ObamaCare’s Relentless Creation of Second-Class Citizens (4)

By lambert strether of Corrente.

And we go to Happyville, instead of to Pain City. –Thomas Pynchon, Gravity’s Rainbow

By design, ObamaCare doesn’t treat health care as a right, and does not give all citizens equal access to health insurance, let alone to health care. In three earlier posts, I gave examples of the whimsical and arbitrary distinctions that ObamaCare makes between citizens who should be treated equally; in this post, I’d like to give three more. Two are based on jurisdiction; one is based on class. I’ll start with jurisdiction.

First, let’s talk about how 11.5 million poor people got thrown under the bus because of where they live.

Our famously free press, along with the ObamaCare sales force, keeps saying that ObamaCare provides “universal” coverage. In practice, ObamaCare will cover only 7 million additional people in its first year, and leave 26 million without coverage when and if it’s fully rolled out. Sloppy implementation could account for that, of course — or the sheer fun of throwing people under the bus — but ObamaCare, right now, could never provide universal coverage. This propaganda video on healthcare.gov flat out lies: “And now everyone will be able to find health insurance at the health insurance marketplace.” No, not “everyone,” and the reason is Medicaid:

When Americans begin shopping for benefits on the law’s health insurance exchanges on Oct. 1, the people who would qualify for Medicaid but live in the 20-plus states where Republican governors or state legislators won’t approve the expansion will see a note explaining that federal law allows them to get coverage that their states’ leaders won’t provide them, said Jeanne Lambrew, deputy assistant to the president for health policy.

(One can only wonder whether the note give the contact information for the state’s Democratic Party.)

Why can’t they get coverage?

Obamacare set aside billions of dollars for states to expand their Medicaid programs. Twenty-four of them, most led by Republican governors, have opted out since the Supreme Court ruled a year ago that states could choose not to participate in the expansion. That’s left their low-wage workers in a bind: They make too much to qualify for Medicaid in its present form, but too little to afford a plan their employer might offer. And they don’t earn enough to qualify for subsidies available to help the uninsured buy plans on the state-run Obamacare marketplaces opening in October. These subsidies are available to people with modest incomes—$24,000 to $94,000 for a family of four. Democrats in Congress who wrote the law figured anyone making less would get coverage through the Medicaid expansion. 

How many are there? Only a few million:

As it stands now, an estimated 11.5 million uninsured, non-elderly, poor adults live in states that have opted out, according to research from the Urban Institute.   What happens to impoverished citizens in states that don’t expand? The most likely answer is that they’ll slip through the cracks and remain without health insurance. 

How did this happen? Brad DeLong:

Back in 2009, President Barack Obama could have proposed a program as comprehensive as the one initiated by Bismarck [who proposed universal coverage as part of a successful plan to c-opt the Socilalists]. Such a program could have allowed, encouraged, and made it affordable for uninsured Americans to obtain health insurance similar to what members of Congress have; or it simply could have expanded the existing Medicare system for those over 65 to cover all Americans.

Instead, Obama put his weight behind the complicated ACA. The reason, as it was explained to me back in 2009, was that the core of the ACA was identical to the plan that former Massachusetts Governor Mitt Romney had proposed and signed into law in that state in 2006: “ObamaCare” would be “RomneyCare” with a new coat of paint. With Romney the Republican Party’s presumptive nominee for the 2012 presidential election, few Republicans would be able to vote against what was their candidate’s signature legislative initiative as governor. Thus, the US Congress, it was supposed, would enact the ACA with healthy and bipartisan majorities, and Obama would demonstrate that he could transcend Washington’s partisan gridlock.

Of course, the explanation proffered by DeLong’s interlocutor is exculpatory, self-serving nonsense; a classic exercise in Democratic blame-shifting. (Had the White House been acting in good faith, they would not have censored single payer advocates, but allowed them to drag the Overton window left.) The Republicans were and are the party that impeached Bill Clinton over a **** ***! There was only one way to deal with them — well, besides morphing into them — and that was force majeure. And in 2009, the Democrats had the House, the Senate, the Presidency, while Obama — the greatest orator of his time, remember? — had a mandate for “hope and change,” and the Republicans under Bush the Lesser had been completely discredited in the eyes of the public; the 2008 election was a virtual referendum on them. If Obama, and the Democrats, had truly wanted a universal plan that guaranteed health care for all Americas as a right, they had the political power to pass it, and by a majority vote (either through reconciliation or by abolishing the filibuster). There’s no point blaming the Republicans, whether in Congress or in the state houses, for unforced strategic errors by Democrats (if errors they were indeed, and not simply corruption; in 2008 Obama — unlike She Who Cannot Be Named — never advocated for a universal plan in the first place).

The bottom line here is that if Obama and the Democrats had advocated for and passed a single payer Medicare for All plan in 2009 — which they had the power to do — 11.5 million poor people would now be going to Happyville: They would be first class citizens with access to care today. Instead, the Democrats sent them to Pain City in the Second Class car. 

Next, let’s talk about geography. To be fair, there are some forms of discrimination that ObamaCare forbids: Gender, prior conditions, and so forth. But there’s one major form of discrimination that ObamaCare preserves and legitimizes: Geographical discrimination. Here are two examples.


[Julia Lambert, president of Wakely Consulting Group] said the monthly average premiums are “all over the board depending on who you are and what plan you choose.”  Geography … makes a difference. Litchfield County has the lowest average premiums in the small group market and Hartford County has the lowest average premium in the individual market. Fairfield County has the highest average premiums in the individual market.


For the same health coverage from the same insurer, a 40-year-old Sacramentan will pay $78 more per month than a Los Angeles County resident through the state’s new insurance exchange.

In rural Mono County, the disparity will be even larger: $150 per month, nearly 60 percent higher than for identical benefits and co-pays offered in Los Angeles County.

The premiums provide relatively basic coverage from Anthem Blue Cross, but similar regional differences exist in plans proposed by other insurers. The numbers reflect new rate-setting standards: How sick you are no longer matters, but where you live does.

“This is a huge change from the current marketplace, where people are rated individually based on their health status,” said Anthony Wright, director of Health Access California, a nonprofit advocacy group.

How on earth can this be justified? Why should a first class citizen who lives in Los Angeles County go to Happyville with a lower premium, and a second class citizen in Mono County go to Pain City with a premium that’s 60% higher? I suppose the answer will be: Because that’s necessary for the actuarial soundness of the program. But that logic applies to a profit making entity like a health insurance company; it doesn’t apply to a government agency working for public purpose (unless that agency has been cognitively captured by private industry). I mean, we don’t pro-rate Social Security benefits for life expectancy by Zip Code or Standard Metropolitan Statistical Areas, do we? So if we don’t discriminate by geography for Social Security, why should we do it for ObamaCare?

Third — and I have to admit this is a relatively minor, symbolic gripe — this headline really frosts me: Obamacare exchange navigators expected to earn $20-$48 per hour. That’s — let’s be generous — from $10-$38 more than many an adjunct professor makes, teaching our children organic chemistry or calculus or Mandarin or (heaven forfend) how to write a coherent essay with a topic sentence and logical flow.

So I guess that tells you how complicated ObamaCare really is, doesn’t it? Walking somebody through it pays better than teaching a college-level course.

The God(ess)(e)(s) Of Your Choice, If Any, know that people need jobs, but I’m envisioning a classified ad that looks like this:

Good jobs in the rental extraction field!

Contact: rube.goldberg@whitehouse.gov.

Of course, under single payer Medicare for All, there could be jobs delivering actual health care, instead of meta-jobs figuring out how to purchase insurance that may, or may not, deliver care at some future date. I mean, how come we’re paying navigators more than we’re paying home health workers who take care of our elders and who, in Texas, will be too poor to be subsidized, yet won’t be able to get Medicaid?

