFIT costs…4 ALL…ridiculous…

        1. sierra7

          There are tons of first person/family testimonials from sailors who visit multiple countries in their sailing lifetimes and pass on those stories of how health care is treated in other countries of the world.
          In a nutshell, our country is a disgrace!
          There are certain “things” that must not be “for profit” in a progressive society….Health Care, Education, “damage” to our environment (in the name of profit and, technical “progress”)
          The only option we should have embraced is single payer, universal health care…
          Anything else is a sham and will eventually have a horrible impact on our society, or what will remain.

      2. fresno dan

        I heartly agree. Atul Gwande article on McAllen Texas and medicare is a great example of how medicine, when paid for in a piece work fashion, can provide stupendious profits for doctors (er, I mean entrepreneurs – I take most people will note the “rich” irony of “entrepreneurs” using a social program do generate outrageous profits…)


        1. banger

          Because we culturally value profit, hustling, selfishness over compassion and what were once considered Christian moral values.

          1. skippy

            Christianity is a uninformed hedge in most cases (mortal insurance) and an enabler in high places.

          2. F. Beard

            What does Christianity enable? The Bible is against usury from one’s fellow countrymen, oppression of the poor, widows, orphans or alien and profit taking. It commands debt forgiveness every 7 years. Agricultural land could not be sold but only leased out for 50 years at most and was subject to early redemption for the price of the number of crops till the next Jubilee when ownership would automatically revert to the seller or his relatives.

    2. nonclassical

      don’t blame the VICTIMS-it’s NOT the “fault of those in the mirror”, though much of the rest of your tome is accurate enough-needed public option-but it was bushbama stacking commission studying with blue dogs that created what he wanted all along-$ub$idies to insurers, to buy favor for DLC dems…bought and sold.

      1. Lambert Strether Post author

        See above on the public option zombie sparkle pony. It was never a serious policy proposal, not once and not ever. Originally proposed by academic entrepreneur Jacob Hacker, it was originally supposed to cover 47 million people, and all Obots screamed with joy and started posting and runnning (commission-generating) online campaigns for it. After many shape-shifting twists and turns, a public option was finally added to the House version of ObamaCare, and covered only 9 million (i.e., too small to have any bargaining power, the original raison d’etre, assuming the “progressives” pushing for it were acting in good faith, which I do not for a minute do, since they simultaneously imposed a news blackout on single payer, and censoring and banning its advocates). It then whimpered and died, since Baucus’s Senate bill, crafted by Liz Fowler of Wellstone, was making the running anyhow. In policy terms, the public option was a lot like the Iraq WMDs, the difference being that Bush got caught on his fakery.

        I go through this tedious history because the dusty public option playbook is no doubt on the shelf in “progressive” think tanks everywhere, and at some point the usual suspects will dust it off and run it again.

  3. General Washington

    You know it’s going to be another bad day in Obamaland when Lambert has to break out the Color Coding System &#153

  4. HotFlash

    “Currently health care costs to small employer are continually rising and possibly out of control.“

    Well, yeah. In a civilized society, such as mine (Canada) healthcare (*not* health insurance!!) is universal. This is s great boon for small businesses such as ours. Universal single-payer creates great peace of mind and may, in fact *be* the confidence fairy. Well maybe I exaggerate a bit, but it really helps to not have to worry about employee health insurance on top of everything else. Helps the employees, too.

  5. sleepy

    It’s been mentioned before, but bears repeating I think–

    People living in those states which haven’t opted out of the medicaid provisions of the ACA, whose incomes are below 133% of the federal poverty level (and states can raise that to, I believe 200%), are automatically enrolled in the medicaid program.

    By law, medicaid has a “clawback” provision. In other words, medicaid has an effective lien on all of the beneficiaries’ assets. A person at 133% of the poverty level will generally not have much, but at least in some small towns and rural areas plenty of poor people own their homes and may have some rainy day savings set aside. So when the individual dies, the state scoops up whatever property the “beneficiary” has.

