Wednesday, October 23, 2013
Conservatives in particular think this website has broad implications for liberalism as a philosophical and political project. I think it does, but for the exact opposite reasons: it highlights the problems inherent in the move to a neoliberal form of governance and social insurance, while demonstrating the superiorities in the older, New Deal form of liberalism. This point is floating out there, and it turns out to be a major problem for conservatives as well, so let's make it clear and explicit here.
[T]he smarter conservatives who are thinking several moves ahead (e.g. Ross Douthat) understand that this failed rollout is a significant problem for conservatives. Because if all the problems are driven by means-testing, state-level decisions and privatization of social insurance, the fact that the coreconservative plan for social insurance is focused like a laser beam on means-testing, block-granting and privatization is a rather large problem. As Ezra Klein notes, “Paul Ryan's health-care plan -- and his Medicare plan -- would also require the government to run online insurance marketplaces.” Additionally, the Medicaid expansion is working well where it is being implemented, and the ACA is perhaps even bending the cost curve of Medicare, the two paths forward that conservatives don’t want to take.
The Healthcare.gov glitches are troublesome, and it's hard to overcome first impressions. Yet I have confidence that the trend of Obamacare's popularity rising will continue as the problems get ironed out (though there's the possibility that some fixes could cause more issues, per NASA engineering experiences) and more people realize how they're benefitting from the law.
Rube Goldberg contraptions have lots of failure points, so simpler is generally better. One way to use Obamacare as a good move forward is to follow Vermont's lead in 2017 and offer single-payer through the exchange system. Perhaps when things are running more smoothly, add a Medicare Buy-in option. The contrasts between single payer and the regulated-but-still-for-profit patchwork of insurance vendors will beome even more stark.
There are legitimate criticisms of the new regime, both from the left and right. What I'd like to see from our side is less "Obama fucked up" to "this is how we can make it better." That has a significant likelihood of causing the conservative nightmare of using Obamacare as a stepping stone toward socialism become reality.
This is becoming less pie-in-sky as the political environment post-shutdown changes.
October 23, 2013 | Permalink
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There are a lot of "what if's" here. If the Supremes hadn't decided to cut off the Medicaid requirement, states wouldn't have dithered about whether or not to take the Medicaid money (that delayed things for months at the Fed's end; they really never imagined so many states would turn down the money in order to leave so many people (thank you, Rick Perry!) without insurance at all).
Congress also refused to fund the set up of the program, so HHS had to scrounge dimes from everywhere to staff the start up.
There were also all manner of delays in starting to write the program, including wondering if the Supremes would throw the whole thing out.
Then there is the scrambled mess of trying to get the computer programs across so many agencies to talk to each other (they still haven't straightened out the computer mess at the VA, and that's just one agency that's been supposedly tackling that mess for years!).
In short, the GOP has been determined to sabotage the ACA since it passed. I'm not too worried about how slow it is to work now, given that so many didn't want it to work at all. Besides, it will eventually work and people will eventually get insurance. What, they're gonna all walk off in a snit because they had to wait a while? Some of these people wait for free clinics to come to town so they can go and wait there just for a doctor to say: "Sorry, you have cancer, and there's nothing we can do here."
Besides, Medicare is about the most "socialized medicine" program on the planet. Which is the deepest irony of all.
Posted by: Rmj | Oct 23, 2013 4:23:54 PM
Obviously I'm just growing rather tired of the general "what a boondoggle this is!" attitude of many. Many others, that is.
Posted by: Rmj | Oct 23, 2013 4:25:08 PM
Indeed, I wonder what it would've looked like had people not actively tried to undermine implementation after the law was duly-enacted. It's astonishing how much it's already helping and working despite their best efforts over the past few years.
Posted by: NTodd Pritsky | Oct 23, 2013 5:04:17 PM