The bottom line in these United States today is that if you get near enough to the stream of rents to skim something off, you go to Happyville, first class. Otherwise, you go to Pain City in coach. Single payer Medicare for All would eliminate those rental streams, which is why the political class won’t put it on the table.

NOTE * The national minimum wage is $7.25, and many adjuncts make less.

Print Friendly, PDF & Email
This entry was posted in Guest Post, Health care on by .

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. Skeptic

    Second-Class Citizens

    Economists and financial analysts are busy examining egg production, widget shipments, the minutiae of the Big Picture.

    One of the very obvious Big Picture items to analyze is: how much has the value of American Citizenship been devalued over the last fifty years?

    Here’s a few issues to plug into the analysis: People can live illegally in the US pretty easily, so wages for an actual American citizen have decreased. You have lost many of your constitutional rights. The national and state debt owed by each citizen has increased substantially. The delivery of public services has decreased. You could be Droned at any time. The general quality and safety of life have diminished. More and more people around the world hate Americans. Probably a few others.

    So, one of the most important possessions of an American citizen has decreased substantially in value but the subject is not even worthy of analysis.

  2. Tom

    I watched Obamacare get passed. You can whine all you want about shoulda coulda woulda, but that is an incredibly naiive view of the political obstacles at the time. Some people are never happy unless they’re complaining.

    1. XO

      There were no real political obstacles the the time. I don’t remember an all out war over this piece of bankrupting dreck and Government Option/Single Payer. Obama had the full capacity of a mandate for “change.” He could have governed as a populist, but instead, he chose ‘neoliberalism.’ (god, I hate our vague political nomenclature).

      Obama folded a winning hand for the benefit of corporate behemoths.

      “Whining?” Really? No one is happy when they are subjects of a shakedown under the color of law. I guess you simply suck it up when you get screwed.

      1. reprobate

        By their syntax ye shall know them. The use of expressions like “whiner” or “crybaby” to brush off critics is an Obot tell. They are attempting, not terribly successfully, to channel Obama as the parent who must convey harsh realities to a childish, unappreciative electorate.

        That this is the best they can do in the face of substantive criticism is a sign of either remarkable arrogance or serious disengagement from reality. Your guess as to which is as good as mine.

      2. lucky

        “By their syntax ye shall know them.”

        Does accusing Obamacare of creating second class citizens count?

      3. Jeff W

        There were no real political obstacles [at] the time.


        In fact, Ian Welsh, who has blogged here and is linked to often—and whom no one could reasonably accuse of being “incredibly naive”—commented on his own blog back in September, 2009:

        But here’s a truth for you. According to at least one person I know who works in the house, there are enough votes in the House of Reps to pass single payer straight up. My personal guess is that with a lot of arm bending, such a bill might get from 48 to 50 votes in the Senate.

        He then added

        Senate numbers are my own guess and I’d be hard pressed to justify it, though I think it’s true.

        and further clarified

        [T]he votes may be there in the House, but it will not pass if the House leadership is defacto opposed, which they are. If they got behind it, however, they could pass it. To pass it in the Senate would require both the leadership and Obama whipping it. That’s not going to happen.

        Of course Ian’s comments are hardly dispositive on the issue but I think they offer a reasonably-informed, real-time perspective of the “political obstacles” at that time.

        1. Dan Kervick


          You can’t pass a health care bill in the Senate by whipping 50 votes? The Republicans have created a system of permanent filibuster. You need 60 votes for everything controversial.

          1. Lambert Strether Post author

            No. See links and discussion elsewhere on this thread. In addition, such a bill could have been passed with the reconciliation process, also by a simple majority.

      4. Dan Kervick

        In fact there was a very big war. Remember the Scott Brown election? Pelosi had to beat back Rahm’s panicky idea to dismantle the bill into incremental pieces, and then drove the Senate-passed bill through House reconciliation and a lot of unhappy House members so that it wouldn’t return to the Senate that had just lost its filibuster-proof margin.

        1. Joe Firestone (LetsGetitDone)

          Dan, I think you’ve got the time line wrong. Had Obama wanted it, Medicare for All could have been passed in the Spring of 2009 either through using reconciliation or getting rid of the filibuster in the Senate. That was long before Scott Brown, when Teddy was still around. teddy cast his last vote in the Senate in late April. Medicare for All could have passed the Senate before that if Obama had focused on it, pushed it, and demanded passage from Reid and Pelosi. Had Medicare for All HR 676 been passed and implemented by January of 2010, there would have been no Scott Brown victory nor a Republican victory in 2010, and Obama would have gotten a second chance at an adequate stimulus. Let’s face it. Obama either blew it intentionally or was incompetent. Take your choice! With Obama’s cards in January of 2009 the Democratic Presidents who could have passed that bill include FDR, Harry Truman, JFK, LBJ, and Bill Clinton. Maybe even the ineffectual Jimmy Carter (but maybe that one’s a stretch).

    2. ambrit

      Dear Tom;
      I too watched “Obamacare” get passed at the time, and I’m with Strether et. al. on this one. The reason being that good politicians, and I mean ‘good’ as in competent, get things done. Reactionary politicians can stymie the public good only if the so called Liberal ones don’t do their job. There were several ways the healthcare programs could have been accomplished. What was lacking was the will. Make no mistake about it; the present day Democrat Party is acting like the older day Republicans used to. When the Democratic Parties President proposes a healthcare plan to the Right of what dick Nixon admitted was in the Nations interest, you have a grand repudiation of the New Deal coalition and its’ interests. (That coalition happens to be us, Tom. Try asking a wealthy person for help the next time you or a family member needs a medical procedure. I actually had to do that once. The outcome was not pretty. It still p—-s me off, thirty years later.)
      So, when the dust settles, what we’re faced with is an all out class war. The elites had better thank their lucky stars that it has stayed mainly within the political arena so far. Read your unexpurgated history of America in the first half of the Twentieth Century. We’re just getting to the interesting part.

      1. lucky

        “That coalition happens to be us, Tom.”

        Gandhi said, “There go my people, I must hurry to catch up with them for I am their leader.”

      1. The Pale Scot

        Apparently, Yes.

        You’re subscribing to the Green Lantern theory of politics, that you just have to want something enough and it will fall into your grasp. Comparable the IJA’s belief that the “indomitable spirit” of the Japanese fighting man was sufficient to defeat the U.S. Or the Tea People’s insistence that everyone can find a job if they just get off their asses. Politics is the art of the possible, and the ReNuts vocally asserted that their goal was a failed one term president, no matter who got hurt.

        1. Lambert Strether Post author

          Well, at least Tom’s supervisor sent in somebody smarter. I show how it was possible to do the right thing, and all you give me is a cliche. In fact, you prove my point: Given the nature of the “ReNuts,” the only way of dealing with them was force majeure, as I argue.*

          Adopting the strategy Obama and the Democrats did adopt — assuming, for the sake of the argument, that they were acting in good faith, which I doubt — brought about the outcome we see today: Billions of dollars wasted in rental extraction, and thousands of excess deaths.

          Try harder.

          NOTE * ZOMG!!! The Republicans who impeached Clinton over a ******* [hat tip JH] actually opposed Obama!!!! Reach me my pearls, I’m heading for the fainting couch!

          1. N. Eugene

            You didn’t show anything. Your argument relies on the assumption that all Senate Democrats + Lieberman would’ve voted for a single payer plan if Obama had just proposed and argued for it. Where is the evidence for that? Remember, Lieberman didn’t even support a public option. Your argument isn’t that the PPACA is less than ideal, which is a perfectly legitimate argument, but that it could’ve been way better had Obama just wanted a better law harder. I’m not saying you’re necessarily wrong, but your argument lacks a lot of the evidence you’d need to prove that. It’s amazing that you can point out many of the law’s shortcomings (and I agree that they’re absolutely shortcomings), yet proceed to argue that those who fought tooth and nail to prevent the expansion of health care coverage should be held blameless, and instead we should lay all of the blame for the law’s shortcomings on those who genuinely wanted to expand health care coverage. It’s bizarre.