    The kicker in all of this is that presently under medicaid, if your assets are above a certain amount, you won’t qualify. Does anyone know whether this barrier will apply under the ACA? If it does, the system is more of a shambles than I thought.

    Second, even if that asset test applies generally, I believe I have read that it will not apply to those over 55. In other words, a laid-off 60 yr. old with a house, living on his/her savings, biding his/her time until social security and medicare kicks in will potentially lose whatever they have on their death with the clawback.

    1. Jagger

      As far as I know, Medicaid estate recovery applies only to long term care costs. I don’t know if estate recovery has been expanded recently to other types of medicaid services.

    2. nonclassical

      …just happened last year, to dear friend, in Washington State…people appear unaware…question-is it fair?

    3. Bob G

      Medicaid clawback applies if you’re OVER 55.

      From Paul Craig Roberts

      … the Omnibus Reconciliation Act of 1993 (OBRA 1993) – a federal statute which applies to Medicaid, and, if you are enrolled in Medicaid, it will apply to you depending on your age.

      a) OBRA 1993 requires all states that receive Medicaid funding to seek recovery from the estates of deceased individuals who used Medicaid benefits at age 55 or older. It allows recovery for any items or services under the state Medicaid plan going beyond nursing homes and other long-term care institutions.”

      1. sleepy

        A real screw job isn’t it?

        I am 62 yr. old and lost my job a couple of years ago. I have assets–a home and some savings that I draw down on to stick it out until SS and Medicare kick in. I am far from wealthy, but am fortunate that my home is paid for and that I can live on about $1000/month from my savings.

        My present income, effectively zero, will force me into Medicaid. I would much rather buy some BS policy on the exchanges than have the state scoop whatever I have accumulated over a lifetime of work, and would like to leave to my son and grandkids.

        But, it looks like by law I will be prohibited from buying that BS policy.

  6. Klassy!

    Nothing in here to control costs– meaning negotiating lower payments.
    The idea that regular check ups are going to save money is fantasy. Sounds reasonable, but is simply not true for most Americans.

  7. banger

    Some years ago we had a “debate” on health-care that never happened. The Democratic Party, the mainstream media, and much of the left/progressives supported Obama no matter what he said or did–he was the “one.” So no debate really happened. No facts, no science no serious comparison or examinations of the health-care system, particularly those rated the best (France). The rest of the world, as far as U.S. progressives did not exist outside of Canada, sometimes cited. People believed that the choice was either a single-payer, public-option or the Rube Goldbergian insanity. No, no, no, no, no! Those were not the only choices!

    We opted for the Rube Goldberg device. That was when I lost complete faith in the progressive wing of the Democratic Party. They are utterly hopeless and not worth supporting in any way. Better to join the nihilists on the right.

    1. Lambert Strether Post author

      It’s actually worse than that. “Progressive” supporters of Obama actively censored and suppressed single payer discussions. When Doctor Margaret Flowers of PNHP, for example, got herself arrested for civil disobedience in Max Baucus’s hearing room because he didn’t have any single payer advocates on the panel, *** crickets *** from these guys. In this, “progressives” merely followed the lead of the White House, which censored a single payer question from a PNHP doctor at one of its kayfabe town halls on health care.

      This is all in 2009, remember, when Obama had just been elected on the whole hope and change thing. Quite an eye-opener if you were paying attention.

      UPDATE Adding, I’m actually a pragmatist! I know there are a lot of systems out there, most of them better than ours, and all of the industrial countries better than ours. However, single payer: (1) in Canada, very similar to us (i.e., not France even if at some times French; (2) “Medicare for All” polls well, (3) as it should, and (4) the legislation would be very simple. So I’m not in quest of the ideal solution. I also think that the solution for the health insurance industry is abolition not regulation.

