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BREAKING! The American Political System Does Not Inherently Gravitate Towards Optimal Policy


And we have yet another article wondering why Prime Minister Obama didn’t just eliminate the American health insurance industry:

So what would be the costs if we had a president willing to nationalize health care now that Obamacare is the law of the land? Since 2009, when single-payer was taken off the table, the stock market has been lifted by the Federal Reserve’s desperate attempts to compensate for fiscal austerity and public and private disinvestment. The Treasury check would have to be bigger today, perhaps on the order of $500 billion – much less if the payoff to shareholders went from colossal to merely enormous, for instance. The public’s return on investment would still be over 30 percent.

The answer, of course, is that Obama didn’t take single payer “off the table.” It was never on the table. The idea that there were 60 — hell, that there were 30 — votes for single payer in the Senate is sheer fantasy. Diaz-Alvarez doesn’t even try to explain how “a president willing to nationalize health care” could have actually gotten the relevant legislation enacted. (Again, given that the answers tend to be self-refuting things like “threaten to primary legislators who aren’t running for anything” or “offer to campaign for candidates in states where you’re enormously unpopular” this is probably for the best.) Rather, this is a teleological argument. Single payer is more efficient, therefore policy outcomes should naturally gravitate in that direction and if they don’t the only explanation must be that the president — the sole meaningful inhabitant of the American political universe — must be obstructing it. I’ve already said enough about this line of argument, but wow.

One final point:

So what would make a self-described market-lover like Obama take such an obvious solution off the table before the discussions even began? As it turns out, Obama is a fan of a very specific kind of market – the kind of complicated, opaque market full of rules, moving parts, variables, exceptions, and complexities that generate lots of opportunities for rent extraction.

Right, it’s Barack Obama who created a high-veto point system that provides lots of opportunities for rentiers to extract payoffs. If he had just made an empty threat to nationalize health care all of the vested interests benefiting from the current system would have just melted away.

The idea that the ACA reflects Barack Obama’s love of complex markets, however, is one reason why exposing the “ACA was just the Republican Heritage Foundation” myth is important. If Obama actually believed that opaque markets were the best way of arranging things, he could have easily followed the Heritage Foundation blueprint and proposed rolling everything — including Medicare and Medicaid — into the exchanges. (He could have also just settled for token quasi-reforms, therefore leaving the same opaque markets in place only with a lot more uninsured.) Between the historic expansion of Medicaid, the preservation of Medicare against an organized Republican campaign to destroy it, and the more stringent regulation of the markets that had to be preserved, the ACA got us as far from inefficient health care markets as was viable within the political context that existed in 2010. This is the kind of thing that’s easy to miss when your strategy for political change is hoping that a benevolent daddy in the White House might give you everything you want someday even if the current one won’t.

As a corrective, I strongly recommend Alex Pareene’s piece on Elizabeth Warren. The White House isn’t where transformations begin; it’s where if they’re successful, they end.

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  • Reactionary that I am, a magazine called Jacobin pretty much tells me up front that I don’t want to read what’s inside it.

    Doubtless I’ll miss something good that way, but the internet is large, and life is short.

    • JL

      I was suspicious at first because of the name, but they actually have a lot of quite good stuff (and I remember them being linked favorably from this blog in the past, for instance their takedown of Adbusters not long ago). They also have some stuff that misses the boat, like this piece.

      • Marxist-influenced interpretations of some things are valuable, such as class. It’s got some value for kind of macro-analysis of history. But for talking about procedural matters in the US political system and the regulation of healthcare…uh, not so much.

        I give them a little credit for being among the few non-political scientists who actually spend any time thinking about structural matters, the failure to do so coherently being maybe the biggest weakness of US progressives and liberals. But they do put out a fairly high percentage of fantastical wishes in the guise of analysis.

        • This being, of course, a laughable example of the supposed structural analysts swapping structural analysis out for petulant complaint.

        • NonyNony

          But they do put out a fairly high percentage of fantastical wishes in the guise of analysis.

          To be fair, this is pretty much the Washington Post’s editorial model when it comes to economic issues (and foreign policy issues!) and it doesn’t seem to have hurt them or their pet causes at all.

          • You must have missed every article written about the health of the Washington Post over the last 8-10 years.

            Besides, what a low bar…

        • John Emerson

          Jacobins are not Marxists.

          • Take that up with Jacobin:

            So in 2009, during a medical leave from his sophomore year at George Washington University, Mr. Sunkara turned to Plan B: creating a magazine dedicated to bringing jargon-free neo-Marxist thinking to the masses.

      • Scott Lemieux

        It’s a very good magazine. I just really don’t understand all this green lantern crap.

        • JC


        • Pat

          At some point, Scott, you can just start cutting and pasting paragraphs from your series in response to these slow-learners.

        • Connor Kilpatrick

          Perhaps it’s a thought-experiment to be circulated among progressive types so that, long term, folks 1. understand what it would entail to nationalize the health insurance industry, financially speaking 2. know what the actual costs are, and 3. who the real power players are (not the ostensible “owners” of the health insurance companies, i.e. shareholders)?

          And perhaps the author does not believe there’s anything to be gained by *not* speaking ill of the Prez and, in fact, quite a bit that can be gained by emphasizing the difference between the Democratic Party and left aspirations?

          Or it could be those “daddy issues,” as you mentioned.