            1. Dan Kervick

              There was very little possibility of a single payer plan in 2009-10. Way too much opposition in the Senate, and the health-industrial complex would have launched a scorched earth war against it.

              The key Obama failure and betrayal was trading away the public option. The public option was they way to get the public’s foot in the door. Once it was up and running, we could have used a public program’s bargaining and price-setting power and competitive advantage as a non-profit enterprise to push the door open wider and wider. The health kingpins knew this, and so did Obama, which is why they opposed it. But they would have had a harder time politically fighting against a mere “option”.

              1. Lambert Strether Post author

                No. You’re mistaking the Public Option Magic Zombie Sparkle Pony for something other than a distraction designed to suck all the oxygen away from single payer. In fact, the public option was nothing but an ever-changing series of bullet points. Period. GENIUS marketing by the career “progressives” and their associated policy entreprenuers, and a clever way to leverage the Medicare brand, of course, but amazingly, people still hanker after it as if it were real.

            2. Code Name D

              Let’s say they did vote it down.

              What is to keep you from making it an issue with the next election? Those who voted against it will be replaced by new candidates who support the initiative, and you bring the bill to the floor again. You keep doing this until you get the strength you need to pass the legislation you want.

              1. N. Eugene

                Nothing prevents you from continually trying to improve on the legislation, but you know, there were actually people working really hard to try to pass something that would expand health care coverage to more Americans while a party that actually supported that goal held the Presidency and a tenuous majority in Congress. If you write the perfect health care reform legislation and nobody votes for it, there is absolutely no guarantee that you’re going to get another chance in the near future with a more friendly Congress. Remember when Clinton tried healthcare reform? Some people think expanding affordable healthcare to more people is actually a worthy goal in and of itself, even if it means they have to pay off the insurance lobby to get a bill through. I am one of those people.

                1. Code Name D

                  There you go again, insisting that we are demanding rainbows and ponies.

                  You on the other seemed to have convinced your self that passing a Republican agenda, built on Republican philosophies, that we already know in advance can not work – is some how progress. Even worse, you seem to think that this penny wise but pound foolish is a sound strategy.

                  It’s also flatly untrue.

                  Obama and Baucus never aloud single payer or universal healthcare to even be discussed at the committee level, or from the pulpit. We have no idea if the votes were there – or not.

                  Republicans had to be arm-twisted into voting for their own reform-agenda.

                  Pulling data at the time showed strong popular support among the voters for single player. Even a substantial percentage of Republicans would have backed it. And this without any campaign in support of the policy.

                  The insurance industry was given red-carpet treatment to the Whitehouse while single payer advocates were locked outside. Memos have since come to light that Obama had made a deal early on to push what later became ACA. This means that there WAS no debate, and that the bill was authored in closed smoke filled rooms.

                  Obama also lied about his intention behind the bill. He promised skeptics that there would be follow-up legislation to continue advancing healthcare reform. Critics at the time here highly critical of ACA because it only dealt with insurance, leaving unexamined the numerous other dysfunctional natures of the healthcare system in its entirety. Issues that are in urgent need of address. We now know there was never any intention of any further legislation. ACA is in, and it is all we will likely see until new leadership dares to challenge the new normal. It may be a decade before data detailing ACA’s inevitable failure come to light in academic circles. Ignoring the persistence of other life-threatening deficiencies still in place.

                  In the meantime, ACA lends false credibility to neo-conservative ideas of free-markets and neo-liberal economic polices. Lending credibility the Republican Party that it doesn’t deserve, and that we are supposed to not allow into office.

                  The short of it is that the ACA is going to make our healthcare system even worse – not better. That is not progress. And the one who thinks they live in a world of rainbows and ponies – is you.

                2. Lambert Strether Post author

                  As far as the continuous improvement buzzword, the Navy was a saying that covers this: You can’t buff a turd.

                  Single payer advocates want to put in place a proven system that will save at least $400 billion dollars a year and many lives as well. The Obama administration, and you, on the other hand, wish to perform what amounts to an medical experiment on the health of the American people without their informed consent (because single payer advocacy was suppressed, by Democrats and “progressives” alike). That’s immoral.

            3. Joe Firestone (LetsGetitDone)

              Lambert’s not assuming that. He’s assuming that either the filibuster or reconciliation could have been used to allow only 50 + 1 votes to pass HR 676. That would have let Lieberman, Ben Nelson, Baucus, Landrieu, Bayh, Conrad, and one or two others defect if they wanted to. The others could all have been whipped into place by Reid. As for Reid he would have to go along since he has every prospect of being a dead duck in 2010 without Obama’s support. All Obama had to do was mention the word “primary” to Reid to whip him into line if need be.

            4. Joe Firestone (LetsGetitDone)

              This one’s for Dan. Obama had the cards. He’s the one who framed things right at the start of his first term taking Medicare for All off the table. Had he acted quickly putting a full court press behind Medicare for All, there wouldn’t have been time for the industry to implement a scorched earth policy before passage of the bill. The sequence should have been

              1) Get rid of the filibuster on Day 1 of the Congress;

              2) block the change in the mark-to-market accounting rule the banks were subject to;

              3) take the big banks into resolution, taking them out of the political picture;

              4) pass a stimulus bill twice as large as the one actually passed within 3 weeks of taking office;

              5) Pass Medicare for All by the middle of March 2009, scheduling full implementation by January 2010;

              6) then move on to “lesser” legislative priorities like energy foundations, climate change, education, and infrastructure.

              The Republicans wouldn’t have known what hit them.

                1. Lambert Strether Post author

                  All his golden words are spent…

                  Adding, Hamlet, Act V, Scene 2, of Osric. I notice this is your first time here, oddly, or not. Please tell your supervisor to send us somebody who can go more than one round. At the next shift change, perhaps?

            5. Lambert Strether Post author

              Yeah, Jeebus, the Dems only had the House, the Senate, the Presidency, The Greatest Orator of Our Time in the Oval Office, a mandate for hope and change, and a thoroughly discredited opposition. I mean, it’s not like they had any political power or anything. What was I thinking?

              1. jonboinAR

                He freakin’ BEGAN by conceding the PO, IIRC. Whud a doosh! C’mon! (not you, the prez). Recalling now, didn’t he negotiate away the PO privately, with the insurance lobby, right at the get-go. Yeah, that made it easier to pass, I’m sure! Well, he got a bill he was willing to sign.

            6. jonboinAR

              I don’t know, of course, what goes on behind closed doors. My problem with the way President Obama campaigned HCR was he made no visible attempt, at all, to champion single payer, so we’ll never know if it was possible. Very early in his administration the Repubs went on the offensive, publicly, and this administration never met them challenge for challenge. Everything got pushed way rightward of where IT SEEMS LIKE it could have been. But with Obama continually backpedaling and conceding without challenge, “I really would prefer the Public Option,…you know,…if it were up to me…” Dude! He was feckless.

          2. The Pale Scot

            Harder? OK. Ahem….

            Um, Filibuster?

            “in 2009, the Democrats had the House, the Senate”..

            “At the start of the 111th Congress, the Democrats held 56 seats in the Senate, with the two independents continuing to caucus with the Democrats for a total of 58.”
            One of the indies was Lieberman, who’s wife is a drug company lobbyist, Claire McCaskill and Ben Neslon would not have voted for single payer. Ted Kennedy was dead by that time and replacing him was its own separate drama.

            I don’t remember enough about the rest of the Democrat senators but I don’t think all of them would have voted for it, there was too much money being thrown around even before Citizens Cnited.

            So you have potentially 55 votes, but I think it would have been somewhere between 45 to 52 votes. Unlike today, there was no debate about changing or eliminating the filibuster.

