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How to Falsely Claim That the ACA is a Republican Proposal

[ 126 ] January 2, 2014 |

I’ll have a longer piece about Michael Moore’s op-ed on the ACA forthcoming. But I did want to identify a crucial trick used by people advancing the erroneous argument that the ACA was really a Republican proposal. The bait:

What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank

And the switch:

and birthed in Massachusetts by Mitt Romney, then the governor.

The Heritage Plan legitimately reflects Republican priorities on health care, and consequentially is a horrible policy proposal, but it’s radically different from the ACA. The plan passed by massive supermajorities of Massachusetts Democrats over 8 Mitt Romney vetoes is reasonably similar to the ACA, but this is neither here nor there as an argument that the ACA is a bad law. (Indeed, the fact that something similar to the ACA was passed in a much more favorable political context makes the argument that we could have had European-style health care but Barack Obama didn’t. even. try! even sillier than it already is.)

The fact that the argument that the ACA is really the Heritage Plan requires conflating it with a plan that’s vastly different tells you all you need to know. And people who attack Obama for his excessive faith in bipartisanship should really stop pretending that the Republican Party has any offer to the uninsured other than “nothing.”

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  1. Aimai says:

    I really appreciate your many posts on this, Scott. I have found them invaluable in talking to people about the ACA. Its really an important issue and it is just very useful to have had you banging the drum on this.

    • Vance Maverick says:

      Yes. In this case, though, I think we should acknowledge that Moore’s conclusion (support the ACA by making it better) is valid.

      • Scott Lemieux says:

        To be clear, as I’ll say in the longer piece I do agree with a lot of the op-ed.

      • Aimai says:

        I do support the ACA and want to see it made better–but I fail to see why, say, a fireman whose job it is to save a house thats burning down has to stop and throw some shade on it first. The house’s job is to shelter the family, ugly or not. The fireman’s job is to save the house, ugly or not. Stopping to complain that the original workmanship isn’t up to par is really besides the point. Moore’s bitching is completely useless and distracts from a message that is honest and useful:

        The ACA has some problems because you’d expect that given the enormous headwinds we face. Most of the problems result from Republican intransigence and attempts to defund and destroy it, and absent that insistence on refusing to cover people who are covered under the ACA. The quickest way to fix the ACA is to boot out or attack the REpublican legislatures that refused to expand Medicaid and all Republican legislators and governors who refused to set up functional exchanges or to distribute information about the program. Once everyone who is entitled to ACA protection is enrolled or covered we can start talking about tweaking it to make sure that the people who are caught in the loopholes are also covered in an affordable way and starting up with single payer etc… in individual states.

        But given that the Red States simply refused to participate in the ACA as currently constructed the idea that some small state like Vermont is going to lead the way by doing anything–whether that is single payer or offering rainbows and ponies to all its citizens–is absurd. We are living in two Americas: one that is governed by people who want their own citizens to live in misery and die young, the other that is attempting to ameliorate human misery and get everyone health insurance. You can’t showboat your way to universal coverage in a riven country even if Vermont or some other state “gets it right.” The Red states don’t want to cover poor people. Thats the problem.

        • And “The Cold Civil War” is still being waged.

        • Vance Maverick says:

          I’m with you, but I’m not sure how quick attacking those legislatures will be. Here’s hoping that some members of the non-Republican party start campaigning on this issue (see Ryan Cooper for some ammunition).

          • Aimai says:

            Attacking those legislatures takes, what? Political will? Deep pockets? An ability to recognize that the target for his vituperation is not people slightly to the right of himself but all the way to the far right?

            People like Moore and “the left” –to the extent they exist–should be attempting to win back the white working class by appealing directly to its sense of resentment at being passed by while other people get some goodies. They already think Obamacare is a giveaway to poor black people. That means they are very, very, susceptible to advertising that has local white people complaining about being “turned down” by local Republican governors and legislatures. Because they already feel pissed off and disrespected. The most bang for our buck is going to be when Florida accepts the medicaid expansion and/also when voters get pissed off enough to vote for bennies which they think are being denied them. More people will be affected by a medicaid expansion in a single state than even tinkering around the edges and improving the ACA for particular, small numbers, of aggrieved white people.

        • Shining Realtiy says:

          Most of the problems result from Republican intransigence and attempts to defund and destroy it, and absent that insistence on refusing to cover people who are covered under the ACA.

          That is simply not true.

          The defund attempts failed and had no effect at all. It was funded. And blaming Republicans because part of the law as unconstitutional is just ludicrous. Why not blame the court instead?

          The problems with ACA is because the bill sucked and no one took the time to read the bill to see that it sucked.

