America’s Shopper-in-Chief Has His Staff Sign Him Up for ObamaCare (But Not His Family)

By Lambert Strether of Corrente

And in a genius PR move, the White House describes Obama’s act of successful shopping avoidance as “symbolic.” As indeed it is, although not in the way the White House thinks, or could be said to think. WaPo has the details:

President Obama has enrolled in the federal health-care insurance exchanges, selecting a bronze-tiered insurance plan on the D.C. marketplace, the White House announced Monday.

The Bronze? The metal for losers who can barely scrape together the meagre coin to avoid being forced onto Medicaid? WTF?

The president’s health care will continue to be provided by the military, according to a statement distributed to reporters from a White House official who demanded anonymity.

My Canadian friends tell me that in Canada — they have a single payer plan up there that covers everybody; they call it Medicare — medical services that are covered by Medicare cannot be covered privately (leaving profit-mongers to sell cosmetic surgery, for example, to the wealthy, and a very fine thing that is, too). That way, the Canadian Prime Minister and the lowliest prole all have the same incentive to make Medicare work well; they all have the same skin in the game; their own.

Obama’s premium will be less than $400 a month, but it only covers himself, not his wife, Michelle, nor their daughters, Malia and Sasha, according to a White House official.

But Obama, as you see, has no skin in the game at all; not himself, and not his family. Yet oddly, or not, Obama places great emphasis on others having skin in the game. (Troll prophylactic: Before anybody raises the argument that Obama couldn’t legally go on the Federal Exchange, or wasn’t eligible for the exchange because of income, remember that Obama’s the same guy who whacked a U.S. citizen with a drone strike without due process. Let’s also remember that ObamaCare is a hot mess of triaged requirements, slipped statutory deadlines, abandoned mandates, and rewritten regulations that reinterpret the law so loosey-goose-ily that the law might as well have been a ginormous stack of “This page intentionally left blank”s. In short, if Obama had wanted to put himself and his family on his wonderful Exchanges, like the rest of us, he could have. Let’s not kid ourselves here.*)

Although Obama was involved in selecting a plan, he didn’t sign up himself. The president’s staff did that for him, going in person to the D.C. exchange over the weekend, the White House official said.**

Ha ha. How I wish I had staff! And if the DC Exchange was really crash-proof, do you really imagine that the White House PR operation would have passed up the chance to make a YouTube of “tech savvy” Obama signing up on his own laptop from the Oval Office? And then propagating the YouTube to the “young invincibles”? No way. No, instead the White House operation has the staff go over the weekend, and then releases the news of our glorious leader’s enrollment on Monday of Christmas week, which is about the same as burying it at 5:00 on Friday.

But let us pass on from the pleasant duty of calling bullshit on Obama’s imperial prerogatives, which let him slide out from under the shopping experience he’s mandated for the rest of us — at least, those of us without staff — because there’s a larger point that I’d like to approach by way of example. Let us pass on, that is, from the airing of the grievances to the feats of strength. Here’s a report from the field (hat tip, BC) of one person trying to work the Federal Exchange in Missouri with the help of a Navigator

Success with takes patience, persistence

Aaron Swaney, the certified application counselor [Navigator] based out of the Family Health Center, first helped [Jeannie Wyble] make an account on the marketplace on Nov. 15. By the second of week of December, her account still says “in progress.” … They made another appointment to see each other the next day, hoping the sixth time would be the charm.

Shop ’til you drop! And now the key point:

Jeremy Milarsky, who, like Swaney, has been certified to help consumers enroll on, sums up the situation:

This is a system that lends itself very well to people who are organized and follow up. If you’re the kind of person who just sits back and expect everything to fall into place [as, for example, with Canadian-style single payer Medicare for all] you’re more likely to run into problems.

In other words, ObamaCare is optimized for shoppers; that’s really what what “patience, persistence” headline means when you think in systemic, as opposed to characterological, terms. In fact, given that statistically at least, lives are at stake, we might consider the ObamaCare marketplace as a Darwinian environment where those who do not display adaptability to the shopping environment — I hate shopping, since it’s a massive time sink — are more likely not to get the health care they need, and hence more likely to get sick, and hence more likely to die; some people call that a “nudge,” but I’d call it more like shooting the wounded.

Because — and this is the most important point — the neoliberal “market solution” is always about that truly transcendent human endeavor — shopping — isn’t it? Supposing for the moment that we consider the non-elite human, of course. As Corey Robin wrote (quoted by Yves):

In the neoliberal utopia, all of us are forced to spend an inordinate amount of time keeping track of each and every facet of our economic lives.

As did Jeannie Wyble, thereby giving productive employment, except not, to Aaron Swaney.

That, in fact, is the openly declared goal: once we are made more cognizant of our money, where it comes from and where it goes, neoliberals believe we’ll be more responsible in spending and investing it. Of course, rich people have accountants, lawyers, personal assistants, and others to do this for them, so the argument doesn’t apply to them, but that’s another story for another day.

And so do Preznits!

The dream is that we’d all have our gazillion individual accounts—one for retirement, one for sickness, one for unemployment, one for the kids, and so on, each connected to our employment, so that we understand that everything good in life depends upon our boss (and not the government)—and every day we’d check in to see how they’re doing, what needs attending to, what can be better invested elsewhere. It’s as if, in the neoliberal dream, we’re all retirees in Boca, with nothing better to do than to check in with our broker, except of course that we’re not.

If ObamaCare is permitted to entrench itself, the next step will be to have a “Retirement Marketplace,” with Social Security as the “public option,” so that the rentiers can run the 401(k) scam a second time for more fees, because shopping.*** Does anybody really believe that won’t happen?

In real (or at least our preferred) life, we do have other, better things to do. We have books to read, children to raise, friends to meet, loved ones to care for, amusements to enjoy, drinks to drink, walks to take, webs to surf, couches to lie on, games to play, movies to see, protests to make, movements to build, marches to march, and more. Most days, we don’t have time to do any of that. We’re working way too many hours for too little pay, and in the remaining few hours (minutes) we have, after the kids are asleep, the dishes are washed, and the laundry is done, we have to haggle with insurance companies about doctor’s bills, deal with school officials needing forms signed, and more.

That’s not a bug. It’s a feature.

What’s so astounding about Romney’s proposal [which became Obama’s]—and the neoliberal worldview more generally—is that it would just add to this immense, and incredibly shitty, hassle of everyday life. One more account to keep track of, one more bell to answer. Why would anyone want to live like that? I sure as hell don’t know, but I think that’s the goal of the neoliberals: not just so that we’re more responsible with our money, but also so that we’re more consumed by it: so that we don’t have time for anything else. Especially anything, like politics, that would upset the social order as it is.