            For Obama to do it your way, he would have to walk into the Oval Office completely focused on eliminating the filibuster. He would have to immediately put his political organization on to threatening wishy-washy Democratic senators. let’s call them DINOs. These actions would have been done while the Repubs were conducting their usual campaign of delegitimizing the Democratic president, calling him a liar in chambers and questioning his citizenship. If he had accomplished that, eliminating the filibuster and strong arming Dem politicians, all of the media, not just the agitprop networks and blogs, would have been calling him ruthless and confrontational. A black man can’t be that here in whitey’s world (AH! SCARY). Along with the assist from Citizens United, the 2010 elections would have been worse for the Democrats, they would have lost the Senate. And here in 2013 President Rick Perry would be signing the spermatozoa personhood act, eliminating contraception, Single payer would be dead, and collection agencies would be going after anyone who may have received a dime from government healthcare.

            The reality is politicians aren’t swayed by opinion polls, they only worry about survival. They aren’t worried about majority of americans who can’t name their senator, who call themselves conservative but when specifically questioned about policies are more than liberal than 90% of Congress, who are too exhausted from running the hamster wheel to learn about more than the world immediately around them. They are worried about the 27% who think evolution is a crock, are pretty certain they’re going to meet Jesus BEFORE they die, who don’t have to spend any time sorting out the world because Fox News tells it like it is, and belongs to a community willing to join together, march down to the town-hall event, and yell illogical blathering about keeping government out of their Medicare.

            The thought that those opposing single payer can be shamed or reasoned with is doesn’t hunt. They aren’t concerned about people not seeing a doctor when they are sick, that’s not a bug in the system, it’s a feature. At least 30% of steady church goers in America go to a Calvinist church. In their mind, misfortune happens to those who aren’t right with their Best Invisible Friend, and they deserve it.

            1. Jeff W

              Unlike today, there was no debate about changing or eliminating the filibuster.

              Well, some people were talking about it at that time. Just offhand: here (Matt Yglesias), here (Ezra Klein), and here (Joe Firestone — he might be too modest to mention it), among others.

              1. Lambert Strether Post author

                There was a humongous debate about the filibuster (under the heading of “the nuclear option”) during the Bush administration,

                Every insider in DC is doubtless familiar not only with that debate but with the procedural options to eliminate the filibuster as well.

                So, the claim that “unlike today, there was no debate about changing or eliminating the filibuster” is at best ignorant and at worst a Big Lie. I wonder which in this case?

                1. The Pale Scot

                  * “Every insider in DC is doubtless familiar not only with that debate” what matters is how one would get the majority of senators to give up a powerful weapon they use to wield personal influence. Remember Baucus’s extortion. Your overestimating the influence that writers and talking heads have on the process. Yglesias and Klein? Ya, like anyone in office gives a frack what they think.

                  * I’ll admit “completely focused” is clunky, didn’t have the time to refine it. But I don’t think making the filibuster a “top priority” would had been enough. To accomplish it Obama would have had to run a scorched earth policy, burning bridges along the way. Since we’re using WW2 metaphors, you believe that Obama could have done a Zhukov, throwing men and materials at the opposition until the the pachyderm was blasted off the Rhiechstag. Obama doesn’t have the street cred of an LBJ, he is an outsider in DC, and didn’t have the 30 years there LBJ did or inclination to pal around with reactionaries. His position is more like Rommel’s, limited resources. Rommel threw everything into an attempt to grab the Suez Canal. But even if he had succeeded, he would have been surrounded and isolated there since the Allies had complete control of the sea lanes.

                  Which is what I tried to say in the second half of my post. If single payer had been passed in 2009, It would not have been possible to completely implement it in a year. Citizens United was passed in Jan. 2010, and the elections were 10 months after that. I believe what I hypothesized would have happened. Also I don’t think single payer would have survived the Roberts Court. The federal government would have been in the hands of people like those in North Carolina. It would have taken decades to repair the damage that would have caused. Medicare vouchers, privatized education, Elimination of the EPA for starters.

                  That said, I think not using single-payer as the starting point was a frack up. Expecting the Repubs to negotiate was naive. And I would have been
                  heartened to hear Obama describing the Repubs as the nuts they are. But as I tried to say, American racism doesn’t allow it. What Obama does is going to have an impact on future black presidential aspirants. Until that 30% of the population that runs around rubbing pooh in their hair to ward of demons is educated or put reservations, that’s the America we live in.
                  Lunch is over, gotta go, Cheers.

                  1. Lambert Strether Post author

                    “Your overestimating the influence that writers and talking heads have on the process.”

                    No, that’s commenter Jeff W here. Do try to keep the commenters straight.

                    Reid, Frist, et al. negotiating on the “muclear option” in 2005, when the Democrats were busting the Republicans’ chops — those are the insiders I mean. Senators who know the rules, know how the game is played, and have actual power, unlike Klein et al.

                    For the rest of your comment: It’s one rationalization after another for not trying for the best policy for the American people because — and I know this will come as a surprise to readers, who will have to think carefully about this — there would be political obstacles. Oh, come on.

                    NOTE I’d like to see contemporaneous evidence on your claim that the Roberts Court would overturn single payer. If Medicare (and heck, the VA) are possible, then so is Medicare for all. This new argument smacks of throwing in the kitchen sink.

                    1. The Pale Scot

                      I’m not insisting that passing a single payer bill was absolutely completely impossible. I am saying that implementing it would have been impossible. The actions the administration would have had to take to pass it would have left it unable to counter the agitprop that Obama is a dictatorial black communist dedicated to taking the guns, golf courses and woman away from the white man. You keep focusing on passing a bill instead of actually implementing it. If Obama had a six or eight year term to install the program I’d agree with you.

                      But just look at North Carolina and the other states run by Repubs to see what losing the presidency and both houses would mean. These fuckers are crazy, It would be the rule of Dennis Moore, “steal from the poor, and give to the rich, stupid bitch” (python 1972). Blowback isn’t just a crappy movie. Currently, the whole New Deal infrastructure is vulnerable to Repub hegemony. Hopefully, when the narcissistic baby boomers are six feet under or drooling in their wheel chairs, the Progressives can exert less effort playing defense.

                    2. Lambert Strether Post author

                      “when the narcissistic baby boomers are six feet under or drooling in their wheel chair.” You mean like the blog’s proprietor? Or me?

                      Strategic hate management from an Obot. Sad, really. I suppose it’s better than the race card.

                    3. The Pale Scot

                      I’m not insisting that passing a single payer bill was absolutely completely impossible. I am saying that implementing it would have been impossible. The actions the administration would have had to take to pass it would have left it unable to counter the agitprop that Obama is a dictatorial black communist dedicated to taking the guns, golf courses and woman away from the white man. You keep focusing on passing a bill instead of actually implementing it. If Obama had a six or eight term to install the program I’d agree with you.

                      But just look at North Carolina and the other states run by Repubs to see what losing the presidency and both houses would mean. These fuckers are crazy, It would be the rule of Dennis Moore, “steal from the poor, and give to the rich, stupid bitch” (python 1972). Blowback isn’t just a crappy movie. Currently, the whole New Deal infrastructure is vulnerable to Repub hegemony. Hopefully, when the narcissistic baby boomers are six feet under or drooling in their wheel chairs, the Progressives can exert less effort playing defense.

                      And really, thinking that the deciding vote, Roberts, who has a 100% record of agreeing with corporations since he took the bench, would have voted to remove corporations from running the health care system. Right.

            2. Lambert Strether Post author

              “For Obama to do it your way, he would have to walk into the Oval Office completely focused on eliminating the filibuster.”

              Well, if he actually wanted to get anything done, yes, he would have (especially given that progressives had been yammering about the filibuster for years when the Republicans used it.)

              * * *

              “For Nelson to do it your way, he would have to strategize for Trafalgar completely focused on how to defeat the French and Spanish Navies.”

              “For Churchill to do it your way, he would have to fight the Battle of Britain completely focused on defeating the German Air Force.”

              “For Ted Williams to do it your way, he would have to completely focus on the science of hitting.”

              And so forth.