          • Scott Lemieux

            1. understand what it would entail to nationalize the health insurance industry, financially speaking 2. know what the actual costs are, and 3. who the real power players are (not the ostensible “owners” of the health insurance companies, i.e. shareholders)?

            All of which could have been easily done without adding some abject nonsense about how we could have had single payer if Barack Obama really wanted it.

          • Enrique Diaz-Alvarez

            Like Connor says. The point of the piece was to 1) point out that single payer would have been cheaper, easier to execute, *and* more capitalist-friendly than Obamacare and 2) the rent extractors that Obama chose not to take down are a very different class from the old-style capitalists.

            Maybe y’all knew this already, in which case maybe you should have written the article and collected the very lucrative fees.

            Re: political impossibility of health care. Adding up Senate votes is not may are of expertise, but maybe there is something to it. Why, if Obama had tried to take out the insco rentiers, the Republicans would have gone nuts. Maybe to the point of threatening default to stop it!

            Re: “benevolent daddy”, I am more of a “sultry MILF” type of guy.

            • MattT

              Adding up Senate votes is not may are of expertise, but maybe there is something to it.

              Maybe as a practice exercise, you could add up all the Democratic votes in the Senate that were there for single payer. Or just continue pretending Democratic senators will vote however Obama tells them and all that matters is what Obama wants. Either way.

              • And you could just add up all the votes of Democrats when everyone was there, regardless of their position on single payer. At no time did it go above 58 unless you counted a guy who was a Republican at the beginning of 2009, and a guy who’d defeated a Democrat in a general election and endorsed the Republican nominee who’d run against Obama the previous year.

                • Scott Lemieux

                  Yeah, but Comrade Evan Bayh was worth at least five votes for nationalized health care, so I still blame Obama’s lack of will.

                • Same with Ben Nelson and Kent Conrad and Max Baucus.

                • Nathanael

                  But 58 is enough to pass legislation, Dana.

                  It drives me crazy when I see “failurists” treating the filibuster as if it were natural law.

            • B. Terwilliger

              so your position is that cheaper = easier?

            • SebastianDangerfield

              The problem (or perhaps one of the problems) is that that is not how you framed the piece. It did not simply make the two points that you’ve set out above, it repeatedly suggested that, as the title states, this notional back-room deal The “Could’ve Given Us Single-Payer.” In other words, you posited that your notional deal could have cleared Congress. Even speaking as someone who thinks that Scott’s anti-Green-Lanternism veers toward the extreme from time to time, that posit is simply transparently wrong. The idea that putting health insurers permanently out of business based on a one-time payoff to the shareholders of that portion of health care insurers that operate as for-profit entities is simply cracked. Leaving aside a CBO score that would have given ConservaDems the vapors, the whole idea that the *only* class of rent-extractors in play is the class of shareholders of for-profit health insurance companies is wrong. That’s odd since for-profit health insurers only manage to bank something like 3.5 percent in profits for their shareholders. Where does the rest go? Much of it goes to board members, executives and highly compensated employees of health insurance companies, all of whom have serious vested interests in the health insurance industry remaining in place as a source of income. You gonna buy them out as well? (Notably this phenomenon holds even more true for non-profit health insurers.)

              • SebastianDangerfield

                1. my kingdom for an edit function; writing too fast, hitting “send” too eagerly. Please excuse the syntactical monstrosities above. Hopefully they can be read through and the gist discerned.
                2. On the subject at hand, what Scott said above about doctors, too. While we’re at it, let’s not forget medical device manufacturers, who also make bank on the private insurance system. Let us know what the back of the envelope looks like once you’ve figured these players into the bribe menu.

              • Warren Terra

                Not to mention something like a million people working in the industry. Many of them likely hate their jobs, and heaven knows there are better uses for their time – but we’re nowhere near full employment, and displacing that many workers is a massive cost to society. We could choose to spend the money to cushion that blow, but (1) we haven’t demonstrated a desire to do so for other job seekers; and (2) it would, as you say, give the conservadems even more of the vapors.

            • Ian

              the rent extractors that Obama chose not to take down

              Seriously? You’ve read Scott’s post and you still think this is a matter of the president’s choice?

              Why, if Obama had tried to take out the insco rentiers, the Republicans would have gone nuts.

              Here’s a big hint: the issue isn’t the Republicans in Congress.

            • Scott Lemieux

              2) the rent extractors that Obama chose not to take down are a very different class from the old-style capitalists.

              Let’s leave aside the idea that Prime Minister Obama could have easily obtained any policy outcome he desired. You don’t honestly think that insurance companies are the only, or even the most important, vested interest with a powerful stake in opposing European-style health care reform, do you?

              • The Ny quote about stuffing the GPs’ mouths with goal to silence their highly effective opposition to the NHS comes to mind.

              • Nathanael

                Most important is quite likely the pharma companies, followed by the hospital conglomerates, followed by the insurance companies, then the medical device makers, and finally the doctors.

                The pharma companies are getting to be widely hated by everyone, so their power is dropping. The hospital conglomerates are still somewhat off the radar, though the pharma companies are doing their best to point in that direction.

            • djw

              Adding up Senate votes is not may are of expertise, but maybe there is something to it.

              If you admit you have no idea if the votes are possibly there (and couldn’t be bothered to investigate further), why did you repeatedly suggest that they were, if Obama wanted them to be?

              • B. Terwilliger

                clearly everyone would have agreed with whatever the best policy was.