Indeed. A social order where the rich have staff to do their shopping for them, Presidents slide out from under the mandate to shop that they impose on others, and the rest of us… Well, here’s what we’re expected to do:

The key point to remember in all discussions of ObamaCare is that neither it, nor indeed the entire private health insurance “industry,” should exist. They are rent-seeking parasites, economic tapeworms. One does not improve a tapeworm; one removes it.

We’re mandated to keep that tapeworm fat, happy, and well-fed. By shopping for a defective product with time we have to steal from what we’d really rather be doing than shopping for insurance, and that means almost anything. The Canadians don’t have to crap around with any of this. Why should we?

Bush famously said “I encourage you all to go shopping more.” Leave it to Obama, not to “encourage,” but force us to shop!

NOTE * “If I elected, my family and I will purchase health insurance on the exchanges together” would be a great campaign promise for a populist campaign, especially when followed by “until such time as we pass Medicare for All, which I expect to do in my first term.” Bernie? Brian? No, not you, Elizabeth.

NOTE ** There’s also the argument that Obama would have had difficulty signing up because of Experian’s identity validation software might not have been able to handle his special case. Really? So have Obama get on the phone with support, like the rest of us. Symbolism, ya know. Symbolism. And don’t tell me he doesn’t have time; he’s on his way to a vacation in Hawaii!

NOTE *** We might consider making the experiment of mentally replacing “because free markets” or “because liberty,” when encountered, with “because shopping.” Could be interesting!

NOTE The Republican reaction is priceless:

“I’m glad he did it,” Rep. Jason Chaffetz (R-Utah) said in an interview Monday. “I’m not going to take a cheap shot at him for signing up.”…. [It’s a tough job, but somebody has to do it!] Chaffetz added: “He’s the president of the United States. His health care is a little different than the rest of us.”

Not in Canada!

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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. Clive

    This is the ultimate fate that awaits almost all of the “Great Communicators”. Eventually they simple end up hoist by their own PR. Tony Blair went the same way. At first, whatever eloqnant verbal novelties they either devise or come naturally to them seem fresh, new and due to their unfamiliartiy somehow more convincing.

    If the words are backed up by deeds, then yes, in very rare exceptions you have a great statesman.

    If not, as is the case with Obama, the inner huckster shines through. Then, the harder they work their act, the more obivous it becomes. At least with a one-trick-pony, when you’re bored with the same old trick, you still have the pony.

    On the bright side, the good thing about this stunt is that it could become to be seen as Obama’s “he jumped the shark” moment. More experienced Obama watchers than I might rush to tell me at this point that episode aired at least two seasons ago…

    1. human

      That episode aired during analysis of his Senate voting history, and certainly by the time that he had distanced himself from Reverend Wright in ’08.

      1. NotTimothyGeithner

        The 2004 DNC speech was nothing more than rah rah blather combined with attacks on Edward’s Two America’s imagery. Even then, Obama announced wealth inequality wasn’t a concern of his.

        Other than that, Obama has been the beneficiary of his not too black skin color and biography. Obots don’t quote Obama platitudes because Obama like most charlatans doesn’t drop wisdom. Lambert does a wonderful job of parsing O’s speeches, and they are weak sauce at best. People heard what they wanted to hear, and Obama’s real problem is now people want results especially with the Dems trying to do a victory lap over the stock market.

        Many of the great statesmen of the past were terrible speakers or shied away from speaking (Lincoln, Jefferson, Washington). What they left behind possesses the same intelligence and care they used in life.

        1. tongorad

          Obama’s branding con game appeals to American’s insatiable lust for high self-regard. The Obots cling to Obama for the same reasons people think that buying the latest Apple gadget makes them cool and smart.

          1. Alexa

            Yeah, and I fear that this propensity remains embedded in the typical Democratic Party voters’ psyche.

            I’ve never understood this. Until 2004, I was practically a “yellow dog” Dem.

            But never engaged in cult of personality politics like many did in the 2008 campaign.

            Only until Dems starting voting based upon logic and rational thinking–not some sort of “hero worship”–will we ever get rid of the toxic DLC/Third Way/No Labels corporatist Dems that have hijacked our Party.

            I’ve only blogged for two years, but from where I sit, it doesn’t appear that ANYTHING has changed.

            If anything–it’s only gotten worse.

            1. NotTimothyGeithner

              I don’t want to speak for low info voters because they are subjected to constant propaganda and lies, but I saw a comment here where someone had described political affiliation as a religion. Many “yellow dog” Democrats derive their value and sense of self-wroth from the “D” affiliation, and I think the personality cults derive from the obvious institutional failures. If the party is a whole has problems, Democrats have to question their sense own sense of self worth, but if they hold out for a messiah, they don’t have to question the larger problems or their own lack of action because the messiah will bring about the salvation (853rd dimensional chess; chill, Obama’s got this, and so forth) despite the solutions to our problems being in the public domain for ages.

              1. Alexa

                Great points, NTG!

                Speaking only for myself, prior to 2004, when I was still willing to “pull the lever” for any candidate with a “D” in front of their name–wouldn’t say that I actually derived my “self-worth” from anything political, much less from politicians (not a “lot” that I’ve ever held in very high esteem).

                It was more of a case of actually still “believing” Dem Party talking points.

                Yet, incredibly, I was doing quite a bit of reading on my own (mainstream newsprint media), and was a regular watcher of C-Span programs (Washington Journal, etc.).

                BUT, I was still incredibly “gullible”–didn’t realize and/or understand the corporatist neoliberal agenda which the Dem Party ushered in “big time” in the 90’s.

                IOW, I did not fully comprehend how dishonest and corrupt Dem Party (corporatist) politicians had become!

                In short, I believed that it was ONLY Republican politicians who were weasels.

                Hard to believe, now, that I was ever that naive!

                But I’ve NEVER been into “hero” worship, personally. And this is a really worrisome phenomenon, IMO.

    2. Alexa

      Agree with most your points, Clive.

      But what I worry about, is the Dem Base getting sucked into another “scam” Democratic Party health care program. IOW, false promises of MFA from a candidate who has “no intention of” delivering.

      Since no one took a strong stand against the ACA (other than weak lip service) at the time of the writing and passage fo the ACA, hopefully the Dem Party Base won’t be duped again.

      None of the potential 2016 Dem candidates are proposing an authentic “true” Medicare-For-All health plan–that I can find.

      Certainly, as I’ve posted here before, the DLC “Hyde Park Declaration” calls for the same atrocious plan that PBO has implemented.

      And most of our most prominent potential Dem candidates (except maybe Sanders and Warren–who will talk, but won’t run) and maybe Howard Dean, are DLCers: Clinton, O’Malley, Schweitzer, Booker. Not sure if VP Biden was ever a member of the DLC–but he may as well have been.

      All one has to do is read Bowles-Simpson’s “Chairman’s Mark” proposal–The Moment Of Truth.

      And listen to C-Span.

      Possibly this year, the Dems will get their much sought-after “tax overhaul.”