              * * *

              I mean, if taking away the biggest obstacle to passing progressive legislation that serves the public purpose isn’t worth completely focusing on, what is? Given all the good results — not just single payer — that would come from it?

              NOTE Of course, I sense the straw man in “completely focus.” I’d replace that tricky verbiage with “make it a top priority.”

            3. jonboinAR

              I was concerned at the time that he would prove to be too callow. I think I was correct. I suspect, like others do, he may have been corrupt.

        2. Denise B

          And then there are those who will claim that however little is accomplished, it was the very best that could be done.

        3. Ms G

          “Or the Tea People’s insistence that everyone can find a job if they just get off their asses …”

          Actually Obama said exactly the same thing in nearly exact same language except “asses” — I think he used “if they try hard enough.” Something like — “If people try hard enough they can get job(s) to get buy.” (I apologize for the lack of a link — I’ve been searching and excavating the web to find the quote and can’t. I think it was about 6-7 months ago. Maybe state of the union.)

    3. Charles LeSeau

      Let me guess, you’ve already got insurance and your life will be very little different with this crap, right? The ACA is fast becoming the Democrat version of “I’ve got mine.”

      The only fun I had with any of this was predicting out loud everywhere I could what the Supreme Court decision on the ACA was going to be before it happened. Considering our current SC, it was completely obvious to me. But if that decision didn’t tell you everything you needed to know, there’s no number of facts that could hit you over the head and get you to see what a racket this is.

      I’ve boycotted the insurance scammer middlemen scum all my adult life, and now I’ll have to pay *not* to buy insurance from one of these useless shysters. Great. And I get to listen to some 50% or so of Americans telling me it’s socialism, which is a real hoot and a half too – especially knowing that some large percentage of that 50% knows it’s not, but are lying their asses off about it.

      But “complaining” isn’t allowed in rough & tough America. Sorry, I forgot.

    4. Cynthia

      Obamacare is NOT Universal Healthcare by any stretch. It’s an “Everybody MUST buy insurance from a cartel” plan, plain and clear. Americans already pay nearly twice as much as everybody else for healthcare, and Obamacare looks set to double those costs again.

      While the idea is sound enough, the power of lobbies, along with poor planning and now poor execution, make this a terrible plan over all, in my opinion.

    5. TK421

      Yeah you guys, there was no way for the Democratic party to overcome the filibuster that the Democratic party put in place!!!!!

    6. curlydan

      Obama had 60 votes in the Senate. If he’d wanted to, he could have gotten those folks to tow the line for a better solution. But he outsourced the writing of the bill and its passage to Max Bauchus (and his staffer and former Wellpoint executive). In the end, the bill was written by the health care industry with a few tweaks to satisfy Ben Nelson.

      LBJ was rolling over in his grave from the weak effort to pass something better.

      1. Lambert Strether Post author

        You only need a majority vote to abolish the filibuster at the start of a session, and there are other ways to abolish the filibuster with a simple majority during a session. In addition, reconciliation bills are passed by majority vote. The filibuster objection is blame shifting by Democrats, pure and simple. (Obama apologists always object that the Republicans would get really mean if they did that, but they also say the Republicans are crazy even now, so what difference would it make?)

    7. James Cole

      Once the bill went to reconciliation in the Senate it was clear there were enough votes to pass *with* a public option (since reconcilation is filibuster-proof), Obama’s people began whipping *against* the public option in the House . . . because he had already promised no public option to his insurance company overlords and lied about it to the public.

      1. Dan Kervick

        That’s true. That was the sell-out. There was never a realistic path to a single payer or Medicare-for-all bill. But there was a path to a public option. And that would have opened the door.

        1. Joe Firestone (LetsGetitDone)

          No. There should never have been a compromise on a public option. The compromise, if any, should have been: enhanced Medicare for All for everyone over 45 and under 25; and let private insurance continue to exist for the healthy people. Then come back again in 2011, after winning the election of 2010 (the extension and enhancement of Medicare for All would have been enormously popular. A public option with an implementation date of 2013 – 2014 would not have been because it wouldn’t have helped people in time for the election of 2010.

          1. Jeff W

            And it wouldn’t have been popular, because, unlike what many people thought, the so-called public option would have been out of bounds to those who had access to health insurance through their employer. Sen. Ron Wyden said his constituents were “stunned” to learn that the public option would not be available to most of them: “They nearly fell out of the bleachers.” President Obama reassured a Joint Session of Congress on 9 September 2009—months after he had, in fact, secretly bargained the public option away—that “less than 5% of Americans would sign up,” although I suppose he meant “fewer than 5%.”

            It seems highly doubtful to me that that weak and small public option, deliberately “handcuffed,” to use Sen. Claire McCaskill’s phrase, would have “opened the door” to anything.

      2. Lambert Strether Post author

        Yes, Obama did — and I know this will shock and surprise many readers — lie about the public option. He secretly betrayed his progressive supporters by making a deal with Big Pharma in IIRC January 2009, but let them continue to advocate for it for months afterward

        However, can we please put a stake through the heart of The Public Option Magic Zombie Sparkle Pony? It was never a serious policy proposal; rather, it was an ever-shifting set of bullet points proposed by policy entrepreneurs (primarily Jacob Hacker) designed to suck all the oxygen away from single payer, which it did, successfully. See here and here for the sordid history.

  3. XO

    “How on earth can this be justified? Why should a first class citizen who lives in Los Angeles County go to Happyville with a lower premium, and a second class citizen in Mono County go to Pain City with a premium that’s 60% higher?”

    Obamacare is a cash cow for the Insurance industry. Nothing more.

    We already dropped the ‘RE” from our FIRE economy, once. We can’t afford to lose the ‘I’.

    If we do, then all that will be left is the ‘F’, and the middle class will be on the receiving end of it.

    The Roberts SCOTUS called Obamacare a “tax.” The first tax, ever (that I know of), to be levied by the government and paid directly to private industry.

    1. Jim Haygood

      Offhand, I would have guessed that premia in rural areas such as Mono County would be LOWER than in urban areas such as L.A. County, given higher salaries and overhead costs in big metro areas.

      Is this anomalous pattern due to demographics, or to less competition in rural areas? Or is it just one of those actuarial opacities that the hoi polloi shouldn’t worry their little heads over?

    2. Lambert Strether Post author

      “The first tax, ever (that I know of), to be levied by the government and paid directly to private industry.”

      Ding! (Although it is true that some states send payroll taxes directly to corporations.)

  4. Jim Haygood

    ‘The Republicans were and are the party that impeached Bill Clinton over a **** ***! ‘

    Can’t cite any etymological authority for this, but I believe that “**** ***” is customarily spelled “*******”.

    And no — it may be therapeutic, but it’s not covered.

    1. ambrit

      Dear Jim;
      Careful pardner, you’re venturing onto that famous “slippery slope;” the Mound of Venus.

  5. TomDor

    Well, it’s quite simple, really. If one would treat healthcare as a public good, an infrastructure investment like the national highway system or the hoover dam, or the electric grid or any other number of public investments in the public good that lower the cost of living and working…… lower the cost of living and working and doing business……. you would raise the standard of living in the USA. Of course, the rentier class clamours and bristles at the thought. The rentier class chirps like chicken little, whines like a spoiled brat, tantrums abound. They say, where is my free dough, why can’t I eat dessert first, the sky is falling etc……what a bunch of cowards, brats, terds. They care not for the public good, they care only for the money that is their god. Fuck them.

    1. TomDor

      My last comment… i should have avoided the pejorative…since we are talking health care…put another way:
      In the field of health we have the emergence of multi-drug resistant bacterium that is jepordizing our health outlook.
      By the same token we have multi-economic resitant pathology thet is jepordizing our economic outlook…. the host is dying from economic infection. In the medical field…much research is going into finding a way to kill these parasites-on-steroids to save the host. In economics we believe the parasites will save us – something is terribly wrong.
      The host is us and our planet….should we not be looking for the cure? I propose we look for a cure before it is too late…maybe I hope for to much.