          Wanna blame somebody? Blame those who voted for a pig in a poke.

          • Aimai says:

            Oh, please “No one took the time to read the bill” has to be the most asinine piece of Rush Limbaugh-esque moron speak of all time. Look, cupcake, despite the proof texting of the Pelosi quote which still reverberates in the empty spaces of your mind no large piece of legislation is without some problems that are unanticipated by the drafters–none. That doesn’t mean that the legislation is fatally flawed or needs to be junked. It just means that every piece of legislation needs some tinkering afterwards when you see how implementation goes.

            In the case of the ACA one of the primary “failures” was that the Dems didn’t write it to be asshole proof. They didn’t expect the Supreme Court to make an entirely out of the blue decision about something which most people considered settled law and treat the medicaid expansion as optional. If the medicaid expansion were not, suddenly, optional (and I blame both the Republican governors and the Supreme Court) then literally millions of people would be receiving coverage, many of them for the first time in their lives.

            • Vance Maverick says:

              That doesn’t mean that the legislation is fatally flawed or needs to be junked.

              But you’re omitting the most trenchant, best argued part of Shining Realty’s proof — that the legislation “sucked”? I mean, how can you not grapple with that?

            • David Hunt says:

              Also (as you wrote) , all large pieces of legislation need patches to fix the unintended consequences and holes in them. Unfortunately, the turnover in the House to GOP control is allowing the Republicans to absolutely refuse to let any fixes get done. The don’t want to fix problems in the Healthcare system as set up by the ACA. They want to destroy it, and nothing less is acceptable.

              • Shining Realtiy says:

                David,

                It’s just started and now you’re complaining that it needs major fixes. If that’s not “suck” what is?

                • Malaclypse says:

                  If that’s not “suck” what is?

                  The Iraq War, for one. Katrina, for another. Forgetting to fund Medicare Part D.

                  I can go on, sunshine. Say the word.

                • Republican legislatures not participating in the implementation of legislation and then complaining when it doesn’t work well for them? That kind of sucks.

                  Republican SCOTUS justices overturning key parts of the legislation on the basis of freshly invented bedrock constitutional principles? That sucks pretty bad, I have to admit.

                  Republican legislators refusing to consider any revision to the legislation other than dismemberment and appeal? Seems sucky to me.

            • Shining Realtiy says:

              Yes…yes…it’s always someone else’s fault even though the Democratic party was in full control.

            • slightly_peeved says:

              Actually, they did write a bunch of protections against assholes into the ACA. The main one is that the federal government determines the base requirements of the plans to be offered on the exchange. states can add extra requirements, but not remove them. another was the rule that any state not implementing an effective exchange would have a federal exchange instead.

              Obama wanted the entire exchange system to be federal, but Lieberman didn’t agree to it. getting the exchanges federally managed was what Obama got in exchange for not having a public option. In hindsight, seems like a pretty good deal, though the people complaining about the lack of a public option don’t seem to consider that.

        • N__B says:

          Thanks to Charlie Pierce, I recently reread Dos Passos on Sacco and Vanzetti.

          they have built the electric chair and hired the executioner to throw the switch all right we are two nations America our nation has been beaten by strangers who have bought the laws and fenced off the meadows and cut down the woods for pulp and turned our pleasant cities into slums and sweated the wealth out of our people and when they want to they hire the executioner to throw the switch

  2. Anonymous says:

    OVERTON WINDOW!!!!1!!ELEVENTY!!

    Sorry, I figured somebody would mention it eventually.

  3. Denverite says:

    I’ll also note that he’s playing really fast and loose with his hypothetical couple from Hartford. For a little over $100/month more than the cheapest policy he cites, they can get a policy with a deductible in the $6500 range. He’s also cherrypicking maybe the worst possible insurance demographic — married without kids (so they pay the family rate for the smallest size family possible), just shy of Medicare, and in a high cost state. (In Colorado, by comparison, that same couple could get a silver policy with a $3500 deductible from Kaiser for $1041/month.)

    • Jordan says:

      I guess, but he isn’t wrong that both the hartford case and your colorado case are still way, way too expensive.

      • Denverite says:

        Compared to what? Health care is expensive; financing it is too (obviously). This is especially true of people in their early 60s, who are old enough to need a lot of health care, but also young enough to have the energy to seek it out.

        • Jordan says:

          Compared to the way things should be?

          That is pretty clearly what Moore is doing there.

          • Denverite says:

            Then Moore’s op ed is one long non sequitur. None of what he suggests would affect the price of health care by very much, which is what makes health insurance so expensive.

            (The ironic thing is that there is a lot in the ACA that is actually intended to do this — ACOs, Medicare/Medicaid provider rate cuts, fraud enforcement provisions, etc.)