      And guess what–one cannot drop the marginal tax rates for corporations and the wealthiest Americans to 25% (corporations, and to anywhere from 25-30% for the most affluent Americans) and EVER expect that a massive federal transfer program like “Medicare For All” is going to be legislated.

      “Pigs will fly,” first.

      If progressives or liberals really want to see MFA, they MUST stand up against PBO’s proposed plan to raise tax revenues–it is on the backs of low and middle income Americans.

      If I knew how, I’d post the C-Span video about this overhaul, here at NC.

      Wake up and smell the coffee, as they say.

      MFA can never happen unless the most affluent Americans are willing to pony up. instead, lawmakers are getting ready to enact another huge transference of wealth upward.

      Watch Senator Ron Wyden and Rep Paul Ryan!

      [They hold the key to this, once Camp resigns as Chairman, and Baucus is gone.]

    3. Seal

      “Indeed charisma becomes the undoing of leaders. It makes them inflexible, convinced of their own infallibility, unable to change. This is what happened to Stalin, Hitler, Mao, and it is a commonplace in the study of ancient history that only Alexander the Great’s early death saved him from becoming an ineffectual failure.” The Essential Drucker, Peter Drucker, Harper, Pg.269

  2. MaroonBulldog

    Let’s see if I have this right: The president signs up to pay $400 a month for a high deductible insurance plan that (1) he doesn’t need, and (2) would not provide him much of a benefit if he did need it. What’s not wonderfully symbolic about that?
    He’s obviously just leading by this example he is setting for the all 27-year-olds with money to burn who haven’t quite got around to signing up, yet.

    1. jrs

      The “jump the shark” moment? Nah, the Marie Ationette moment. I’m so f’in rich that I’m signing up to pay $400 month not just for a program I probably won’t use (because the deductable is too high for the average wage) but for a program I”ll NEVER use. $20 bills, I also smoke them in fine cigars. And I wipe my @## with 1 dollar bills. Because I can. YES WE CAN!

  3. charles 2

    ” That way, the Canadian Prime Minister and the lowliest prole all have the same incentive to make Medicare work well; they all have the same skin in the game; their own.”

    Let me fix this for you : ” That way, the Canadian Prime Minister has to use his staff to categorizes his illness as specific if he wants to go to the private sector or the US for superior healthcare; all at taxpayer’s expense of course. The lowliest proles can apply to, but their application will be denied”

    1. ambrit

      Really; America has “superior healthcare?” For whom? Certainly not me or the people I work with, and we have a company policy for now. Like it or hate it, Canadas system shows the benefits and drawbacks of, I kid you not, Socialism. As in, for Societies good, not that of any elites.
      Back to Trollheim with ye.

      1. Jagger

        America has the best healthcare in the world…if you are a multi-millionaire or billionaire.
        All I can say is thank goodness for VA healthcare and serving during a war. Those few years means I don’t have to deal with Obamacare. Who would have imagined I would have ever said that.

        1. OIFVet

          Yes, I would have never guessed that I would be thankful for having gone to war.The VA system has been great in my experience. Yet I can’t help but wonder how long it will be allowed to exist. They already came for the military pensions, how long before they come for the VA healthcare? We will have to “embrace the suck” again sooner or later, mark my words.

          1. Wayne Reynolds

            I might suggest that you and Jagger keep a close eye on Paul Ryan and Patty Murray. They are not your friends.

          2. different clue

            Aren’t veterans together with Active and Retired servicemembers, numerous and organized enough to cause serious pain to officeholders and torture them into leaving VA and TriCare medicine alone?

      1. McKillop

        Too true!
        However, the infestation is not yet recognized as harmful. We’ve been showered with propaganda from the U.S.A. for so long that we accept -except for the hard-core ‘leftys’ (lefties) and die-hard monarchists- that education,healthcare, business ptactices, finance and just about everything else done the “American” way is preferred. We drown in knowledge from United States mass media and have scant understanding of our own politics or law. Usually what happens in the U.S.A shows up here about 5 years later (used to be 10).

  4. Wyndtunnel

    While the Canadian healthcare system is far from perfect it sure as hell beats the shit sandwich that Americans have to deal with. That said, the Prime Minister, high ranking politicians and even star athletes do get a higher standard of access, and I suppose care, in the sense that they generally rub elbows with the best practitioners or know people who do and can have things “arranged”. Mind you, this preferential treatment is based more on political or social stature as opposed to the sheer influence of Mammon which regulates American access and quality of care. Like I said, our system is not perfect. But my Father and Mother-in-law both have had bypass surgery with access to the same cardiologist for follow up visits over the decade since their surgeries and all our families have had to pay has been for parking at the hospital.

    1. McKillop

      Yep, parking, And letters in the newspapers mark complaints about the $6.00 cost.
      There are also hardcore complainers, or propagandists for the politicians and sharp business people who see a chance to make a buck -hard to tell- who object to the poor health care that they never use (I know, I know.)
      That a high proportion of taxes goes to healthcare costs is now the main issue and it’s difficult to point out that lowering tax revenues and expenditures on other government services can change ratios. They also play to peoples’ objections to the high salaries various government bureaucrats receive as c.e.o. compensation, wait time for procedures. It is difficult to get a personal general practitioner doctor, especially where I live in Northern Ontario. Huge government expenditures in cahoots with corporations, costs that have soared as results have not been delivered, have helped create anti-government, anti-socialist feelings.
      The corporations appear to escape censure. The politicians gain employment outside of government.
      My own experiences have been quick and positive and I’ll sing the praises of O.H.I.P. (I’m not familiar with people who use the term “medicare”) and the doctors who-ve helped me, but the opinions wrought by propaganda are not easily dispelled, especially by just one guy.
      What makes understanding difficult is how many politicians, seeking the main chance, pretend to be other than ‘neo-whatevers’, despite the practices they follow, despite the words they preach. Also making opposition difficult is the volume and complexity of financial and legal changes.

  5. Hugh

    Obama’s bronze plan was not so much a cure for his political tin ear but another example of it. Failing elites I suppose are torn between proffering us shit programs with shit excuses on the one hand and dispensing with the explanations altogether and going straight to the looting on the other.

    1. Expat

      Yes…just like the elites who used to appear in public to drink a glass of the water they had polluted or refused to clean up….

    2. NotTimothyGeithner

      Its a desperation move. The GOP has spent years distancing itself from policies they have been advocating for years, and the Democrats now own the healthcare system and terrible GOP ideas lock, stock, and barrel.

      The Democrats don’t know what to do. They chased away liberal activists for money which is only loyal to perceived winners and pursued policies which have made their voters poorer except for a sliver of NPR, latte drinking crowd, the GOP pushed stereo-type is true. I think the Democrats have chosen the path of willful ignorance and are praying all their problems will go away on the 1st with the confidence inspired by the budget deal. They have no plans for what happens when veterans start showing up in town halls asking about why we are wasting money on phony contracts and he has to give up his pension. What else can they do? We know accountability for bad actors is out, probably because at this point the DEmocratic establishment would be fingered as accomplices.