      1. banger

        I agree about eliminating insurance–if you want to keep banks intact then outlawing bank-robbers is what you want to do. If you want an honest system in this country you probably need to eliminate the criminal element.

        Having said that, the root cause of this problem is not the greed of hustlers–that’s a constant–but the lack of compassion and cultural preference for hustling and selfishness that is that dominates our morality.

        Millions in this country consider themselves Christian but they are lying–most American Christians are not what they say they are because they have no clue at all what the Gospels actually say about morality and even economics, e.g., the parable of the vineyard workers or really any of the parables.

      2. Malmo

        I’m a pragmatist too. The first order in my pragmatic line of thought is to abolish insurance right out the gate. 2nd, kill the profit motive ethos prevalent in our heath care model. And of the latter (and I’m no Christian, yet know the Bible well), it’s obviously the Christian thing to do also.

  8. clarence swinney

    Will it contain:
    Increased Spending `1800B to3500B or 90%
    Increased deficit from Surplus to 1400B Deficit
    Increased debt from 5800B to 11.900B
    Decreased 237,000 jobs per month to 31,000 or lowest since Hoover
    Initiated invasion of two destitute, unarmed, innocent nation.
    Alienated 1500 Million Muslims that created hatred in many sick minds
    Created enough damage to justify trial by International War Crimes Commission.
    Nice Guy. Affected by Cheney-Rumsfeld-Neo-Con Disease of Imperialism

  9. Dr. Pitchfork

    I don’t know anything about them yet (I’m going to look), but a friend of mine once mentioned that he and his family are part of a Christian co-op-type insurance scheme. This got me thinking — what would an honest, viable insurance scheme look like? In other words, what if you ran an insurance company like the textbooks say they work (pool risk, take in premiums, pay for medical care and make a fair profit)?

    I’m not experienced at modeling these types of things, but say you model a simple insurance plan that pays either all medical costs, or all costs above a certain deductible. What would the company have to charge for the average customer?

    More to the point, what’s stopping all of us who care about these issues from starting our own insurance co-op along these lines? Are there real obstacles? Ideological ones? Are there cost prohibitions — e.g., would it be impossible to compete without having free reign to screw people over on claims?

    1. LifelongLib

      My understanding is that the only way to make a health insurance plan work is to have mandatory participation ala ObamaCare. That’s because (unlike the things we normally insure against) health is too predictable, so the non-users who would normally pay for the people who make claims are tempted to opt out, especially if premiums rise. This leads to a vicious circle in which the insurance pool fills with claimants, premiums continue to rise, and ultimately the plan collapses.

      1. LifelongLib

        In other words, an insurance system (even if honestly run) is not the right way to pay for health care.

      2. Brooklin Bridge

        An insurance system if honestly run would work fine. Exactly such a system is already being used in Switzerland where there is private health care insurance, but it is highly government regulated; so much so that private companies are NOT ALLOWED to make a profit on basic plans, and basic plans over there would be the envy of most workplaces here. For many years, until recently, it has been highly successful, so it proves that private insurers CAN work. But over the last decade, corporate greed at a global level has started corupting the sytem even there and the future looks doubtful as it does everywhere.

        So can it work?, YES. Would it work here in this country? NO, of course not. The kicker is OUR government will never regulate the insurance companies and these behemoths are going to therefore treat their captive pool of “clients” like fish in a barrel – raising prices (co-pays, etc.,) and lowering service relentlessly until the cost in human suffering and bankruptcy is simply staggering. In the meantime (always the short term) profits will be absolutely amazing for the insurance companies. For one, they will not even have to pay for collection agencies; OUR GOGOVERNMENT IS GOING TO BE THE GUIDO FOR THEM!!! They won’t have to dirty their hands, their corporate image or their balance sheets. Uncle Sam will do it for them, and all at our expense, gentle tax sucka!!!