            • Jordan says:

              You think having a public option wouldn’t affect the prices individuals see on the exchanges?

              • Denverite says:

                No, or at least not by very much. This fundamentally misunderstands health insurance pricing, especially under the ACA. It’s not like selling gas, where if a station across the street cuts its price by a dime, you have to cut your price or go out of business. Health insurance pricing, in contrast, is actuarially determined and closely regulated. If the premium for a particular policy is $1000/month, it’s because the actuaries have determined that the purchaser is expected to spend a big chunk of that — $800 or more by law — on medical costs. There may be a little room to cut the non-MLR payments by 5% or 10% (though even then, remember that Medicare and Medicaid administrative expenses aren’t zero), and perhaps management can lean on the actuaries to fudge their estimates a bit, but there’s really not a lot of room there.

                The real way to cut health insurance costs is to cut health care costs, and a public option wouldn’t really address this in any real sense.

                • Pat says:

                  Again, again, remember that the cheapest rates are for Medicare and Medicaid, and insurers pay more than that. So if a public option pays insurer rates, it’s not going to cost a lot less than insurers.

                  If everybody pays Medicare rates, then the hospitals go under. Hospitals are changing how they deliver care to make it more cost-effective. But that doesn’t happen overnight, or even in three years. It will take decades.

                • Denverite says:

                  You’d be surprised. I’ve seen a number of MCO contracts that undercut Medicare (and now Medicaid, since they’re theoretically the same).

                • Jordan says:

                  While I guess I agree that to reduce health insurance costs you have reduce health care costs, I don’t see why those reductions you do mention don’t count in any real sense.

                • Denverite says:

                  Because it would be a one-time cut of 5%, maybe 10% max. The problem with health care (and thus by extension, health insurance) costs is not that they’re 5% or 10% too high right now. It’s that they’ve been growing by 5% or 10% too much annually for more than a decade.

                  To use my gas analogy, it’s as if gas has been going up a dollar a year since the late 1990s, so that it’s $17/gallon now. Cutting the price to $16/gallon is completely pointless. What you need to do is find a way to stop the $1/yr annual growth.

                • Bloix says:

                  THis is just not correct. The regulators’ job is to make sure that insurance is not underpriced = that is, that insurers collect enough premium to be able to pay expected claims. In most states, the regulators’ interest in holding down profits is minimal (the term of art is regulatory capture).

                  The ACA is supposed to allow competition to work to reduce prices. The point of the insurance exchanges is to allow true comparison shopping so that competition will force down prices.

                  But many states have too few insurers to create true competition. See, e.g., http://www.cnn.com/2013/10/31/politics/obamacare-state-coverage-varies/

                  Also,

                  http://healthaffairs.org/blog/2013/03/06/no-competition-the-price-of-a-highly-concentrated-health-care-market/

                  The point of the public option was to provide an alternative for states where competition was too weak to force prices down to competitive levels. Without it, oligopolistic pricing may well remain the norm in much of the country.

                • Malaclypse says:

                  The point of the public option was to provide an alternative for states where competition was too weak to force prices down to competitive levels. Without it, oligopolistic pricing may well remain the norm in much of the country.

                  That would be true, if you completely ignore the fact that if insurance revenues are more than 25% higher than medical losses, the companies must issue refunds.

                • Denverite says:

                  THis is just not correct. The regulators’ job is to make sure that insurance is not underpriced = that is, that insurers collect enough premium to be able to pay expected claims. In most states, the regulators’ interest in holding down profits is minimal (the term of art is regulatory capture).

                  This simply is wrong. Maybe it was correct a decade or more ago, but since 2010, a number of states (Maine, Colorado, etc.) have pushed back hard against aggressive rate increases. And even in the ones that didn’t (or didn’t publicly), it’s not like insurers can all of the sudden announce that they’re figuring a profit of 30% or shooting for a MLR of 55% when coming up with rates. All of this stuff is capped and reviewed (now by the states and feds).

                  The point of the public option was to provide an alternative for states where competition was too weak to force prices down to competitive levels.

                  No, read the Health Affairs article. According to public option advocates, the point of a public option is that the current system of private payors hasn’t been effective in the slightest at containing runaway medical costs. They contrast that with Medicare, which generally has been much more effective. But there are two things to say about this (neither one of which is actually said by the Health Affairs article, but whatevs). The first is that based on the sheer size of Medicare, it has a huge monopsony that really couldn’t be rivalized on by state-by-state public options. Second, based on the Medicare population, each covered recipient tends to receive a LOT more — and a lot more intensive — medical services. It’s a lot easier to cut prices for a population that’s going to be coming in for service again and again and again.