        • Incontinentia Buttocks


          I’m shocked (no, unfortunately, that’s not quite right…appalled, perhaps?) that so many people I know are linking this piece on fb.

          I guess some people on the left would really rather blame a single person for what’s wrong with our political system rather than structural factors, which seem (and, actually, are) a lot more intractable.

          • B. Terwilliger

            No one on Facebook has read the article. It just has that buzzfeed-like click-bait headline that leads people to think “Ill share this” without actually considering it.

          • Nathanael

            Yeah, well, that’s common.

            The thing is that when you have structural problems, which are tractable, the problem becomes people again. The people in the Democratic Caucus in the Senate who want to preserve the filibuster are an example — they were, by themselves, perpetuating the structural problems and causing trouble for years on end.

            Structural problems *are* caused by people, and by currently living people. It’s a mistake to assume it’s ONE person. But it’s always people.

  • junker

    Right, it’s Barack Obama who created a high-veto point system that provides lots of opportunities for rentiers to extract payoffs.

    If only Obama had used his Presidential time machine to go back to the founding of the USA and tell them that this whole senate business was a big mistake. His decision not to reflects his love for corporate interests!

    • Yup. And him being black, he surely could have persuasively addressed the roots of the southern veto.

    • joe from Lowell

      I’m not saying that building a time machine would have definitely worked, but we’ll never know, because He Didn’t. Even. Try.

      • Malaclypse

        He took the time machine off the table during the 2008 campaign, instead of using it as part of his bully pulpit. If he knew how to negotiate, he’d have told the Republicans he was building two, so that in the end they would have compromised and built one.

        I swear, its like Obambi doesn’t know anything about politics.

        • It was Pelosi who took it off the table when in 2007 she refused to revote the 2002 Iraq war resolution.

          They’re all in on it!

      • Snarki, child of Loki

        The time machine is only good for planting birth announcements in Honolulu newspapers.

        • joe from Lowell

          The planted birth announcement is one of the great details of the Birther conspiracy, but for my money, the best is the theory that Obama is hiding his real birth certificate because he changed his middle name.

          You see, he was born Barack Mohammed Obama, but his handlers decided that the middle name was to foreign and Muslim-sounding, so they changed it to Barack Hussein Obama.

          Cuz All American.

          • mds

            ‘He had made one careless blunder though, because he had skimped a bit on his preparatory research. The information he had gathered had led him to choose the name “Ford Prefect” as being nicely inconspicuous.’

            • etv13

              I’ve never gotten this joke (maybe because I’m American?). I mean, I get that “Ford Prefect” isn’t an inconspicuous name, but what information did he get that led him to believe it was?

              • Hogan

                Somehow he missed this.

              • Nathanael

                Very subtle joke there about the excessive number of automobiles on Earth. Ahead of its time.

  • I often wonder if these yahoos mistake “public option” for “single payer” when they think —

    Oh, wait!

    • Steve LaBonne

      Why yes, they do. I encountered one the other day on another blog who thought every country with universal coverage had a single-payer system. And then tried to rescue himself by claiming the distinction made no difference.

  • Snarki, child of Loki

    Shocked! I am shocked! Ah, bugger it.

    Perhaps we’ll get some useful information from our long ongoing neuroscience experiment: “How few functioning brain cells must one have to still barely function and be elected to Congress?”

    Sounds like one of those studies that Proxmire used to give a Golden Fleece to.

    • postmodulator

      It’s weird being a hard science fiction fan and a liberal. Proxmire was in some ways a great progressive Senator, but if you thought you were going to get to vacation on the Moon when you were a kid, he’s also the Great Satan.

      At one point in the 80s someone in Omni wrote up a proposal to fuel the Space Shuttle with butter, to get buy-in from Proxmire, who represented a dairy state.

  • Robert Farley

    If Obama actually believed that opaque markets were the best way of arranging things, he could have easily followed the Heritage Foundation blueprint and proposed rolling everything — including Medicare and Medicaid — into the exchanges. (He could have also just settled for token quasi-reforms, therefore leaving the same opaque markets in place only with a lot more uninsured.)

    What you don’t understand, Scott, is that we have a high-veto point system that provides lots of opportunities for rentiers to extract payoffs. Otherwise, free market Obummer would have totally privatized the entire health care system, along with social security.

  • Steve LaBonne

    The fact that so much of what passes for the left continues to be mesmerized by the supposed magical powers of the presidency, rather than being willing to do the hard work of organizing from the ground up as conservatives did in taking over the Republican Party (well, first they tried the top-down approach with Goldwater- how’d that work out?), is one of the many reasons why we can’t have nice things.

    • Another factor: demise of labor, which was the only significant force (mostly and sometimes effectively) working for the public good rather than narrow interests. Liberal activists tend to focus their activism more on the presidency and on federal way more than state politics, conservatives–activists as well as ideological donors and movement financiers–tend to be more balanced between state/fed and executive/legislative, and their donors are far, far more strategic in capturing state governments.

      • Another another factor: media consolidation and homogenization.

        Not all that long ago, twenty years or so, the presidential race was a big thing, but it was a big thing only late in the year before an election and during an election year. Media outlets (newspapers, local TV and radio, etc.) had the budgets to cover other news and a diverse enough cast of owners that priorities were all over the place as to who and what got coverage.