      The GOP isn’t going to let them fix* anything, and the GOP doesn’t have the stench of ACA on it. What is an extremely arrogant man going to do? Honesty is out. If Obama admits to selling out the country to preserve corporate profits, any dream he has of a Presidential library or a post-presidency similar to Clinton is done. O won’t be on the conservative welfare circuit with Palin.

      *Radically alter the healthcare system. “Fix” is a terrible word because it implies ACA is a good idea.

      1. Lambert Strether Post author

        “You can’t buff a turd,” as they say in the Navy. The ACA is not a good idea, since shopping for health insurance is not a good idea, and the health insurance industry itself is not a good idea.

  6. Skeptic

    Canadian Healthcare

    Average CDN Joe here.

    “That way, the Canadian Prime Minister and the lowliest prole all have the same incentive to make Medicare work well; they all have the same skin in the game; their own.”

    Not so. The Elite have special hospitals to treat them and their minions. They also resort to queue-jumping, the Electric Rail of CDN healthcare. Queue-jumping is where the Elite and their flunkies jump the waiting line for services. This is little discussed in the CDN MSM since many there also queue jump through their connections and influence. Proof of this is the recent scandal involving Senator Mike Duffy who was receiving Ontario healthcare services while illegally registered for those services. As usual, no prosecution.

    In addition, the CDN healthcare system has many of the usual PHARMA PERPS and other suspect treatments pushed by the sickcare industry. One example of this is the ANGIOPLASTY/STENTING IINDUSTRY. These suspect heart disease treatments are heavily used in Canada. In addition, PHARMA RACKETEERS like PFIZER are alive and well in Canada. The healthcare system here apparently has no problem dealing with criminals.

    Therefore, I myself hedge against this system. I use a Doc who is registered in the system but also practices Integrative Medicine. I pay for additional services from him like nutritional counselling. He is not held captive by the Mainstream CDN Health System but is intellectually curious and open to alternative healthcare practices. Nor is he brainwashed by BIG PHARMA and other corporate health criminals.

    Lastly, on any big health issue, I will never follow the First Opinion. I will seek a Second Opinion at least and that is very difficult to due under the CDN system. It is mostly one size fits all unless you have power and influence. Take it or leave it. So, that would mean in the main going outside the country if one were able.

    Whether CDN Healthcare is better or worse than other systems I do not know. But any such analysis should certainly factor in the above. The analyses I have read do not do that.

    There are certainly to be lots of folks who will die unnecessarily under both systems because they did not practice due diligence. I choose not to be a passive consumer of healthcare.

    1. Banger

      Most systems have problems and I’m sure Canada has problems and that the rich get better health care and so on–but at least the average person gets something they don’t have to pull their hair out thinking about. In the United States we have an insane health-care system. It was insane before Obamacare and is, at the time of this writing, still insane but in a different way. Most diseases are caused by stress and one reason why we have poorer health in the U.S. than most advanced countries is that we have more stress in our society, in part, because we have too many choices and we spend too much time on making them–many of them we are forced to make. The whole Obamacare debacle has made many people even more stressed at a time of year that we definitely don’t need more stress.

    2. Jim Haygood

      ‘Queue-jumping, the Electric Rail of CDN healthcare. Queue-jumping is where the Elite and their flunkies jump the waiting line for services.’

      Thanks for reminding us that Econ 101 still applies: any system that distributes below-cost goods and services must have queues (i.e., rationing) to limit quantities. If they were handing out free beer, the proles would wait in long lines for it on freezing sidewalks, while the nomenklatura would get ‘courtesy’ home deliveries.

      ‘I will seek a Second Opinion at least and that is very difficult to due under the CDN system. It is mostly one size fits all unless you have power and influence.’

      A vital point: when incentives for unnecessary surgeries and medications for life are present, as in North America, second opinions are a must. But with permanent queues, second opinions must be heavily restricted or prohibited.

      For all of Corey Robin’s bitching about shopping, it sure beats having a single-payer do it for you. If we had single-payer ‘free clothing,’ we’d all be wearing prison jumpsuits.

      1. diptherio

        Oh yeah, I’m totally better off with NO health coverage whatsoever. Guess what, shopping for your healthcare is even more of a b*tch when you live on a grand a month. What’s your solution? Everyone fend for themselves? Oh, and who do you think has better bargaining power in price negotiations: a nationwide single-payer system or you and me and everyone else individually?

        Nothing’s perfect, but look at our healthcare prices vs. outcomes and compare them to Canada…you know, look at the data rather than your philosophy. I’d rather have their problems than ours any day of the week…

      2. Lambert Strether Post author

        Are there any other experts out there who think the market for health insurance (and health care) is like the market for clothing?

        * * *

        But you do paint an interesting picture of millions of Canadians, dressed in prison stripes, crawling through the snow on bloody hands and knees, seeking to escape their single payer system so they can shop for care in America, because Freedom.

        How come that’s not happening?

      3. Waking Up

        Over 50% of bankruptcies are due to medical costs in the United States. How many Canadians end up bankrupt from medical expenses with the Canadian system… none.

        1. NotTimothyGeithner

          Yeah, but every Canadian has to wear flannel and listen to Ann Murray because socialism or something.

      4. jsn

        “Below-cost goods”; what does that mean? The market is completely broken in the U.S. for pricing, as a good many things, e.g. diamonds, cell phones, etc.. There are costs of production, which are much lower in Canada because the government cuts graft and mark-up out of the system, encouraging streamlining and standardization in the public interest.

    3. McKillop

      If you pay for additional services from your doc are you not yourself a queue jumper?
      You are correct about the wealthy or influential or entertainingly important (sports figures) gaining well reported and immediate care but I’m not sure that this care comes at a systemic cost. I am sure that the jumping is always controversial and receives negative comment.
      Duffy is a different matter. The guy worked in Ontario and spent much of his time living in Ottawa; I don’t think his example here is the best. As well, many citizens of Canada live abroad but return to Canada in order to re-new residency requirements for healthcare.
      Some of your comments imply that doctors other than yours are accomplices of criminals, intellectually lazy and therefore incompetent or trapped in their practices to One Opinion. I’ve experiences that refute those implications,

  7. ArkansasAngie

    No one wants people to die because of a lack of healthcare.
    Insurance is a way to pool risks to hedge against future problems. First off, in the long run, we are all dead. It costs people money to die. Second, a pre-existing condition isn’t something that happens in the future, it is happening now. It isn’t an insurance event. It is a charitable event.
    Obamacare is at its conceptual core ludicrous.
    And … it needs to be scrapped.
    Healthcare is needed by everyone. It is inherently a monopoly. In a monopolistic situation, you create a rate control. A single payer system which pays product and service providers based upon their contribution to the end product is a proven model. Utility providers (water, gas, electric, garbage, et al) foster a wide distribution of capitalistic ventures (capital equipment, maintenance, service).
    The purpose of capitalism is for the cream to rise to the top. The purpose of controlling a monopoly is to allow capitalism to flourish. Allowing a monopolistic situation to continue is a misallocation of resources.
    I suggest you ask what your candidates think about healthcare in America. And … if you don’t like their answers, write in “No”. The lesser of two evils? Screw that.
    Moral hazard applies to politicians too.