                  Again, I’m not saying a public option would have zero effect, especially in markets where there is reduced competition. But it’s not going to have as many patients, and the patients it does have aren’t going to need as many services, and the services they do need won’t be as comprehensive. Any negotiated discount won’t be nearly as much as Medicare gets, and the competitive pressure won’t be nearly as much as proponents claim.

        • Dilan Esper says:

          Compared to what? Health care is expensive; financing it is too (obviously).

          But that’s kind of the point. Obamacare is sold as the AFFORDABLE care act. That’s sort of the acid test of whether the thing works– if people can afford their health care going forward, it worked; if they can’t, it didn’t. (The other acid test is the quality of the care that is being sold to them.)

          The reverse cherry-picking issue with Moore’s op-ed is real. But every time Democrats talk about this thing it is sold as “now millions of Americans can afford quality health care”. So saying “well, health care is inherently expensive so that’s why people can’t afford it” really doesn’t defend the bill as it has been sold.

          • Malaclypse says:

            Yes, making it affordable for tens of millions of people, while not covering people in states where Republicans killed the Medicaid expansion, makes the whole name a lie.

          • Denverite says:

            Obamacare is sold as the AFFORDABLE care act. That’s sort of the acid test of whether the thing works– if people can afford their health care going forward, it worked; if they can’t, it didn’t.

            This isn’t fair. The point of making insurance policies available on the exchanges wasn’t primarily to reduce the costs of insurance (mostly — there is a little of that going on because now prices are comparable and transparent). The point(s) was (were) to make them available to people with preexisting conditions, even out the pricing so that the old don’t get gouged, and provide a baseline level of minimum benefits.

            Other provisions were designed to address the affordability of health care. They include the Medicaid expansion and ACA subsidies in the short- and medium-terms, and health care cost containment measures in the long term.

            • Dilan Esper says:

              The issue is the adequacy of the redistribution, as I set forth below (and you agreed with). For some people, the redistribution appears to be inadequate. The question is how many people that is true for. If it’s a small number, I think supporters of Obamacare can nonetheless trumpet the bill. If it’s a larger number, such that health care is actually not affordable for a large number of people, it’s a problem.

              • Aimai says:

                “For some people the distribution appears to be inadequate” is really ridiculously vague. People are being quoted as expressing shock that health insurance is expensive–well, it is expensive. It is still more affordable than no health insurance and bankruptcy. People are massively ignorant about how the health care they used to get was priced, how it was subsidized (if they were receiving it through an employer) and how they were being ripped off (by recission and other policies.) But just because people are incredibly ignorant and suffering a kind of sticker shock doesn’t mean that the ACA isn’t, in fact, making health care affordable. Plus your objection is as trivial as saying “Medi-care” is a lie because no one cares about old people, they just give them the medical care because they feel guilty.

                • Denverite says:

                  And to elaborate a little, the attitude that I’m really criticizing is the “OMG, health insurance is so EXPENSIVE, the ACA is a FAILURE!” vibe that Moore gives off in the first part of his op ed (to his credit, he reverses himself a good bit later on).

                  The ACA isn’t really designed to lower health insurance costs (on their face) for the most part (the exceptions being if you previously were in a high cost population, like the near-elderly), at least in the short- and medium-term. In fact, because it’s now requiring a number of coverages, it’s probably going to raise health insurance costs for a lot of people.

                  But the ACA recognizes this, and it attempts to ameliorate it by increasing Medicaid eligibility and providing health insurance subsidies well into the middle (and arguably upper middle) class. Are those parts perfect? No, for a ton of reasons (some of which are the drafters’ fault, and some of which aren’t).

                • Bijan Parsia says:

                  I’m not sure this is quite right. At the very least the mandate is intended to keep the individual market pools broad enough to be reasonable.

                  The thing I’m finding odd is that I was sorta expecting us to get to a point where the individual market was priced for the consumer similarly to employer coverage and that doesn’t seem so. In particular the deductibles are very high. I get that we aren’t seeing the employer contribution (or the worker directly) but reasonably employer like coverage would be a lo more palatable.

                  Possible? I don’t know.

                • Denverite says:

                  No, the primary purpose of the mandate is to prevent a death spiral. Without it, you get a situation where the only people signing up are those who anticipate needing expensive care (the quintessential example being families who sign up when the wife gets pregnant), which explodes costs, which raises premiums, which drives healthy people out of the pool, yada yada yada.

                  As for the employer/individual market disparity, my understanding is that there’s a fundamental difference in the populations of people who are work for employer who provide coverage and those who don’t (or who are eligible vs. who aren’t). The latter simply have more health care costs, for a variety of reasons.