        Now you’ve got just a few companies owning the vast majority of political/news media, and the only thing they care about it that week’s ratings/pageviews/whatever. Presidential horserace bullshit is one of the few things that can reliably attract an audience for “politics”, even out of cycle, and so that’s what they “cover”. One of the by-products of that is this insane focus on the White House as the sole locus of power in the country. It’s all people talk about, so it must be all that’s important.

        • I think that’s not quite accurate, because while media ownership was more diverse, most content was still provided by AP and UPI.

          And media consolidation isn’t as big a thing in nationalizing elections now as is the niche-making of US political media. Nobody would have ever cared about some narcissistic backbench Congressman from Long Island who never passed any significant legislation and who was hated by just about all his colleagues if there hadn’t been MSNBC–whose studios were a short drive from his district–to put him on national cable to be seen by liberal political junkies across America. And, when applied to conservative media, it’s also why Michele Bachmann and Herman Cain could both lead presidential primary polls.

          • And of course, maybe the classic case of niche media having a huge national influence was political blogs–none of which were owned by media conglomerates–having such a big role in the rise of Howard Dean and Wesley Clark.

          • “most content was still provided by AP and UPI.”

            Fair point, but that’s just newspapers, and the amount of locally covered content that they produce, of state reps or federal reps, has plummeted. I’m not trying to paint some halcyon past where everyone knew who their congressman was because nobody knew who Chris Matthews was, just pointing out that any semblance of public interest has been stripped from media coverage in favor of quarterly earnings. And a lot of that has to do with the fact that local bigwigs, and whatever else you could say about them they did live out here in the provinces, got bought out in favor of national bigwigs who wouldn’t know the leadership of the state house if you put them in a lineup.

            “And media consolidation isn’t as big a thing in nationalizing elections now as is the niche-making of US political media.”

            Agreed, but that has to do with the aforementioned homogenization. CNN-FOX-MSNBC are basically three flavors of the same gossip stream, with the actual networks taking their cues from them. Cable “news” has done horrible things to politics because while a local TV channel can always find something local to talk about if there isn’t much going on nationally, a national news channel will chase Anthony Weiner all the way down the rabbit hole no matter how absurd because, hey, that Charles Schwab commercial isn’t going to watch itself.

            • These are reasonable points. I’ve still got a somewhat different view, but it’s hard for me to discuss this subject without writing 3,000 words.

            • Lee Rudolph

              who wouldn’t know the leadership of the state house if you put them in a lineup.

              Not that that isn’t an attractive prospect in and of itself.

        • Warren Terra

          You’re off by at least thirty years. For the most part, aside from certain blowhards fulfilling the need for a dozen fresh hours of content on cable news daily, the media only pay attention to elections in the few months before the balloting, same as it ever was. What changed about fifty years ago (not twenty as you say) was the institution of Public Primaries – such that the biggest meme of 1984 was Mondale’s appropriation of ‘Where’s The Beef” in the primaries, and 1980 was all about Ted Kennedy versus Carter, plus the Republican contest. This means that except for a lull from late June to early August the whole of the election year is full of news about the imminent balloting, as opposed to only the fall as was the case about sixty years ago.

    • The fact that so much of what passes for the left continues to be mesmerized by the supposed magical powers of the presidency

      It does seem to indicate what they think an executive would be like in their ideal gov’t, doesn’t it?

      • ericblair

        Seems to me like a lot of the hard lefties are just as authoritarian as the teabaggers, which is another source of the green-lanternism. A lot of capital-R Rebels don’t have a beef with the power structure itself, just their place in it.

        • Paula

          This might be true.

          Or maybe I’m just reading the stupid versions of the “hard left”.

          Or their obsession with Obama really is a race thing. The POTUS, by definition, sort of has to be a “corporate stooge” in many ways in order for the office to have any effect. Maybe they thought a Black President really would act differently. Or maybe they think, like bob mcmanus, that they’re performing some kind of brave corrective against those who think that a Black President=leftist. Because they are the only one’s who KNOW, man.

        • Nathanael

          The more technocratic leftists are mostly just mad that the power structure is incompetent at providing the bread and circuses.

      • Incontinentia Buttocks

        I think it’s also about not admitting that the Democratic Party is itself part of the problem here. Barack Obama is absolutely representative of the mainstream of his party. But so many folks to Obama’s (and the Party’s) left don’t want to admit this.

        • jmack


        • Nathanael

          Obama is not representative of the mainstream of the Democratic Party as measured by polling the grassroots; he’s much more pro-corporate. Read the polls, you’ll see it.

          Is he representative of the Democrats who get elected to Congress, particularly the Senate? Well, yeah. So the problem is well beyond Obama and is a problem with who gets nominated.

  • Hey look, it’s Scott beating a dead horse!!

    • Same horse people keep putting saddles on and insisting the rest of us could have ridden to victory.

      • Those aren’t maggots, they’re sparkles!!

      • Chilly

        Very well put.

    • joe from Lowell

      A quick look at the financial details reveals that health insurance nationalization was always the real “path of least resistance.”

      What’s truly revolutionary about this article is the thesis that the smartest political strategy for the Democrats to adopt would be the pursuit of the author’s own preferred policy option.

      You just don’t see that kind of insight in the lamestream media.

      • Malaclypse

        Look, if 2008 taught us anything, it is that TBTF financial institutions are easy to roll. The Fifth Amendment is not a suicide pact.

    • Scott Lemieux

      Apparently, Sirota was on Hayes last night asserting that the ACA was the Heritage Plan, so the horse seems pretty live to me.