    1. Alexa

      Hear, hear, ArkansasAngel, to:

      I suggest you ask what your candidates think about healthcare in America. And … if you don’t like their answers, write in “No”.

      The lesser of two evils? Screw that. Moral hazard applies to politicians too.

      BTW–Why doesn’t “blockquote” work anymore?

    2. Cynthia

      What is significant here is that for the first time the insurance company lobby has complained publicly about this. They have quietly gone along with every other move that HHS and Obama have made, even though every one of those moves cost them money.

      But this time they came out and warned about “serious instability in the insurance market”. Let’s be clear about what this means. The stability that they were counting on is lots of young and healthy people being forced to overpay for insurance so as to cover for the losses from covering the expenses of the older and sicker customers.

      Now the individual mandate has been so watered down by the Obama Administration that it is nearly meaningless. It certainly is now toothless as it is easily avoided. And this means that if people act in their own self-interests (as they are prone to do), then there is not going to be a flood of young/healthy people signing up to overpay for full ObamaCare policies.

      And if that does not happen, then ObamaCare is going to have an “adverse risk pool” which means a set of customers upon which the insurance companies will collectively lose money. This will drive up premiums, which will cause cancellations by the few healthy people who did sign up. Premiums will then have to rise again to cover losses by the insurance companies.

      Who knows where this will end, but one scenario is that the insurance companies simply withdraw from ObamaCare (they are not mandated to participate). If that happens, the ObamaCare will end up hurting the very people it was designed to help – those who had trouble getting insurance in the prior individual market.

      1. different clue

        The insurance lobby wrote the law and bought the votes. (Or nudge nudge wink wink promised to pay for those votes “after office”). So now they are hoist on their own petard?
        One hopes so. Happy Death Spiral, guys.

        And we should all ask our officeholder to support Senator Cruz’s (hopefully sincere) effort to repeal the “TARP for Big Insura if Obamacare doesn’t make them the promised profits” law which he is allegedly pushing.

  8. trish

    excellent post. the (corporate) tapeworm should replace the bald eagle as our national symbol.

    “The dream is that we’d all have our gazillion individual accounts”
    Once our schools are fully privatized, our kids can learn to manage their accounts and become responsible and finance-wise and…shopping! so, good americans! Start ’em young.

    wonder if we can work this with our (privatized) prisons…I imagine there might be some (more) population growth there.

  9. DakotabornKansan

    The case with Obama, the inner huckster shines through…

    “You see. No shock. No engulfment. No tearing assunder. What you feared would come like an explosion is like a whisper. What you thought was the end is the beginning.” – Rod Serling

    No “Imperial Me.”

    In Rod Serling’s “A Carol for Another Christmas,” the “Imperial Me”(played by Peter Sellers) in a pilgrim outfit and a rhinestone-bedazzled ten-gallon hat bearing the glittering legend “ME,” warns that those people “down yonder and cross river” plan to infringe upon the God-given rights of the Individuals Mes by talking and debating about “what they call our ‘common problems’.” The Tea Party-like crowd shouts “Unpatriotic!” The “Imperial Me” proclaims the strength and wisdom of the Me People lies in the every-man-for-himself philosophy: “Each behind his own fence!” “Each behind his own barricade! Follow me, my friends and loved ones, to the perfect society! The Civilization of ‘I’!” Only the very strongest will survive, a society of sovereign individuals within his or her sphere of armed autonomy.

    Rod Serling was one of the great proponents of compassion in a world tragically devoid of it.

    “The tools of conquest do not necessarily come with bombs, explosions, and fallout. There are weapons that are simply thoughts, ideas, prejudices to be only found in the minds of men. For the record, prejudices can kill, and suspicion can destroy. The thoughtless, frightened search for a scapegoat has a fallout all its own for the children yet unborn. And pity of it is that these things cannot be confined to The Twilight Zone.” – Rod Serling, closing monologue of “The Monsters Are Due On Maple Street”

    “Any state, any entity, any ideology that fails to recognize the worth, the dignity, the rights of man – that state is obsolete.” – Rod Serling, “The Obsolete Man”

    1. tongorad

      Have you seen Serling’s [i]Patterns[/i] (1956)?

      A masterpiece, IMO.
      “On our level you don’t get fired, you know that. After thirty years of productive work, they can’t say to a man like me, “Alright, now get out!” They just can’t do that. So what do they do? They create a situation. A situation you can’t work in and finally that you can’t live in with this tension, abuse. Small humiliations. It all starts out on a scale so subtle, so microscopic that at first you can’t really believe it’s happening at all. But gradually thy thing begins to take shape. The pieces fit together – all the little bits. And it becomes unmistakable. They chip away at your pride, your security until you begin to have doubts, and then fears.”

      1. MaroonBulldog

        I’m an old labor lawyer. The behavior you describe has a name: “constructive discharge.” It is very real.

    2. Cynthia

      What’s the administration going to do next to try and pull the wool over your eyes? Perhaps Obama should transform himself into a faith healer? He should assemble the sick and lame in the Rose garden. Then with a magic wave of Obamacare legislation and shouting “healed”, they will rise up and walk again. Then he could have the choir start singing and dancing while the 800 number flashes on the screen and say; “quick, send in your dollars!”

  10. pdlane

    I cannot figure out if Mr Strether is either just plain stupid or dumb, getting all excited over a publicity stunt dreamed up by some junior White House Staffer.
    Medical care, by Law, for the President of the United States, The Vice President and their immediate dependents is provided FREE by the Department of Defense, primarily the U.S. Navy Medical Corps. Signing up for ACA was a publicity stunt.

    1. PM Burton

      I cannot figure out if PD Lane is dumb as *** or just an a***hole.
      The whole point Lambert was making was the symbolism of the class structure that
      makes US a ****hole for millions of Americans.

      God what an idiot.

    2. NotTimothyGeithner

      The point of a publicity stunt is to con people, and its the responsibility of people who recognize it to point cons out along with the hypocrisy. Many people will only see the AP article, and Obots will gladly spread propaganda about this to people who lack resources or are under the illusion MSNBC is a credible news outlet instead of a propaganda outlet for Comcast and GE.

      Its also useful to demonstrate that the pressure is getting to the White House. This was not dreamed up by a junior staffer. Obama maintains a small cadre of advisers and is an control freak. This most likely came out of Jarrett’s office.

      Its like explaining a joke.