      1. ambrit

        Dear TomDor;
        The dieing off of the “Lesser Orders” might indeed be a feature of the system, the way it’s going. I seriously would not put a little Social Darwinism, as in, “saving” the planet by enabling a massive human die off, past todays elites.

        1. Massinissa

          Who do you think came up with the idea of social darwinism in the first place?

          It sure wasnt the working class!

    2. Cynthia

      If hospitals were run like public utilities, we wouldn’t have this problem of hospitals being run like costly hotels. You can thank ObamaCare for that. Thanks to ObamaCare, a significant portion of hospital reimbursement is based on patient satisfaction scores. Since patients tend to base their satisfaction score on how well a hospital mimics a high-end luxury hotel, despite this having little, if anything, to do with the quality of their medical or nursing care, hospitals are now being run like hotels. This means that a costly hotel service charge is being added their already costly hospital bill. It is things like this that make me very, very skeptical as to how ObamaCare is gonna cut healthcare costs. My skepticism tells me, ObamaCare, if anything, is gonna cause healthcare costs to soar even higher.

      1. Lidia

        I don’t know about “thanking Obamacare” (although it may certainly make the trend worse). My hospital already has a few Steinway grand pianos in the various atria. They have free chair massages, too.

        But when I had my op., I didn’t sleep or nap for three straight days because the pain med suppressed my breathing and heart rate. I pleaded with a different nurse every shift to either change the med or stop the alarms from going off continuously—I never saw the same nurse twice. It was hellish.

        When I got my “patient satisfaction survey”, though, it was all about shit like parking, and liability stuff like whether I’d had X, Y or Z explained to me. I wish I had kept a copy of it. Oh, one idiotic question I remember was: “The nursing staff is highly-qualified: Strongly Agree, Somewhat Agree, Somewhat Disagree, Strongly Disagree”… !?!?!? How the fuck should I know??

        The surveys themselves are a meaningless waste of time, and will just be arenas for fraud, like the recent donor/charter-school flap.

        1. Yves Smith

          It is so bad that here in New York, which is touted for having teaching hospitals, I’m told the only way to deal with a hospital is to bring your own private duty nurse.

          Tell me how many people can afford that.

    3. ian

      I don’t think it really is that simple, at least until you come up with a precise definition of ‘healthcare’.
      The term covers a pretty broad spectrum – from a cut finger, to liver transplants. What about various types of counseling? Experimental procedures? Elective cosmetic surgery?
      If you are going to maintain healthcare is a right, then you are going to have to get very specific about what is included, and what isn’t.

  6. tongorad

    “Skin in the game” – Our skin, their game.
    Obamacare will not contain costs, and will therefore deepen worker’s fears about bankruptcy and precarity. A more “disciplined” and “flexible” labor market is the goal of all neoliberal policy.

    1. tongorad

      I just returned to the US after 10 years of living abroad. I’m still in sticker shock at my health insurance costs. My employer offered a choice between 2 otptions that would cover my wife and I: $500 a month for the labyrinthianly complex co-pay plan, or a high-deductable ($6000!) that will costs $200 a month and includes something called a medical saving account. Again with the complexity.

      Doubting my decision to repatriate…

      1. curlydan

        It’s these tough choices that will make our healthcare system more effecient….


      2. Lidia

        Don’t I know it! 53 and 54 y.o., my husband and I have been paying $911/month (Jan. 2013 rate) for a BCBS policy with a $2k deductible. This is THE only individual policy available in our state for us as unemployed individuals/early retirees back from overseas.

        I just got a letter today that it is going up to $1091/month. That’s a 20% increase over 7 months. The letter says the plan will be cancelled at the end of this year and we will have to get a plan through our state’s exchange.

        1. Ms G

          That’s appalling. I am so sorry to hear this.

          Well, at least we know that nothing in ObamaCare is designed to end this type of mid-contract or end-of-contract “surprises” (events in the category of financial heart attack and/or personal bankruptcy alert). That’s about all the continuity we can hope for — expect the PTSD-inducing “surprises” at any time, all the time.

  7. polistra

    Strether has it right. If Obama had rebranded in an attempt to bring the Repoofs along, he would have completely misunderstood modern politics. He’s way too smart for that.

    Also, Obama showed us which side he’s on before the election by firmly supporting TARP. Nothing after that should have surprised anyone.

    1. Lambert Strether Post author

      Obama didn’t just support TARP, he whipped for it. It would never have passed without his efforts. But that should have been no surprise, after he flip flopped on FISA reform in July 2008 and granted retroactive immunity to the telcos, after promising to filibuster the bill in January. No wonder the NSA and the intelligence establishment think they can act with impunity. They already do.

  8. Tom

    As I said, naiive. Keep scratching your head on why you can’t ever seem to get that one law that solves all problems passed, but prepare for a lifetime of disappointment where your rhetoric keeps failing to deliver results. Meanwhile, the rest of us will be changing the world.

    1. tongorad

      Changing the world for your fuedal masters. Maybe some of us don’t like licking boots? It seems you’ve found your true calling in life, however.

    2. TomDor

      Not sure I comprehend what you are saying.
      “Meanwhile, the rest of us will be changing the world.” are you implying that all change is good – ie: change for change sake is good. Or, comparatively, that a free market is good because it is free.
      And regarding
      “As I said, naiive. Keep scratching your head on why you can’t ever seem to get that one law that solves all problems passed, but prepare for a lifetime of disappointment where your rhetoric keeps failing to deliver results.”
      Where do you stand on healthcare – is it a standard of living issue that all citizens being equal should have access to. IE: the standard that living requires the ability to maintain ones health?
      Or, are you saying that people need to pay to play and, that if ya don’t have it within you to play then you don’t deserve to live?
      I suppose we ought to penalize the unborn with paying off the debt of their parents – they should be thankful for their life and thankful that, a few wish to charge so much for a place to live and breath on this planet. a planet that existed before man existed. Thankful that a few wish to impose their will upon another through leverage, manipulation and scorn for the least able among us.
      I seem to get the game, it’s not about love or caring or compassion…. it’s about the coin, it’s about taking the earth away from others so that those taking can jack the rents upon those who have been dispossed of the one thing we were given for free and require….. a place on the planet to stand. Lets teach our children that nothing has value beyond coin. Lets teach them that the hunt for coin is more important, valued more than anything else………..

    3. charles sereno

      Tom, I take back my previous comment — “By his own logic, Tom is happy because he’s complaining but I don’t think he’s naiive.” I think you are naiive.

    4. Lambert Strether Post author

      Tom: Your comment is so sloppy I have to assume you’re not paid. Not always my experience with Obots, so that’s refreshing. Back in the day at The Obama 527 Formerly Known As Daily Kos, I observed that “straw man” was, quite literally, the only rhetorical device with which Obots were familiar, so I am not surprised to see you deploy it here.

      You write: “that one law that solves all problems passed.” Of course, nobody on this thread is advocating for that. What I am advocating for is a proven solution, known to work in other countries, called single payer Medicare for All. If Obama were genuinely interested in saving lives and/or money, that was the best policy option for him. Instead, we get the Rube Goldberg device of ObamaCare.

      Thank you, however, for empathizing with the plight of the 11.5 million poor people who won’t be able to get any health insurance at all because of strategic choices made by the Democrats, and Obama, when they controlled the House, the Senate, the Presidency, and had an overwhelming mandate for “hope and change.”

      Oh, wait, you didn’t spare a thought for them? I’m sorry. My bad. Hey, here’s a suggestion: How about they take your vacuous rhetoric about “changing the world,” write it down on a piece of paper, take it in to a doctor, and try to pay for some health care with it. Would that work? What do you think?

      NOTE That’s “naive.” One i, as the baseball player said to the umpire.