      • NonyNony

        Zombie horse?

        • Equonecromancy is a profitable field, it seems.

    • agorabum

      Seems to be Scott calling on people to stop beating on the dead horse.
      That single payer horse died in the Senate in 2009 (and was staked in 2010). Instead, he’s marveling that ostensible ‘political minds’ on the left are trying to rewrite history to pretend the Senate didn’t kill that horse, and it was actually Obama.
      As always, the key is 60-217-5: the votes needed to get the ACA passed. And the vote was 60-219-5. No margins there to get anything further to the left… (FFS)

      • Manny Kant

        The Single Payer horse was dead at least by the time the three major Democratic candidates released their health care plans in late 2007.

        • Davis X. Machina

          This meant switching to Public Option, a dead horse of a different color.

      • Nathanael

        The 60 was the biggest problem, guys.

        There are actually right-wing Republican supporters of single-payer (bizarre though it sounds) — they’re from the theocrat & anarchist wings, not the corporocrat wing. Something more liberal could have passed in the House.

        The Senate was obviously the problem. I don’t think, given how opaque the Senate is, that we can honestly say what could have gotten 50 votes, since nobody ever tried to round up 50 votes for single payer, the public option, or anything similar.

        Worth noting is that ACA didn’t get 60 votes in the end and was passed by reconciliation with 50 votes — but only *after* an endless series of concessions to try to get 60 votes.

        This is just bad tactics. Should Obama be blamed? Perhaps not; perhaps it’s really the short-sightedness of Harry Reid, or of some other member of the Democratic Senate Caucus. It seems to have taken them many, many years to recognize that the filibuster *always hurts them* and never hurts the Republicans. I wish we could have sped up their realization of that.

  • Gwen

    I think once again the apologists at LGM are overlooking the ability of Obama to sic the NSA and/or armed drones on our Congress.

    All presidential whims are achievable… with sufficient will-power!!!1!11!!!!11!eleven!

    • Gwen

      (Note this is intended as satire… but the thing is, Obama is going to be criticized for not implementing socialist utopia, but simultaneously criticized for thuggish “Chicago style” politics in service of said socialist utopia. The reason for this is because American politics is inherently infantile).

      • sparks

        This is why I don’t like Chicago-style pizza. The thuggishness beats on my internal organs and doesn’t leave a mark.

        • It’s hard living in Chicago; every day I’m exposed to rampant hate crimes against pizza.

          • NonyNony

            It’s delicious if you think of it as “meat and veggie pie” instead of as “pizza”.

            As pizza it’s not so good. As a meat pie? It’s pretty good. It could use a top crust, but otherwise pretty good.

            • That’s a good way to see the glass two-fifths full.

              But even at that, now that I’m aware I’m lactose intolerant–I get heartburn, not the more unpleasant reactions–I try to use the lactaid only for things I really like. And I don’t enjoy Chicago-style pizza enough to eat it.

              Italian beef sandwiches, on the other hand, are heavenly. THAT, imo, is Chicago’s best example of cheap but tasty regional food.

              • NonyNony

                I’m a big fan of their weird-ass hot dogs.

                • They’re pretty good. I like the buns, and the sport peppers.

    • ajay

      All presidential whims are achievable… with sufficient will-power!!!

      I think you mean “The technology required is easily within the means of even the smallest nuclear power. It requires only the will to do so.”

      • Gwen

        Mein fuhrer… thanks to socialized medicine, I can walk!

        • ajay

          “Well, I would hate to decide who is eligible for subsidies and who isn’t.”

          “That would not be necessary, Mr President. It could easily be accomplished with a website. And a website could be set and programmed to accept factors from income, youth, health, sexual fertility, intelligence, and pre-existing medical conditions. Of course, it would be absolutely vital that our top government and military men be included to foster and impart the required principles of leadership and tradition.”

    • postmodulator

      Do you ever wish Obama — or any Democratic leader — was as ruthless as the wing nuts accuse him of being?

      “My God, it’s terrifying. No one’s seen Rick Perry since he mentioned secession in that speech…”


      • NonyNony

        Do you ever wish Obama — or any Democratic leader — was as ruthless as the wing nuts accuse him of being?

        No, because it would be pretty horrifying. Their imaginations are really, really dark.

        I do sometimes wish that Obama were a bit more like the Patrician of Ankh-Morpork. But only a little – in real life and outside of a farcical series of novels the Patrician would be pretty horrifying too.

        • postmodulator

          Their imaginations are really dark? I subjected Professor Boxwine to a medieval torture practice.

  • B. Terwilliger

    not sure how being strategist for a Foreign Exchange trading consultant is supposed to give Diaz-Alvarez some unique insight

  • I wonder if somewhere out there is an old crank who’ll bore you rigid by talking about how LBJ completely missed his chance when he failed to create Medicare 4 All.

    • joe from Lowell

      We’re all supposed to get up and cheer because Roger Marris hit 61 home runs in a season, but if he’s just fixed his swing, he could have hit 80.

    • mds

      LBJ completely missed his chance when he failed to create Medicare 4 All.

      Hey, at least he tried**. And failed in doing anything more than laying some groundwork, because there was no way to get it … through … Congress … Hey, look over there! Is that a power ring?