                • Bijan Parsia says:

                  No, the primary purpose of the mandate is to prevent a death spiral

                  Yes, ie to keep the pool broad enough to have reasonable costs. A death spiral is the implosion of the pool due to increasingly higher costs (well plus the no pre existing condition bar). But the point is that broadening the pool spreads the costs which keep them lower for each participant.

                • Bijan Parsia says:

                  As for the employer/individual market disparity, my understanding is that there’s a fundamental difference in the populations of people who are work for employer who provide coverage and those who don’t (or who are eligible vs. who aren’t). The latter simply have more health care costs, for a variety of reasons.

                  If you could point to a source that’d be helpful. I’d be surprised if people who were otherwise comparable (age, education, income) but were self employed would have hugely different health costs. My understanding was that the cost differences came from pooling.

    • Sharon says:

      But these people do exist. Older couples, in coastal states, who make just a little too much for subsidies, do exist. They aren’t unicorns. There are a lot of us out here in Blue America, and as I’ve said in the other thread, the ACA is an improvement, but the individual market is still an expensive place to purchase insurance for some people.

      That’s not trolling or cherry picking, it’s just a fact. Once again, I’ll praise the Medicaid expansion to the skies. I had no idea how many people would be covered under this part of the legislation. It’s been a boon to a number of people that I know.

      • Denverite says:

        I didn’t say it’s trolling. I said it’s cherry picking, or “the act of pointing to individual cases or data that seem to confirm a particular position, while ignoring a significant portion of related cases or data that may contradict that position.” Moore’s point was that even the cheapest ACA policies are overly expensive. To do this, he picked just about the highest cost demographic imaginable.

        He may be right, but his evidence is no more valid than if I said (for example) that ACA policies are super-duper affordable because you can get one for $168/month (for a thirty year-old individual nonsmoker in Colorado — see what I did there?).

        • Jordan says:

          Meh. The claim he is supporting is “For many people, the “affordable” part of the Affordable Care Act risks being a cruel joke.”

          This is true. He then illustrates it with a particularly striking example. In the context of a short opinion article, seems fine.

          Just as it would be fine if you had said, say:

          “For many people, the “affordable” part of the Affordable Care Act is quite accurate. [anecdote about colorado person].”

          Also true! Also then illustrated with a particularly striking example.

          • Dilan Esper says:

            Correct. I think the basic problem here is that to get health care right you have to do a lot of redistribution (because the reason health care is so expensive is that the free market charges the heck out of people with medical problems who can’t really do anything to bid the price down).

            Obamacare obviously does a fair amount of redistribution– the subsidies, Medicaid, the tax increases, etc. But because it keeps the basic framework of “people buying their own insurance from private insurance companies”, it doesn’t do nearly as much redistribution as something like the National Health Service in Britain can do. Indeed, if it did that level of redistribution, there would be a gigantic problem getting younger healthier people to sign up.

            So the result is there are going to be swaths of the population who don’t benefit from enough redistribution to make the insurance affordable. This is an actual flaw in the legislation. Now maybe this was the best bill the system could produce (that’s the other argument the defenders of it make). But it is a flaw.

            • Denverite says:

              So the result is there are going to be swaths of the population who don’t benefit from enough redistribution to make the insurance affordable. This is an actual flaw in the legislation. Now maybe this was the best bill the system could produce (that’s the other argument the defenders of it make). But it is a flaw.

              This is well put. And to the extent there is a population for whom health care financing is essentially unaffordable except at unrealistically high income levels, then it’s a great argument for expanding Medicare.

              • Aimai says:

                As I understand it there are lots of different populations for which “health insurance” is costly and/or unaffordable and both costly and unaffordable have to be seen as rather complex and highly situational.

                There are people who anticipate, rightly or wrongly, that they will not use it during the period they are insured. For those people any amount seems like too much when compared to their imaginary freedom to use the premiums for something else.

                There are people who are in a marked category, such as age or gender, where they can be expected to need more than average health care or they run the risk of having a catastrophic health care incident (cancer, age related illnesses, pregnancy complications, labor complications). For those people the cost of “owning” a policy specific only to their needs can seem high, or even be high in real terms. Because the insurance aspect of the health care (the risk part) is quite high.

                Bringing those costs down may not be possible. For young people who don’t think they are going to need health care the money is always going to seem too high and wrongly appropriated. For older people, people with pre-existing conditions who have mysteriously forgotten that they couldn’t get health insurance at all, and women who don’t think of themselves as having health risks, I’m not sure how the risk and premium cost can come down much more than it has.