    3. optimader

      ” a publicity stunt dreamed up by some junior White House Staffer.”
      a link on that?
      What else do junior WH staffers apparently dream up and apparently approve and put into effect?
      Your not providing much comfort here

    4. MaroonBulldog

      “Signing up for the ACA was a publicity stunt.” One that would better have been left undone. The prez has lately got into that habit of making a horse’s arse of himself, and this time he did it deliberately.

    5. Jerome Armstrong

      Well, you should probably wonder about yourself first, starting out with “I cannot figure it out” is usually an indication of where to begin.

    6. Perry Masonry

      You have what has been described in other circles as a magnificent grasp of the obvious.

      If this comment is your idea of value-added thinking, it’s time to reevaluate your investments.

  11. Ep3

    AMAZING!!!! Absolutely fabulous post!

    This is exactly what they want. We become so entrenched in these things, that we don’t have time to look up & see that drone attack about to take off our heads.
    Has anyone here experienced the situation where you talk with someone (a free market person) about your health insurance experience? What I am saying is that the libertarian will brag that thru his own hard work he found a plan that costs $12,500 a month (example) that he is so proud of because he pays for it. He’s not lazy like Medicaid receipents. I hear these ppl & want to shake them. Why do u do this? Why don’t you join with me & fight for Medicare for all, then u can save that money? But it’s not about the cost or quality. Somehow ppl feel superior by paying such outrageous amounts. They think they are just one step better than you, even tho they are the rube.
    To me, it’s like the Walmart black Friday shoppers. Even tho the deals aren’t necessarily better, and the chaos & the early morning hours are ridiculous, ppl think they got one nugget better than you or I. They somehow feel superior bragging to each other that “I got in line 5 minutes before u did”, or “I didn’t cook dinner this year because it’s such a waste & it allowed me to get in line sooner & so I saved $5 that you didn’t”.
    The founding fathers did not want to end “kings & royalty”. They just were jealous. What they wanted to do was build a country where it was easy to overthrow those in power. Kings were in power thru bloodlines. With the US, kings could be created by whoever had the wealth.

    1. diptherio

      I think Libertarians, of the sort you describe, are extremely insecure. They insist that everything they have is the result of their own hard work (as compared to, say, having the good fortune of being born in the US) because that is where they place their individuality, their sense of self. If they admit that life is a crap-shoot and one’s position is society has to do with many factors that the individual has little or no say in, they will then no longer be able to maintain their sense of superiority: and insecure people need to be constantly reassured of their superiority over others.

      Like Haygood above, many libertarians (although not only them) seem to be more concerned about philosophical purity than about pragmatic solutions. The US has higher costs and worse outcomes than the rest of the industrialized world…but Gawd forbid that we should follow the lead of any other countries. Lower costs and better results?!? Screw that! I’ll keep my freedom, thank you very much! (freedom to pay through the nose for unnecessary care, but whatevs).

      1. NotTimothyGeithner

        Part of the problem is libertarians see themselves as the primary beneficiaries of their proposed policies. The gold bugs are a subset of course, but the gold bugs are interested in gold standards because it provides them a path to power and wealth by not doing anything.

        They don’t want systems that work for everyone because much like the elites this is about power, not about standards of living. The libertarians just want to be kinds of dung heaps as long as they are kings.

        1. tongorad

          Behold the Libertarian’s wet-dream:
          “The Full Damage of Facebook Billionaire Sean Parker’s Fantasy Wedding”

          “From a new report by the California Coastal Commission (unearthed by The Atlantic’s Alexis Madrigal), it’s clear that Parker didn’t give a damn about the consequences of an artificial castle in pristine woodlands—”Neraida,” the company he created just to oversee his wedding, didn’t obtain any necessary permits. He and his wife wanted a dream wedding with elven cottages, and they were going to get it, even if it meant settling with state regulators for $2.5 million after the fact. When you help make Facebook a billion-strong global entity, you don’t worry about permits, my friend. Permits are for the rest of us.”

          1. different clue

            Hopefully some twitter activists will create a twittersite like #TrueFaceofFacebook or some such name, with link to this article and twitter sized advice to “boycott every Facebook Advertiser” and tell those advertisers why.

  12. Katniss Everdeen

    Seems to me that introducing the act of “thinking” into the process of “shopping” could have some pretty ugly unintended consequences for an economy that is “70% the consumer.”

    Mindless, unnecessary, unaffordable over-consumption is what has been making the US world go ’round for decades. Some pretty “bad” stuff could happen if people start “thinking” before they “add to cart..”

    It appears that, when forced to THINK before buying, most Americans would rather not. It could be “Darwinian” selection for the “shopping adaptability” gene, but is “THINKING SHOPPER” the trait that they really want to select for?

    It strikes me that the Robin post and now this one are awfully, effin’ WHINY. “Why do WE have to think about the insurance we’re buying?” Rich people don’t have to think, they can hire flunkies to think FOR them. Employers think for those with employer-provided insurance. Obama had his staff do his thinking for him. (Hmmm…)

    The other kids are sleeping on the couch or out “playing games” and you’re making ME do my homework. Your’e MEAN.

    Make no mistake, Obamacare is a very bad law with a myriad of flaws. Forcing at least SOME people to learn about and confront the realities of the shitty American “healthcare” system is definitely NOT one of them. Imagine what would happen if this leads to more people actually KNOWING what the hell is going on?

    This “critical thinking” thing sounds pretty good in theory, but it can sometimes get in the way of the movies we want to see and rich people are lucky ’cause they don’t have to do it.

    1. jrs

      What if people just hate thinking with no good answers. What if you do plenty of thinking say about the insurance plans you can afford on the exchange? But what if your thinking leads you to believe that all the plans you can actually afford are garbage, narrow networks, high deductables etc..

      Then what? Rack your brain trying to pick your poison? Write your congressperson about single payer? I have employer provided so it’s not my dilemma but nontheless. Plus I think that’s how many of us feel with many of our decisions, not those where we preceive hopeful choices (and the middle class often DOES have choices in purely consumer goods – adding something to the cart – capitalism does suceed at that), but things like say saving for retirement. What the heck use is thinking if all it confirms is how there are no good choices? It’s like a punchline: My very best thinking says: I’m damned if I do and damned if I don’t!

    2. JTFaraday

      “It strikes me that the Robin post and now this one are awfully, effin’ WHINY. “Why do WE have to think about the insurance we’re buying?”

      Well, it’s not like buying deliberately overly complex financial products within a couple of weeks as commanded by the US federal government, on pain of IRS fine, on a website that doesn’t even work is like picking up a pair of boxer shorts:

      Meanwhile–outrage grows!– plenty of people are whining about Joe Boxer.

      If we’re going to critique Corey Robin, perhaps we should fault him for not really thinking this con all the way through.

      For one thing, when I think of the way people signed up for Obamacare, I think of the way people were presented with their mortgages and told to sign on the spot or lose the house, not “shopping” at K-Mart.