      **Or at least supposedly considered, before capitulating to the Money Power.

  • I was going to write a post like this, but you beat me two it. Two other things to add:

    -Search for the words “Senate,” “Congress,” “GOP,” or “Republican” in the article. Guess what? Not there! That’s some awesome political analysis for you.

    -I like Jacobin, and more importantly think that overall the increasing prominence of voices like theirs benefits the whole left. Unfortunately, this kind of college freshman argument obscures the importance of politics to politics and deflects the attention of the left away from the good kind of intra-left conflict (AKA, institutional reform, hunting for leverage, primary elections against Holy Joe-types) and towards the bad kind of internecine intra-left conflict – purity pissing-matches, self-righteous abdication from politics, sellout-finger pointing, handwaving Green Lantern-ism, and the empowerment of rejectionist voices.

    I may still write this post, but meh I think I said it all.

    • Though I will say I appreciate the innovation in this kind of argument.

      1) The maths suggest that my preferred policy option is efficient.
      2) Therefore, anyone who doesn’t support it or implement it clearly ideologically whatever policy they end up supporting politically.
      3) Therefore, Obama is a tool of the health insurers because he really likes health insurance companies because he is a tool.

      And not to link gratuitously to PolitiSomething, but you’d think all these things Obama has actually, you know, said about single-payer may enter the analysis:


      So to recap:

      1) Obama pretty consistently and credibly says he prefers single-payer in theory but that it’s not politically feasible.
      2) Obama supports politically feasible non-single-payer plan that still vastly expands Medicaid to meet half its coverage goals.
      3) The back of Enrique Diaz-Alvarez’s envelope says health care nationalization is obviously the bestest ever.
      4) If the envelope says its the bestest ever than everyone else must agree with him automatically and only elects to promote different policies for craven, self-serving reasons of exploiting the masses, or else is some sort of neoliberal bot.
      5) Obama is a tool.

      One has to wonder why Enrique Diaz-Alvarez thinks we didn’t have single-payer in 1950, or 1960, or 1970, or 1980, or 1990, or 2000…

      • Hogan

        One has to wonder why Enrique Diaz-Alvarez thinks we didn’t have single-payer in 1950, or 1960, or 1970, or 1980, or 1990, or 2000…

        Duh. Obama used his time machine to kill it.

    • NPR report from a couple days ago, on a “civil war” in the Democratic party.


      Guy from Third Way
      Adam Green
      Joe Trippi


      • NonyNony


        • joe from Lowell

          Someday, this will be great news for Megan McCain.

    • Incontinentia Buttocks

      Search for the words “Senate,” “Congress,” “GOP,” or “Republican” in the article. Guess what? Not there! That’s some awesome political analysis for you.

      Exactly. This piece can’t even be bothered to propose magic Green Lantern powers for the President over Congress. It just acts as if President’s make law all by themselves.

      I, too, generally value Jacobin. But this article is hogwash.

  • LeeEsq

    The faction that believes that single-payer was possible has to be really dumb or at best, willfully blind at dangerous levels. It should have been clear from the get go that we would not get single-payer because no Democratic presidential nominee advocated for it in 2008. It should have also been painfully obvious that the American political system will make single payer nearly impossible to get through.

    • JustRuss

      Sadly, this. I went to my congressman’s town hall meeting in 2008, and when asked about single payer he said it was “too disruptive”. When Pete deFazio, founding member of the Progressive Caucus tells you your heart’s desire is too progressive to stand a chance in congress, it probably is.

  • Jesse Levine

    You guys must be arm weary from beating that dead horse. Let’s warm up for the New Year with the Trans Pacific Partnership and fast tracking.

    • joe from Lowell

      That articles like this keep appearing suggests that the horse is not dead.

      However, since you’re calling it dead, does that mean you agree that the argument is nonsense?

      • Jesse Levine

        I thought it made some sense before the first bargaining chips went on the table, but at this point it is nonsense.

        • joe from Lowell

          But could a President, and a Congressional leadership, that hadn’t run on single-payer health care, and that had defeated rival candidates who had run on it, credibly strike that pose?

        • Scott Lemieux

          I thought it made some sense before the first bargaining chips went on the table


          Anyway, let’s talk about the Social Security cuts that Obama is totally going to ram through the upper-class-tax-increase loving House!

  • fastEddie

    This is the definitive post that all other “why don’t we have single payer” posts should link to. Nationalizing a major industry is something few Senators have the stomach for, even if it is the right thing to do. The time for single payer was under Truman, when it was killed because of segregation. Second chance was when Medicare was started. Really no chance now. Now it can only be done incrementally – which is exactly what the ACA does. Which bring to mind 2 sayings – 1) politics is the art of the POSSIBLE. and 2) don’t let perfect be the enemy of the good. And Elizabeth Warren rocks! I’ll be happy to support Hillary, but I would have preferred Elizabeth…

    • mds

      The time for single payer was under Truman, when it was killed because of segregation.

      Yeah, Truman even tried twice, the second time with a mandate from the electorate. And we’re talking about a guy who also tried to nationalize an industry, but got snapped back by some other branch of government which we used to have back then. Why, oh why, did Truman sell us all out to this “Constitution” nonsense?

      • Nathanael

        I actually am getting really ticked off at the Supreme Court. Truman deferred to its inane misinterpretation of the Constitution. Then, more recently, it decided to start stealing elections. We could go back to the Slaughterhouse cases and the Supreme Court’s evisceration of the 14th and 15th amendments, and its invention of corporate personhood. Or we could go back to the Taney court and its Dred Scot decision.