                In an NHS/tax supported system the costs are shared more widely and the actual costs are untethered from the individual so its hard for people to bitch about “my” premiums or see a direct correlation between the premiums and the quality of care.

                I guess I think that Obamacare has some built in problems in its very transparency, at least in terms of consumer satisfaction. People understand what they are buying and why it costs what it costs so very little–and they understand the actuarial risksthey face even less. And yet the system enables them to imagine an apples to oranges comparison with other random strangers, with different health histories, in different regions with different markets. This is going to lead to a lot of dissatisfaction and consumer angst almost no matter what the Obama administration does.

                Basically everyone seems to think their health care should be a minimal fraction of their annual salary, while everyone else’s should cost as much as it needs to to cover their actual and projected needs. Fairness means “I pay the least amount possible for the most coverage” while “you moochers don’t cost me anything.” Such a system isn’t sustainable, but thats what people seem to want.

                • Dilan Esper says:

                  Well, since health care costs are an unfair aspect of life (the people who suffer most also pay the most), they should be spread and redistributed.

                  As I said, Obamacare does do a lot of this. Just not enough.

          • Anonymous says:

            For many people, not smoking will not prevent lung cancer. For many people, driving sober will not stop them from getting into a car accident. For many people, not getting vaccinated against a certain disease will not result in them getting that disease. I could go on using “For many people” as a claim.

    • Pat says:

      I think that we are seeing the actual costs of providing health care for older adults, reflected in these prices. But the way Obamacare is structured, you don’t pay more than 3-5% of your annual income on insurance costs. So yeah, these guys pay a lot. But they can afford it.

  4. FMguru says:

    Didn’t Romney sign the plan only because it was passed by veto-proof Democratic majorities in the MA legislature?

    • Ken Houghton says:

      Give that he had been campaigning on its fundaments and, as Scott noted, did veto eight specific =Sections= of it, that is even more unlikely than that there were 50 Democrats to get “single-payer” through Reconciliation.

  5. Ken Houghton says:

    Quibble: “8 Mitt Romney vetoes” refers to eight “line-item” Sections of the bill he signed, four of which were procedure issues (the Public Health Council and requiring a MA Representative and a MA Senator to be included in the negotiations with the Fed).

    Another was the dental-Medicaid/wellness program, which we can all agree would be great conceptually if they were included in HCR in general or PPACA in particular, but by and large they are not. (Exception noted: that Federal tax deduction for “smoking cessation” plans gives back to the tobacco companies some of what the agreement that they were selling poison to people took away.)

    And coverage of legal aliens was a step beyond what the Clinton Administration was pushing, though we might agree that’s praising with faint damns.

    We can agree that the two quickly-overridden vetoes relating to Employer Assessment (which is extant in Hawaii but which was postponed by the Obama Administration until 2015 [at least]) were disingenuous at best. (“Don’t need the funds”–maybe because of dropping the legal aliens and dental benefits?)

    But by and large the package matched what Romney wanted, and he did sign the bill. Calling eight line-items “vetoes” is only technically true, and severely overstates Willard’s “opposition” to RomneyCare.

    • Anonymous says:

      This.

      Also: People who accept that the Republican Party has no offer to the uninsured other than “nothing” should really start attacking Obama for his excessive faith in bipartisanship.

      Fixed that last sentence for you.

    • Scott Lemieux says:

      he did sign the bill.

      If the legislature didn’t have the votes to pass it whether he supported it or not, this would be more relevant.

      RomneyCare

      Can you find an example of anyone calling the plan this contemporaneously?

      • Malaclypse says:

        I lived here, and was in charge of compliance with the law where I worked. I took numerous seminars. I never, ever delete an e-mail. And the first reference to “Romneycare” in my e-mail was in 2009. Not a single seminar used that term at the time.

      • Dilan Esper says:

        If the legislature didn’t have the votes to pass it whether he supported it or not, this would be more relevant.

        By this logic, nobody gets credit for voting for a bill unless it passes by 1 vote, in which case everyone gets credit for it.

        On this particular point, you are being nothing but a mindless partisan. You don’t want to give Romney credit for it, so you find ways not to do it.

        • Pat says:

          We would give him credit if he campaigned for its existence and fought tooth and nail for its passage.

          But, nope, sorry, he didn’t do those things.

        • Aimai says:

          Hel-lo! Romney himself did not want credit and fought against being associated with THE ENTIRE FUCKING STATE. If we return the favor and wipe him from our memories we are actually being polite. He was a crappy, meanspirited, governor and as soon as he was a candidate he spit all over us good blue country people to curry favor with a red state voter who would as soon see us and our homo friends fall off into the sea and drown.