    3. different clue

      I wonder how many timebombs the Ocare program holds for employER providers of insurance, designed to tax and torture them out of continuing their coverage, and incentivize and nudge-ify them into handing every employEE a voucher for Ocare starting next year?

      1. JTFaraday

        Oh, I am almost certain that one of the primary purposes of Obamacare is to provide employers with an excuse to drop coverage for “full time” employees. The role of the Republicans, who have gone on record opposed to O-care even though it is the Heritage Foundation’s plan, is to whine that the employer mandate is “a tax on business.” We see how well this works with their usual rhetoric.

        So, shoppers everywhere need to start paying attention to the shape of their new national health plan.

        1. different clue

          More than just “excuses”. Deliberate overt pressure. Legal and tax torture against employERS who would rather retain their present plans for employEE coverage.

  13. Dan Kervick

    I don’t get the point of this brouhaha? Would we say that SNAP is a bad program if members of Congress didn’t get food stamps? The main point of ACA was to provide health care coverage for a few tens of millions of Americans, and the help reduce costs of plans for the self-employed by generating more competition, not to address the needs of everyone who already had perfectly adequate employer-provided health care.

    There are so many worthwhile things to complain about regarding ACA. Whether the President himself is enrolled in it is not one of them.

    1. diptherio

      It’s the bizarre PR that is the story here. Bronze plan??? And it’s not like there hasn’t been plenty of in-depth coverage of the ACA’s failings on this site…just gotta critique everything though, dontcha? (I know the feeling)

    2. NotTimothyGeithner

      You are giving the White House too much credit. The main point of ACA was to appease the short term views of Democratic voters while trying to pry doctors and hospitals from the grip of the GOP, flooding Democratic coffers, while serving the bipartisanship god of false compromise. This is the Democratic party, pretty much on every issue.

      1. Dan Kervick

        We can argue forever about the true purpose of ACA, but we know that the point was not to provide better insurance from the fortunate portion of American society that already has excellent health insurance – and that includes presidents and senators. So focusing on whether the DC pols and their families have enrolled in ACA is the most dumbed-down form of cable news fake “gotcha” politics.

        1. MaroonBulldog

          Lambert didn’t post this particular item to invite further debate about any posited “main purpose” of the ACA. He posted this to point out that the president is embarrassing himself, and that worrisome behavior because it reflects on the president’s state of mind. Either the president thought about signing up for this himself and concluded it was a good idea–bad judgment on his part–or he was led by his staff to do it–absence or abdication of judgment on his part. Cumulative evidence that the man can’t lead himself, let alone others.

            1. Perry Masonry

              You have a VERY truncated understanding of symbolism, IMHO.

              Take this little escapade, combine it with his selfies at Nelson Mandela’s funeral, season with his wholesale assault on general staff officers in the military, add in a pinch of his propensity to legislate statutory law from the comfort of the Oval Office, marinate with multi-million dollar travel escapes for himself/family/closest 200 aides while millions of Americans fall into poverty and you begin to get a picture of someone SERIOUSLY OUT OF TOUCH WITH REALITY.

              Why should that concern you? Because they are mile markers on the road to full blown psychosis, of which I believe Dear Leader is suffering already.

              Need a painless lesson in how it all ends up? Take a look at one of the countless You Tube videos of “Hitler learns that…” fill in the blanks. It’s funny 70 years on. For those who actually experienced the results of that madness, not so much.

          1. different clue

            If the President is embarrassing himself due to rising pressure and deepening cynicism about his Ocare law, then shouldn’t we all do our little best
            to destabilize Obama’s psyche and emotion-field as much as we can in order to get him to embarrass himself more and more and more? Shouldn’t we try
            to get him to have a “Nixon breakdown” on prime-time TV? And if comments about the wider purposes and harms of Ocare itself can somehow increase and weaponize the embarrassment, aren’t we making a contribution (however small) to further Obama embrassments which would give more material for more “there he goes again” posts? Which would allow people more chances to sabotage the propaganda-catapult? Leading to a virtuous spiral ending in President Obama’s reputation and power-in-office twisting slowly . . . slowly in the wind?
            So perhaps “offpoint” comments against Ocare serve a long range purpose even to posts focusing on the “Obarrassment” of the President.

      2. Cynthia

        Hard to believe that just two months ago, Democrats helped the Republicans shut down the government to prevent any changes in ObamaCare. Now they are dismantling the whole thing in violation of the law.

      3. different clue

        I thought the main point of Ocare was to guarantee enslaved revenue streams to Big Insura and also to poison the well against “health care reform” so thoroughly that the issue is not even re-mentioned for several decades to come.

    3. Lambert Strether Post author

      Did you read past the first third of the post, Dan?

      * * *

      “The main point of ACA was to provide health care coverage for a few tens of millions of Americans”

      Just confirm the size and color, and I’ll have the bridge you bought out on the back loading dock. The main point of ACA was to guarantee the health insurance company a market, and to try to entrench them into the American health care system permanently. A secondary, long-range point (IMNSHO) is to serve as a test-bed for a marketplace “solution” that will then be applied to other social insurance programs, especially Social Security.

      1. Dan Kervick

        Again, the debate about the “true purpose” of ACA and what it does and doesn’t accomplish is unrelated to silliness about Barack Obama’s family’s health care plan.

    4. Alexa

      That’s only “partly correct.”

      The ACA was intended to benefit three entities/cohorts:

      1) Governments (local, state and federal) by passing the “burden” of healthcare on to the “individual”–cost shifting.

      2) To aid [by bringing down the cost of their health insurance premiums] the most affluent Americans–especially small business owners–by “cost shifting.”

      3) And, lastly, the ACA was a give away to FIRE (insurance industry)–one of the Democrats most ardent contributors as of late (just as the energy industry pours millions into the coffers of the Republican Party).

      Giving “health insurance coverage” (not the same as actual health care) to “the poor and/or low income Americans” was simply a “cover story” to achieve these means.

      Oh, and stay tuned–after New Year’s I’ll be writing here about my “perfectly adequate” group health insurance plan.

      Thanks to the ACA and the “Cadilac Plan” provision–our plan deductible that was only $250 a few years ago (and approximately $1,000 by Bush’s last year in office) is now slightly less then $8,000–for a couple.

      If I were a Democrat, I’d spend (midterms) election day in Nome, Alaska!

    5. Cynthia

      If Obamacare is so great, Dan, why doesn’t Obama and his family and all the other Democrats who voted for it sign up for it? It’s like a chef that doesn’t eat his own cooking. You might not want to eat at that restaurant.

  14. Seal

    Rep. Jason Chaffetz (R-Utah) wants BO off the hook because Congress has a super cush plan of their own. THEY have NO – zero – skin in the game.