        Who elected the Supreme Court to run the country, pray remind me? They’ve been pernicious for most of American history… and when they’ve been right, they’ve often simply been ignored, as with the Trail of Tears, where Andrew Jackson just violated a Supreme Court order.

        Really, the Supreme Court is an excuse. The problems like in the President and Congress. Especially Congress, which has the power to impeach Supreme Court members, pack the court, remove authority from the court, and pass laws telling the court what to do. In Truman’s case, he didn’t have the backing of Congress. In Obama’s case, yes, he didn’t have the backing of Congress to do better than he did.

        So let’s focus like a laser on Congress, which is supposed to be the most powerful branch according to the Constitution.

  • junker

    Every time you link to one of those old posts I have to take a half hour to reread all of the comments. Whatever happened to Nathanael anyway? I’ve been reading this blog for a long time and I feel like the commenters have been doing a great job driving out the crazies lately.

    • Snarki, child of Loki

      It’s not the commenters driving out the crazies.

      It’s the pancakes. The RWNJ’s just can’t handle pancakes.

    • The crazies are coming from inside the commenters!

    • Nathanael

      I’ve been (a) busy, and (b) reading blogs with more relevant content. LGM got dull (to me) for a while.

      After roughly 20 hours spent on the phone, I managed to pick a plan and sign up for ACA. This is in NY.

      Advantages: It’s somewhere between half and a quarter the price I was paying before. (I was paying a savings-destroying $1200/month before to get very similar insurance. This is NY.) This is valuable, I’m not underestimating how valuable it is, it’s huge. We’ll see whether it lasts through 2015 or if premiums skyrocket again.

      Disadvantages: I lose out-of-network coverage, which has been completely removed from all plans in my part of New York State.

      The companies are concealing information, meaning that it took 20 hours to get answers to simple questions about exactly how the plans work.

      “Cost sharing reductions” in the silver plans turn out to be a TRAP if you have a variable income. If your income unexpectedly changes from one cost-sharing tier to another, you are required to report it midyear, and you’ll be shifted into a different cost-sharing tier. AT WHICH POINT YOUR DEDUCTIBLE WILL RESTART, and so will your “out-of-pocket” limit — you could pay twice the out of pocket limit in one year. (Theoretically twelve times, since the government can force you to change plans up to once a month if your income changes that many times.)

      Accordingly silver plans are no good for anyone with variable income. It took me a long time to figure this out. Lots of people are going to be pushed towards silver plans by the way the advertising works, and it’s going to realize a LOT of bad press in mid-2014.

      What bugs me is that most of this could have been fixed with some really trivial regulations, if the people writing the law had ever considered that people on the individual market *usually have variable incomes*. The Senate and Obama both seem to be living in a Versailles world of the out-of-touch. The political repercussions are disastrous, with the ACA being the least of it.

  • Anonymous

    The Democrats had a veto-proof supermajority…as long as you count Joe Lieberman as a Democrat. That should buy you a few minutes’ peace.

  • UserGoogol

    It seems worth pointing out the rest of the argument which seems pretty questionable too. When the author says to nationalize health insurance, he doesn’t just mean to create a single payer program, but to actively buy out existing health care companies, and then to buy it out at a high markup to sweeten the deal. (Which then, he argues, would then make the plan politically feasible because then you have those people on your side, while still making money in the long run.)

    But that’s a really weird misunderstanding of how single payer works. When you’re nationalizing mines or railways like in the example he gives, the government needs to actively get its hands on the land, and that requires either a buyout or appropriation. But when you’re creating an insurance company, you mostly just need offices and money, which the government is quite capable of acquiring on its own. Existing insurers then go out of business simply because there’s little point selling a product the government is already providing (except for things like supplemental plans) so there’s no need to provide “just compensation.” It’s just a massive bailout of shareholders for no good reason.

    On the other hand, this argument does have the advantage that it does somewhat address your issue. Rather than simply will-powering through deadlock he’s basically arguing that you can buy out existing shareholders to get your way. (Although with some confusion as to the need to bail out shareholders blurring this idea.) But the idea that you can just throw money at special interests to get your way is still rather simplistic. People have sincere political preferences and aren’t going to give up just because you throw money at some of the relevant factions. (Or if you want to stick to a more Marxian approach, single payer isn’t just about health care, but about the overall structure of class relations.)

    • gmack

      Right. I only gave the piece a cursory glance, but my impression is that his argument (or rather, his evidence) might work as an interesting thought experiment trying to illustrate just how much more rational a single payer system would be than the system that got constructed. If it’s true that it would be more economically efficient simply to purchase the insurance industry, dismantle it, and then construct a nationally run version (and I have no idea whether it is), then this is an interesting illustration of how irrational policies end up getting institutionalized. However, as an argument showing that a health insurance buy-out could have actually happened… well, it’s hard to overstate how stupid it is. In addition to the issues you m mention (the fact that people have sincere political preferences), there is still no mention of basic structural factors (the resistance of members of Congress, often based on a combination of ideology and interest grow pressure). And there is also no mention of just how much resistance there would have been on the left to a massive give-away to health insurance companies.

      • Scott Lemieux

        Another crucial problem is that it assumes that insurance companies are the only crucial vested interests. But doctors — who stand to lose big under single payer or nationalized health care — are an even bigger roadblock, and buying them off would squander most of the efficiency gains.