          • MAJeff says:

            Romney himself did not want credit and fought against being associated with THE ENTIRE FUCKING STATE.

            This. So much this.

            Fuck that milquetoast cracker, hard.

        • Scott Lemieux says:

          By this logic, nobody gets credit for voting for a bill unless it passes by 1 vote, in which case everyone gets credit for it.

          This really isn’t true. In a separation-of-powers system responsibility is always shared. But to compare Romney’s role in MA health care and Obama’s role in the ACA is absurd. Obama was leading the party that passed the legislation. Romney wasn’t, and there’s zero chance that anything like it would have passed with a Republican legislature.

          you are being nothing but a mindless partisan.

          LOL

  6. (Shakezula) says:

    Moore is in danger of becoming a parody of himself. (I realize people may disagree with my tenses.)

  7. Nobdy says:

    Apparently “Die in the streets like a dog after your family has been drained of all financial resources and been forced into bankruptcy” is NOT an attractive offer? What do you people WANT?

    -Compassionate conservative.

  8. Tom Servo says:

    Roger & Me was excellent. The rest of Moore’s output? Crap.

    • jim, some guy in iowa says:

      Moore did give Ben Hamper a gig. ‘rivethead’ is/was good reading

    • Jordan says:

      Nah. Canadian Bacon is great.

      A little more seriously, though, I’ve liked parts of almost anything I’ve seen or read by him and disliked other parts. I will admit I haven’t really seen or read anything by him for a while though.

    • Stan Gable says:

      Badgering an obviously senile Charlton Heston was what did it for me.

    • TribalistMeathead says:

      I dunno, the signal-to-noise ratio of Canadian Bacon is pretty low, but it has a moment or two.

      • Tom Servo says:

        Valid point. What I really mean, I guess, is that his most popular stuff is terrible,
        Just terrible. Bowling, Fahrenheit, Sicko. All important topics, atrocious and superficial execution. Moore doesn’t make documentaries so much as comic essays. That’s what pisses me off the most, really. Most of his output doesn’t deserve the documentary nomenclature.

        • TribalistMeathead says:

          We knew what you meant, we were just making a little joke. And I agree. He started to drift from documentaries with BfC and it hasn’t gotten better.

        • Tristan says:

          As someone who lived in Toronto I haven’t been able to take Moore at all seriously since the ‘they don’t lock their doors!’ bit.

          • Lee Rudolph says:

            Well, sure, now you lock your doors: wouldn’t want Rob Ford wandering in in a stupor.

          • Tristan says:

            More accurately, that was the beginning of a growing skepticism that more or less solidified when Sicko, intended as a critique of the American health system, got so hyperbolic in its praise of the Canadian system that it could have served equally as well as government propaganda for us, at a time when our own governments were really screwing the pooch on health care.

            It sits really poorly with his image as the guy who implores America to be better because it can. He relies very heavily on the fact that large numbers of his American audience are ignorant of his subject matter and won’t fact check it afterwards.

    • Anonymous says:

      I liked The Big One, which few have seen. And TV Nation was a great show (on Fox!) which even fewer have seen; kind of a proto Daily Show, but all offsites.

    • DocAmazing says:

      The worst of Moore’s output is superior to An Inconvenient Truth.

  9. JRoth says:

    The idea that state legislatures operate under the same policy restrictions as the national one is spit take-inducingly stupid, Scott. I really wish you’d stick to arguments that don’t suck, but you love to marshall every conceivable argument against your foes, not merely the good ones.

    But seriously, if Mass had wanted to enact Medicare for all, there would have been no practical limitations at all. Really. Great argument.

    They also should have passed a trillion dollars in stimulus in 2009, and the fact that they didn’t proves that Obama couldn’t have, either. New rule in political discussions: if the Mass Legislature doesn’t pass a law first, it cannot pass the Federal Legislature. For conservative-leaning efforts, you may substitute the Texas leg.

    • Marc says:

      Are you seriously claiming that passing liberal legislation is easier nationally than it is in Massachusetts? Because it sounds as if you are, or that you’re claiming that there isn’t a significant clue in the failure of a liberal state to pass more liberal legislation than the ACA.

    • nate says:

      Must agree. Exhibit B: Quoting Niall Ferguson to bash Ralph Nader. That was jaw-dropping.

    • Scott Lemieux says:

      The idea that state legislatures operate under the same policy restrictions as the national one is spit take-inducingly stupid, Scott.

      Um, what?

      I really wish you’d stick to arguments that don’t suck

      Generally, before you start hurling insults it would be better if you actually rebut anything I argued first.

      But seriously, if Mass had wanted to enact Medicare for all, there would have been no practical limitations at all.