      1. MaroonBulldog

        Lambert, one day you will see single payer Medicare for all in the United States. But the time is not yet ripe. Private medical insurers–both profit and not-for-profit insurers–still control enormous reserves of financial assets, assets that must be depleted before the managers that run such firms will give up the game. There should be no doubt those reserves will be depleted over time–private insurance is not a viable long term business under Obamacare, but raiding the reserves is a viable medium term plan for the agents that manage them.

          1. MaroonBulldog

            I’m reminded of the line from Samuel Beckett’s “Endgame”: “If I don’t kill that rat, he’ll die.” Private employers do not want to bear the burden of sustaining the private health insurance industry; they will gladly transfer their health insurance obligations to the state. It’s only the financial resources of the health insurance industry itself that buys the political influence that keeps it alive, and those resources are bound to waste away over time.

            1. krys

              Yes, the State will (continue to) finance private heatlh insurance profits; Obamacare will increase access to public resources by private profiteers. More of the public resources that should go to actual healthcare will be diverted into profits.

      2. Onemoretime

        There were 2 problems with Obamacare from the git go. 1st, removing single payer. 2nd, the pharma giveaway.
        Now eventually I believe we will get to single payer. It’s seems like the only workable solution if you want 100% national coverage, as several countries have proven. The problem is there will be a lot of pain and hardship between the time Obama had a chance to improve healthcare and when we get back to it again. Like financial reform, Obama had a chance to improve the lives of a majority of Americans and he blew it. Politically these opportunities just don’t come along that often.

        1. Lambert Strether Post author

          I think forcing people to purchase a product is also a problem. Ask yourself: What next?

          (I don’t accept that mandating automobile insurance is a good analogy because people can choose not to drive. But people can’t choose not to be treated for a heart attack or appendicitis — at least not in the same way.)

      3. Code Name D

        Oh, wait, you didn’t spare a thought for them? I’m sorry. My bad. Hey, here’s a suggestion: How about they take your vacuous rhetoric about “changing the world,” write it down on a piece of paper, take it in to a doctor, and try to pay for some health care with it. Would that work? What do you think?

        Actualy, it might be better used in the bathroom. The only question then would be over or under. Hay, there’s a free market choise for you.

  9. Michael Hudson

    It’s worse than you say, Lambert.
    Dennis Kucinich tried to bring up Single Payer at the Democratic House committee meetings. They refused to let him speak! They told him that he could NOT bring it up, and censored him. Pelosi was adamant: no plan that would cut campaign contributions.
    This is worse than just the (admittedly horrendous) video you cite. It was a totalitarian commitment as a giveaway to the health insurance rentiers. The plan explained to you (we’ll get Republicans on board) was just an excuse. Follow the money contributions.
    (As you know, I was Economic Advisor for the Kucinich for President 2008 campaign)
    The problem is the Democratic Party leadership. I don’t see it getting better.

    1. Lambert Strether Post author

      Exact same thing where I was, in the “progressive” blogosphere. When PNHP’s Dr. Margaret Flowers got herself arrested in Max Baucus’s hearing room because he didn’t have one single payer advocate on the panel, what did we hear from “progressives”? *** crickets *** And on and on like that. And that’s before we even get to the hideous role “progressives” played running interference for Obama with the “public option” bait and switch scam. Just appalling.

  10. clarence swinney

    Back in the 1980, the Reagan campaign and the Republican Party made a deal with the men who led the Christian Right movement in America.
    Republican officials sat down with the likes of Jerry Falwell, Ralph Reed and Pat Robertson, and made a deal.
    That deal was about mutual support: The Republican Party would support the Christian Right, its teachings and its messages and, if they got control of the government, would transfer hundreds of millions of dollars in taxpayer funds to “Christian” efforts ranging from Christian schools to outreach centers operating under the guise of sex education programs, soup kitchens, and shelters. In exchange, the Christian Right would support the economic and political goals of the Republican Party.
    Ever since that deal was done, the Republican Party has positioned itself as the “Christian Party,” and the “Party of God.”
    And then things got really odd.
    Ronald Reagan, the messiah of the Republican Party, almost never went to church, and launched a war, called “Reaganomics,” on poor and working people, while vastly enriching the already-rich.
    And George W. Bush, who’s presidency ushered in a second wave of Republican religiosity in America, and who once said [1] that he had made the decision “to commit my heart to Jesus Christ,” went on to kill hundreds of thousands in the wars in Iraq and Afghanistan.
    This was the same George W. Bush who also told Palestinian leaders in 2003 that, “I’m driven with a mission from God. God would tell me, ‘George, go and fight those terrorists in Afghanistan.’ And I did, and then God would tell me, ‘George go and end the tyranny in Iraq,’ and I did.”
    This is not Christian behavior by pretty much any metric.
    In Matthew 25, Jesus was very specific about what it means to be a Christian:
    “For I was hungry and you gave Me something to eat; I was thirsty and you gave Me something to drink; I was a stranger and you took Me in; I was naked and you clothed Me; I was sick and you took care of Me; I was in prison and you visited Me.”
    By the criteria of Matthew 25, the Republican Party is not a party Jesus would recognize.
    Earlier this month, Republicans voted to cut billions in spending from the SNAP food stamps program over 10 years, and nearly 3 million Americans would have lost food assistance in the next year as result.  
    Meanwhile, Republicans have repeatedly filibustered or blocked legislation to help homeless veterans; have tried to cut programs like Section 8 housing, which provide affordable housing to low-income residents; and have cut funding to homeless shelters nationwide.
    Just last year, according to the Department of Housing and Urban Development, Congressman Paul Ryan’s Republican austerity budget would have taken away housing assistance for nearly 1 million American households.
    According to the Center for Budget and Policy Priorities, the Republican-driven sequester has pushed as many as 140,000 American households into homelessness.
    And, while Republicans refuse to address the epidemic of homelessness in America, they also refuse to address the issue of healthcare in this country.
    Obamacare was passed so that more Americans could have access to lifesaving healthcare at affordable costs but Republicans have tried 39 times to repeal it without offering any alternatives at all.
    They’re also working to slash funding to social safety net programs like Medicare and Medicaid, which keep millions of low-income and elderly Americans alive.
    The Republican Party says that it’s pro-life, but waging endless wars, refusing to back background checks to keep violent people from buying guns, and taking away healthcare from millions of Americans shows that they lie.
    And then there’s the absurd claim Republicans make about being against abortion. In reality, Republican-backed policies are increasing the number of abortions in America.  
    Republicans love to push abstinence-only sex education, but the only measurable thing that an abstinence-only education does is increase the number of unwanted pregnancies and sexually transmitted diseases.
    The Republican Party also claims that it’s pro-family, but again, throwing Americans onto the street, slashing unemployment benefits, and devastating programs like SNAP and Medicaid all prove otherwise.
    In Matthew 6:24 of the New Testament, Jesus says that, “No one can serve two masters. You cannot serve both God and money.”
    It’s pretty clear that Republicans are doing very little to serve God, and a whole lot to serve money.  
    If Republicans want to go down the Christian road, instead of listening to hustlers like Ralph Reed and Pat Robertson, they could start by listening to Pope Francis.
    Pope Francis, the leader of the Catholic Church , the largest sect of Christianity, has repeatedly denounced the very ideas that today’s Republican Party promotes.  
    In May, this “Pope of the Poor” lashed out against predatory capitalism, saying that, “Unbridled capitalism has taught the logic of profit at any cost, of giving in order to receive, of exploitation without looking at the person.”
    In July, he said that the global community must, “fight against wild capitalism and confront social injustice.”
    Pope Francis is even concerned about the environment, something Republicans brag about trashing and exploiting.
    During his trip to Brazil this past week, Pope Francis called for, “”respect and protection of the entire creation which God has entrusted to man, not so that it be indiscriminately exploited but rather made into a garden.”
    He also preaches tolerance, something the very intolerant Republican Party should learn.
    Just this morning, the Pope told reporters that, “If someone is gay and he searches for the Lord and has good will, who am I to judge?”
    So if Republicans really want to keep calling themselves Christians, at the very least they should start listening to the Pope, and change their policies to reflect the basic tenants of Christianity and its founder. Thom hartman july 18 2013

  11. petridish

    “The Roberts SCOTUS called Obamacare a “tax.” The first tax, ever (that I know of), to be levied by the government and paid directly to private industry.”