        • snarkout

          “I stuffed their mouths with gold.” — Aneurin Bevan

        • gmack

          Good point.

        • JC

          The American Medical Association, in June 2009: “The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”

          • JustRuss

            I wonder if the AMA could point to one insurance plan that doesn’t “restrict patient choice”.

            • Scott Lemieux

              Those restrictions are restrictions by merit, not rationing.

      • snarkout

        We’re imagining here that the Senate, which was too hidebound to shovel free stimulus money to people, would have spent hundreds of billions of dollars on an enormously controversial buyout of a significant piece of the American economy that everyone would have hated. As I said on Facebook, he’s right that that would be a better system, but as political analysis he’d be better off arguing President Batman vs. President Wolverine.

        • ajay

          Since he is effectively immortal and immune to all injury and disease, I would question whether President Wolverine would be adequately committed to the project of health care reform.

          • Lee Rudolph

            He’s not even committed to the project of jumping off the building!

          • B. Terwilliger

            hmm not sure “immune” is the same as “recovers incredibly quickly from”

        • Nathanael

          The core political problem since roughly 2001 has been fixing the Senate. It would perhaps rankle less if Obama had made some effort to do so.

          In the end, we have had to wait until Reid got completely fed up, and perhaps we would always have had to wait that long, but could it have hurt to put the idea in the Senators’ heads that they had a non-functional gridlock-based legislative body, and that that was bad?

  • rnelson

    Look, I get the Green Lantern critique, and largely agree with it. But really, even if the “horse” isn’t quite dead yet, why don’t you start beating on one that might have some real impact in the immediate future? Lets see, shall we devote multiple posts in less than a week to critiquing the lack of nuance in certain lefty pieces about Obamacare which will have little impact on the world going forward, or think critically about the Trans-Pacific Partnership, the largest trade deal ever, and put it more immediately on peoples’ agenda? Easy answer!

  • PhedUp

    I’m not sure if this point has been raised elsewhere (including this thread), but can anyone seriously argue that if a true single payer plan had landed on his desk, Obama would have vetoed it?

    • N. Eugene

      I don’t think it’s been attempted, because I don’t think anyone would take that argument remotely seriously. It’s just so much more fun and attention-getting to imagine that a chosen political path reflects an ideal policy preference, and then whine about how disappointed you are.

      I think you’re right on though. The only response you need to this “Obama could have passed single payer if he’d wanted to!” argument, no matter what form it takes, is “Do you think Obama would have vetoed Medicare-for-all if it had made it to his desk?”

      • PhedUp

        Exactly! Because if you say no, then the problem is the fact that the plan couldn’t/wouldn’t get to his desk.

      • Nathanael

        Given Obama’s record, I actually think he would have vetoed it. :shrug:

        • Nathanael

          (Look at his financial regulation “record”.)

  • Paula

    Hey, LGM, you are apparently supposed to talk about the TPP, absent any specific policy that has actually been presented for passage by the US Congress or any of the other corresponding governing bodies of the countries involved.

  • scott

    I don’t disagree with any of this, necessarily, but if we all know that single-payer is the solution to the problem, which we do, someone in a position of authority on the Dem side needs to start making the case for it. The question of what Obama or any Dem leader could or could have gotten at a snapshot moment in time in 2010 is interesting but narrow. It’s more interesting to me why the idea of single-payer doesn’t even get discussed by Dem leaders as a way of building support for it. The radio silence on that isn’t very reassuring.

    • Sharon

      Expanding Social Security was an “unpossible” policy until it wasn’t. There may only have a handful of Senators willing to sponsor the Harkin-Begich bill, but it’s a start. And it’s a popular policy that other Democrats can run on in the mid-terms.

    • My take is that if you know you will never (in the foreseeable future) come close to sufficient support for something to pass, you tend to be careful about exposing yourself to the negatives associated with that position (or exposing your move vulnerable members).

  • Anonymous

    Enactment of even a ride-along public option was almost certainly impossible.

    What about advocacy? Failing that, what about simply allowing a respectful space for testimony from such advocates in the hearings on reform?

    While you may need a super-majority, a friendly press, a stacked judiciary, masses of organized supporters chanting in the streets, a timid opposition, vacillating at-risk interests with poor messaging, and NICE WEATHER for enactment…

    Since when is all that needed for the most powerful person in the world to call the best reform option what it is, Medicare for all?

    You don’t need to imagine insuperable hidden obstacles, or a cryptic total sell-out; all you need to imagine is that this was about getting something passed while soothing a few select groups of people and interests.

    I just wish there was much less of the latter, and SOME threatening at least would have been nice. As with the tax cuts, here we had enough practical leverage and public support to get not capitulation but visible squirming and perhaps further concessions.

  • Data Tutashkhia

    Enrique Diaz-Alvarez makes a good point: insurance companies executives are the most powerful anti-single-payer constituency, but they, at least nominally, are accountable to the shareholders. And the shareholders might be able to wipe them out, given enough incentive. And the AMA doesn’t really sound like such a diehard opposition.

    Keep writing Enrique, don’t listen to the idiots here.

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  • Nathanael

    “when your strategy for political change is hoping that a benevolent daddy in the White House might give you everything you want someday even if the current one won’t. ”

    Don’t mock it. It worked in 1932. We’ve literally never seen anything else which worked to get us out of a Great Depression. You got a better strategy?

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