  15. bob smith

    Once the manchild neoliberal mish shedlock got cancer, he began to question the for profit “health care industry” — you see he had an epiphany. when faced with the prospect of losing control of his bladder, and of erectile impotence, due to the procedure the doctor demanded that he undergo, he began to wonder if a for profit surgery that treated him like a piece of meat was really the end all be all of human existence.

    you see, the doc wanted to “cure” the cancer as quickly and cheaply as possible, to the doctor, thinking about his bottom line, Mich living for the rest of his life, in a diaper as a eunuch didn’t factor in to the doctors P and L.

    Mich and a lot of other magical thinking neoliberal magical market children have begun to debate, and to wonder, if a for profit medical industry is really the best way to go- but only when then themselves are faced with a medical emergency.

    1. El Guapo

      Thats how it is with those types. Faith in The Market only holds as long as its other people being opressed.

  16. Peter L.

    I grew up in Canada, lived in two provinces, and for the last ten years have lived in the United States. Like most Canadians I know, I have many and varied complaints about the health care system in Canada. However, I prefer the system there, strongly to prefer it, to what I’ve endured here.

    I never worried about access to health care in Canada. I never had to deal with bureaucracy before or after receiving medical care. My experience in the United States is just the opposite.

    Having experienced both systems, I think it is difficult for Canadians to understand exactly how crazy the health care is in the United States. I am still learning how to deal with the US system, and am still surprised by what I find.

    To be clear, I prefer the Canadian system, and from personal experience, it is clear to me that the United States ought to adopt a single-payer system. However, I think something from the post is misleading, namely the idea that all Canadians have skin in the game, and the implication that we are thus all responding to that incentive to make the system work: “My Canadian friends tell me that in Canada — they have a single payer plan up there that covers everybody; they call it Medicare — medical services that are covered by Medicare cannot be covered privately (leaving profit-mongers to sell cosmetic surgery, for example, to the wealthy, and a very fine thing that is, too). That way, the Canadian Prime Minister and the lowliest prole all have the same incentive to make Medicare work well; they all have the same skin in the game; their own.” (From the above post.)

    Health care is administered by province. Things are not entirely uniform across Canada. In Alberta, for example, the legislature there is trying to undermine the system. I don’t know if elite policy makers are actually working against there own interests, but it is quite clear that they are trying to make the health care system not work as well as it could. In that province they are also successfully introducing policies that create different “tiers” of health care access.

    Thus, I’m not sure that Strether is right about the incentives facing the Prime Minister, but even if he is, the incentive structure is not enough to prevent significant segments of Canadian policy elite from undermining the system.

  17. Bridget

    “Signing up for ACA was a publicity stunt.”

    No shit, Sherlock. And an excruciatingly lame one at that.

  18. Jerome Armstrong

    Too rich. He choose to be bronze, 3rd place. Just showing up.

    Anyway, Mark Warner put on his cajones and told Sebelius to open up the caveat that I not need to sign up for this bamboozle, getting to keep our plan, so there’s that… The Democrats are going to lose seats next year, without a doubt, not that anyone cares.

    Merry Christmas all. Love showing up here to read up Lambert, Yves and the others. Best game of links in town.

    1. Lambert Strether Post author

      Obama’s phoning it in, at this point. There is a subtype of Obot that believes the country isn’t good enough for Obama, and no doubt Obama is of the same opinion.

      And thanks for the kind words!

      1. different clue

        Was there a kind of German like that at the end of WWII? Hitler was certainly Obamaform in that regard, thinking that Germany was not good enough for his leadership when it all ended.

  19. CHeale

    The stupid thing about this PR for the ACA, is that he signed up for the bronze plan. No one is going to believe that he couldn’t afford the best gold plan going, so it’s going to be seen through immediately. In fact it shows he is so arrogant it’s insulting. Whoever wrote that it’s a Marie Antoinette moment IMO is exactly right.

  20. kareninca

    My husband has a friend in Canada whose husband has MS. He is getting what I consider poor to middling care. I wish he would come down to the U.S. and enroll in a clinical trial, or go to a specialty clinic; there are a million things to try that he is not getting the benefit of. They can afford a trip to the U.S. for that, and they absolutely believe that he might benefit from such extra treatment. However, he will not come down for extra/better treatment, because they both consider it unethical to go to the U.S. for better care. This really depresses me. I certainly see the ethical point, however seeing a guy in his early 50s skinny and with a cane (that was when I saw him last, about eight years ago; he’s in much worse shape now) make me want to just drag him to the Mayo Clinic or Hopkins or somewhere.

    The American system pre-Obamacare was a disaster (and now it is a different disaster). But it did create amazing specialty treatments; world class treatments that people come from all over the world to get. How to keep the research going, and the specialty treatments available, while managing universal access; that’s the thing.

    1. jrs

      Yea the thing is almost noone in the U.S. is going to have the specialty treatments pretty soon either. The thing about those narrow networks increasingly offered on the exchanges and perhaps coming soon to an employer plan near you: the leave out major research hospitals! They really do. So that’s what’s coming. And who even wants to live in a world where not only the poor can’t afford the specialty treatments but neither can anyone in the 99%.

      1. kareninca

        Yes, you are very right jrs: the Obamacare networks are creating that here too. If your network doesn’t contain the cancer hospital you actually need to survive, you will die. If it doesn’t contain the research hospital with the MS trial that is curing people, you will not be cured. Unless you have a lot of money and can self pay. Very few people will be able to self-pay.

        Without a sizable stream of paying patients (and to get a sizable stream, you need insured people; there just aren’t nearly enough cash patients), those specialty/research hospitals will not have the money to keep researching and treating. They will go under if they don’t have enough patients providing enough income. Even the rich will be screwed to the extent that that comes to pass.

  21. different clue

    The Dems will fight like cornered tapeworms to prevent Obamacare from crashing. The Reps say they will repeal it. Is there any reason to believe the Reps are being more truthful than Obama here?
    If there is, could a case be made for voting straight Republican in the hopes of getting Obamacare repealed? If not, why not?

    Or further down-ladder, would a Republican President deter the House and Senate Dems from privatizing Social Security, because the House and Senate Dems want to save that “go to China” achievement for a Dem President?

    1. NotTimothyGeithner

      “Or further down-ladder, would a Republican President deter the House and Senate Dems from privatizing Social Security,”

      No. Only voters stopped this attempt by Obama and W. The Democrats were open to discussions back in 2005 as Monahan from NY was a long time supporter of W.’s eventual proposals. Seniors and boomers quickly soured on the GOP, and the GOP discarded the idea for fear of losing their base. They even cooked up the Terri Schaevo non-sense to stem bleeding, and wavering Republican support returned to the GOP camp as a result. The issue was never about “right to life” but the optics of the relatively young widow fighting against the wishes of the sage like parents.

      The Democratic Party is dominated by neo-liberals and do-nothing tribalists who only care about the spectacle of politics. The do-nothings may prevent active complictiy, but the neo-liberals will join hands with any Republican they can find who isn’t actively burning mosques or churches they just don’t like.

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