        It’s simply unworkable here and not simply because of the Rethuglicans. Mostly because of the Vichy Democrats and thier progressive base. They are utterly corrupt, utterly duplicitous. No matter what they say, no matter how liberal the noise, at the end of the day they effectifly do the bidding of the rich – some visibly, others behind the scenes. One would think their greatest sport is to gaffaw at the poor rubes who trust them again, and again and again.

        Of course single payer will never be offered or even considered in our current corporate centric version of neo feudalism, or fascism (or what ever it is). But if one is dreaming of the best systems, single payer would clearly be the best in many ways. Beyond the savings in cost, and the almost most universal coverage, once implemented, it would be the hardest system for politicians to corrupt and sell out just as Social Security has proven to be up until dear Obama came on the scene – and God willing, even then…

        In our corporate culture, the very positives regarding Single Payer are exactly the reasons it can never be allowed see the light of day. As Lambert might say, “It’s features are bugs, bad bugs to some pretty bad people”.

        1. LifelongLib

          A quick glance at Wikipedia shows that purchase of health insurance is compulsory in Switzerland, so obviously they recognize the problem with insurance that I describe.

          I support a universal single-payer system funded by either general tax revenues (ideally a progressive income tax) or plain-old MMT deficit spending.

          1. Brooklin Bridge

            Yes, when I said private insurance, I incorrectly assumed the mandate was clear (why can’t people read my brain?). Of course mandates are fine when the government strictly controls the insurers so they are not allowed to make a profit on basic plans.

            It is tragically incorrect, however, to imagine that without government control, and the funds to implement it, that insurance companies will keep costs low simply because they have a large pool of captive payers.

            The main point I was trying to make (and I have made it elsewhere) is that in the right circumstances, a lot of systems private or public or private and public CAN work. Just not in ours where the private companies litterally write the legislation, where criminal behavior is rewarded rather than punished, and where politicians go through revolving doors between their government positions and those lucrative ones at the head of private corporations.

    2. Don Levit

      You pose some excellent questions, and these are the areas that 3 of my partners and i are looking at.
      A cooperative effort makes sense – where all parties win over the short term and the long term.
      Where insurer reserves are used to provide paid-up monthly benefits, so that as the deductible rises (and the premiums fall), the deductible is fully paid for.
      Where the young and healthy are able to cut traditional premiums 60-80%, over 3-5 years.
      Where the unhealthy pay premiums far below what the ACA is projecting, particularly for the older cohorts.
      This patented design will hopefully be on the 2014 Exchanges in 3 states.
      Don Levit

  10. telee

    From everything I’ve read ( last week there was an interview on the real news with Margaret Flowers ) Obama CARE WILL NOT PREVENT BANKRUPTCIES! This is one of the more odious features of his Heritage Foundation health plan. It will drastically increase the number of underinsured who will pay 40% of costs, enough to cause bankruptcy.

  11. papicek

    As many of us said back in 2009, we will be revisiting the topic of health insurance again. ACA was really only the tiniest of steps in the right direction and as we all know, is deeply flawed, as only a market based system can be. The only question is, will we have to wait another 40 years?

  12. Bridget

    “There’s a case to be made that there’s no reason for states to get involved in a “train wreck” by building their own exchanges, implying that ObamaCare will end up making Rick Perry look good. Yikes.”

    Not to mention Perry’s decision to opt outof Medicaid expansion and the results of the Oregon Medicaid study.

  13. Renodino

    Obama’s message is “I’ve checked out, now so should you.” He doesn’t care; he’s moved on. His work is done here. Those nagging details are somebody else’s problem. But he does like the sound of “Obama Care.” Reminds him of favorite person in the whole world.

  14. pws

    All he has to do is wait out the clock.

    Then that giant pile of gold he’s worked for will finally be his. Permanent financial security for himself, his children, his grandchildren and his great grand children. A family name that means something, not being some nobody like the rest of us poor schmucks. A life of unbelievable ease, privilege and luxury, a chance to join the stateless global aristocracy.