    Behold the “public-private partnership” in all its treacherous glory. Undoubtedly it will not be the last such tax that you see.

  12. MaroonBulldog

    “Why should a first class citizen in Los Angeles go to Happyville, and a second class citizen in Mono County go to Pain City with a premium that’s 60% higher?”

    Why? Because California is a “democracy”, Los Angeles is in the south, where most of the votes are, and Mono County is in the north, where relatively more money and jobs are.

    In California, the taxes are collected in the north and spent in the south; the water is collected in the north and channeled to the south; and, now, apparently, the north is going to subsidize the south for health care, too.

    Northern California would be much better off as the 51st state, but it can never happen. Southern California will never yield the votes to let them go.

  13. Cynthia

    “Obamacare exchange navigators expected to earn $20-$48 per hour. That’s — let’s be generous — from $10-$38 more than many an adjunct professor makes, teaching our children organic chemistry or calculus or Mandarin or (heaven forfend) how to write a coherent essay with a topic sentence and logical flow.”

    This sort of thing is also happening in hospitals, Lambert. Hospitals have recently started to hire RNs as “care coordinators” to do low-end clerical work, which merely involves the rather mindless task of scheduling patients for inpatient and outpatient procedures. Needless to say, it’s very wasteful and cost ineffective to hire RNs to do this kind of low-skilled, low-stress work when a moderately-smart person with a GED and some clerical skills can do the job with the same level of proficiency at half the price! It’s even worse than that. RNs who are employed as care coordinators generally fall in a higher pay grade than RNs who are hired as critical care nurses. I have yet to figure out why hospitals are doing this, especially given that care coordinators, unlike critical care nurses, never have to deal with life and death issues, and never have to put their license on the line to do what they do. Nor can they bill Medicare or any other insurer, public or private, for the work that they do.

    1. ian

      Look at it this way: the complexity of dealing with ObamaCare will create a lot of well paid, full-time jobs. I say its about time.

      1. Code Name D

        I have a feeling that Cletus and Claudia will not be qualifying for those jobs. At least not until they get a Harvard Law degree and a few reconditions from the insurance industry.

  14. Ed S.


    Gotta make one snarky comment on your quotation (didn’t watch the video):

    And now everyone will be able to find health insurance at the health insurance marketplace

    Sure, everyone will be able to FIND.

    AFFORD — well that’s a different question.

    I think they choose their words VERY carefully.

  15. Lori

    “Back in 2009, President Barack Obama could have proposed a program as comprehensive as the one initiated by Bismarck [who proposed universal coverage as part of a successful plan to c-opt the Socilalists].”

    Well, there’s your problem right there. Not enough socialists to put the fear in non-socialist politicians.

  16. chris

    Isn’t it true the Bush Administration insisted that the new (post Saddam) Constitution of Iraq establish a single player national health service?


  17. Jess

    There is one good thing you have to say about the passage of the ACA:

    It ripped the mask off the DINO party once and for all, exposed its true venality for all to see.

    It also demonstrated that it was — and is — the intention of the entire Democratic party to f*** the non-1%ers who are the party’s “pretend” constituency.

    Obama was always out to f*** us.
    The Dems — every single one including Warren — were always out to f*** us.

  18. Gaylord

    If you want to get a sense of who is running the show, just ask yourself what demographic dominates the healthcare industry. Then you’ll understand why the profit motive determines policy, just as it does in the financial sphere and increasingly in most other ones.

  19. Brooklin Bridge

    It’s not a gaffe. Not some goofy slip up where the President or VP putt’s his foot in it à la Dan Quayle jester. It’s a carefully calculated message to let folks know what the new middle class is shaping up to look like.

    Obama is also reviving Larry Summers who got a bit bruised by HuffPo – of all digital rags. http://thehill.com/blogs/on-the-money/banking-financial-institutions/314693-obama-defends-summers-record-amid-liberal-criticism#ixzz2adr76Tj1

    HuffPo, in a revolutionary wave of truthy exuberance reported some facts about Democrats; some of them were pushing back on Obama saying that Summers would be a horrible choice for Fed Chairman, but Obama is using his position as Pres. to twist arms for his boy just like he did for the Public Option. Ahh, no actually not quite like the Public Option. Then like he does for all the liberal promises he has made such as protecting Whistle blowers which you can go see on his web site… Um, no, not that either (and don’t bother looking on his web site – he took the promise off, conveniently, just before Bradley Manning’s verdict). Oh-well, he is using his position to show that when he wants to and not when he doesn’t want to, he can twist arms and use the bully pulpit just like any other President and in the case of Larry Summers becoming the next chairman of the Fed; well you can object to your congress-critter till the cows come home, or till your partner tells you the check is in the mail. Whatever, you can take it to the bank (any bank in Cyprus to be specific)



    {I just signed this petition — will you?

    I just took action to urge Supreme Court Chief Justice John Roberts should apply the Code of Conduct for United States Judges, which already applies to every other federal judge in the nation, to the members of the Supreme Court.

    I think you should too!

    http://org.credoaction.com/petitions/tell-supreme-court-justice-john-roberts-apply-a-code-of-conduct-to-the-supreme-court?sp_ref=.4.210.e.0.2&source=mailto_sp }

  21. Barry

    “Innovations In Leftier-Than-Thousim”


    Starting paragraph:

    “It must be said that lambert’s argument that single payer was there if Obama wanted it is a minor classic of the genre. Every vacuous pundit cliche that can be used to ignore concrete realities of power and institutional structure is there — “mandate,” “Overton Window,” the bully pulpit — you know, all the tools that allowed Clinton to ram health care reform right down Congress’s throat in 1993. We’ve been through this silliness before and I won’t reiterate the arguments here.”

    1. donald

      I don’t know if single payer could have been passed–I’m doubtful–but I never understood (except as a typical Obot response) why there is such viciousness towards anyone who mentions the Overton Window. Obama himself has started, years too late, to push back a little bit regarding how the economy is discussed. (Of course he also still wants his Grand Bargain.) Are we seriously supposed to believe that the way to bring about progressive change is to allow the average person to think that centrist policies are “progressive”?

  22. Carol Sterritt

    There were actually enough votes to add a public option.

    Much discussion of this over at DemocraticUnderground. Among the offerings is this one: http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=102×4283389

    And the deplorable thing is that back when Barack Obama ran a campaign to get into the US Senate, he was utilizing the meme that Single Payer Universal HC was the “most logical and best solution” to the Health Insurance crisis. Then he gets into office, and avoids even using the bully pulpity of the oval Office to address this “most logical and best” solution. Instead, he thumps the Constitution and states that as President he is not able to comment on any legislation that OCngress is drafting! Separation of powers, don’t you know?(Although he has since ignored that dictate of his, for instance when giving the upper four percent their Bush era tax extension extension, and when admonishing Congress this past week to continue with the funding for the Totalitarian Surveillance State.)

    1. Lambert Strether Post author

      So what? The so-called Public Option Magic Zombie Sparkly Pony was never a serious proposal. So Jacob Hacker wrote a book about it and Digby shilled for it. So what?

      And if the public option meant anything, here’s what it would turn out to mean:

      Social Security would become the “public option” in a “marketplace” with competing private “retirement plans” — generalizing the ObamaCare model to social insurance programs generally. Is that the policy outcome you want?

      1. Donald

        So what–it’s more evidence of bad faith by the Obama people, that’s what is “so what” about it. Whether or not the policy itself was worth fighting for, it wasn’t sufficiently far to the right, so even the public option got dismissed.

Comments are closed.