    Listen along with Obama, tick-tick-tick, it’s the sound of moving closer and closer to the reward for all his mendacity and cruelty.

    1. nonclassical

      wrong-“Django Unchained”-not for no reason Tarantino played this theme and

      bushbama will forever be “HOUSE NEGRO”…

  15. Jimmy

    The VA is the most efficient delivery system for Health Care.
    If that wasn’t by far the case, the system would have been handed over to Kaiser or Blue Cross to manage.
    My guess is that VA care costs about 30% of what private care costs. You won’t hear that from Obama.
    Maybe after the “train wreck” occurs (my premiums are up about 100%) we’ll get to something that makes sense.

  16. down2long

    Dear Leader is such an irrellevant corporate tool as to to bev meaningle ss [serves his hubristic sold out soul right – the ultimate indignity. Soaring speeches everyone on their cels]. Here inCaliit’s getting bad with the insurance companies trying to dump post 50 insuredbeforethey can’t. In mycase the held my check for $1000 [that’s per month my friends, healthy 55 y.o. $5K deductible] sent certified, return receiptfor 6 days to cancel for non payment. My buddy John 62 y.o. pays almost $3Ka month for himself, 60 y.o. wif andtwo under 25 y.o. kids. Anthem, our glorious non_profit-turned-for-obscene-profit just told him pay 3mos in advance-instead of
    monthly as he has for 20 years – or adios.

    1. down2long

      Sorry folks my internet’s been down and have had to use the phone. Terrible skillset on the phone keypad. In my analysis the Cali health “insurers” (sic) are dumping what’s left of the individual post-50’s who signed on in their 30’s (when there was still some semblance of competition in Cali – at one point Blue Shield even suspended all “pre-existing exclusions” on my policy) get em off the rolls, then raise the rates and make them sign up for the bare bones Obummer care at an even HIGHER premium. There HAS to be a financial incentive to dump us old fogies, (aside from just getting rid of us before we get sick.) And God forbid trying to get them to pay for anything.

  17. jrs

    “In other words, top management is going to keep changing the requirements up until the very last minute. At least in some software development methodologies, that is not a recipe for success. (Readers, do any of you know what methodology the developers of the Federal Exchange are using?)”

    Agile is the methodology that is preached as being able to handle continual last minute changes. Or frAgile as it’s detractors call it. Selling software methodologies like Agiles is a scam IMO. They bring in all the preachers of how much better their methodology will be, who get paid far more per hour than any employee does, and they preach their salvation via methodology, and half the time the entire experiment is abaondoned in a year or two. But oh those preachers must feel good about themselves only seeing the sale and the delusion. Software methodology makes me angry :)

  18. Jill

    Well, I just received a letter from Debbie Wasserman Schultz wherein I learned the following: “And thanks to President Obama and Democrats, no American will want for access to basic health care”. So I don’t see what the problem is.

    But seriously, it was Max’s high level aid, just revolving from Wellpoint back to his office, who wrote that bill. Why is Max worried?

    1. NotTimothyGeithner

      Max isn’t worried. He was polling under 45% which is the death-knell for Senate incumbents and decided to not run again.

  19. FRauncher

    Congratulations Yves: finally you’ve found a picture of an animal that symbolizes the operation of the US economy, ever since Reagan.

  20. steve from virginia

    More outrages from the establishment … what do people do about it?

    Nothing. Bend over. Whine on the Internet.

    Same ol’ politicians roll around predicable as Punksatony Phil and they get elected over and over. Anyone offering to do ANYTHING different … “Nah, that would never work, we will never go along with that! That’s too RADICAL!”

    Oh well …

  21. Lambert Strether Post author

    You, The Patient: Fired. A lovely portrait of insurance industry players at a conference, along with a vivid description of what is to come under ObamaCare’s ACOs (Accountable Care Organizations), which are a lot like HMOs, except with all the human warmth left out.

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