      What in the holy fuck are you talking about? Perhaps you should read the posts before commenting.


      They also should have passed a trillion dollars in stimulus in 2009, and the fact that they didn’t proves that Obama couldn’t have, either.

      Well, obviously states can’t pass stimulus bills so the legislative context for that issue isn’t more favorable at the state level, even in the most liberal states. How this makes the policy context for health care less favorable in Massachusetts than the United States Congress is much less clear. But, hey, if you have evidence that the median legislator in Massachusetts is to the right of Ben Nelson or Joe Lieberman I’m happy to look at it.

      I would appreciate it if you would stop making arguments that suck this egregiously.

    • RS22 says:

      Is this just a play on the phrase “Medicare for all” or is there really some practical limit to Massachusetts passing single payer? It’s well within a state’s power to set up such a system, far moreso than passing a trillion dollar stimulus.

  10. grouchomarxist says:

    And people who attack Obama for his excessive faith in bipartisanship should really stop pretending that the Republican Party has any offer to the uninsured other than “nothing.”

    Not disagreeing with most of your argument, Scott, but I’m with Anonymous at 2:25 PM in saying that as originally written that sentence makes no sense whatsoever.

    • Scott Lemieux says:

      We can argue about the quality of the prose, but it makes perfect sense. The re-wording intentionally inverts the meaning.

      • Bloix says:

        I’m a person who attacks Obama for his excessive faith in bipartisanship. I argue affirmatively that the Republican Party as it exists today has nothing to offer the uninsured. So I don’t quite understand what you’re getting at. I appreciate that you perceive some sort of contradiction in my views, but I don’t see it.

        • Scott Lemieux says:

          I argue affirmatively that the Republican Party as it exists today has nothing to offer the uninsured.

          That’s nice. But you did argue that the Republican Party as very recently constituted had an offer to the uninsured that manifested itself in the “Republican plan” that was the ACA, which is equally erroneous.

      • grouchomarxist says:

        No, it doesn’t make sense, and the quality of the prose makes no difference.

        Understand that as far the ACA is concerned, you’ve convinced me that calling it a “Republican” plan is deceptive. The only real similarity to the Heritage Foundation proposal is the mandate, apart from that, there are some mighty crucial differences. And fwiw, “decoys” seems a perfectly fair description of those 1993 bills, at least from what I remember of the Clinton years.

        When it comes to more recent history, my recollection may be faulty, but I thought the Heritage Foundation/RomneyCare argument didn’t originate with Obama’s critics, but rather as a tactic used by the ACA’s supporters to call out the GOP for their hypocrisy. Like you pointed out, as regards the mandate, they were for it afore they were agin’ it.

        The “RomneyCare” angle allowed supporters of the ACA to say, “Here’s a state — with a Republican governor no less — that successfully implemented your mandate, so what’s your problem with the bill?” Which might also have been part of an attempt to split off hypothetical “reasonable” Republicans, by holding Romney up as an example of that quasi-mythical breed. (Remember, this was before Mittens repudiated all that to court the cracker vote.)

        If nothing else, it’s sort of ironic that that disingenuous comparison then got turned against the ACA by critics from the left.

        And people who attack Obama for his excessive faith in bipartisanship should really stop pretending that the Republican Party has any offer to the uninsured other than “nothing.”

        Given that the ACA passed with exactly one Republican in the House and zip in the Senate voting for it, any faith in bipartisanship appears excessive. It seems particularly inexplicable in Obama’s case, because he had plenty of opportunities before he became President to observe the modern GOP, both from a distance and up close and personal. Hell, even an outsider like me, who couldn’t be further removed from the halls of power, could predict that the Republican response to his election would be Clinton Years redux, cranked up to 11.

        No criticism I’ve made of Obama in relation to what seems a real fetish about bipartisanship has ever required me to pretend that the Republicans would offer anything of real value to the uninsured. And I’m neither stupid nor ignorant nor crazy enough to actually believe such a ridiculous proposition.

        • Scott Lemieux says:

          Given that the ACA passed with exactly one Republican in the House and zip in the Senate voting for it, any faith in bipartisanship appears excessive.

          Indeed. There’s nothing wrong with criticizing Obama for excessive faith in bipartisanship. But any such error on Obama’s part is dwarfed by people who think that conservative Republicans secretly secretly support(ed) the ACA.

          No criticism I’ve made of Obama in relation to what seems a real fetish about bipartisanship has ever required me to pretend that the Republicans would offer anything of real value to the uninsured.

          This error is not universal or necessary, and I think it’s pretty obvious that I’m not implying otherwise unless you’re determined to read uncharitably.

  11. Tom Servo says:

    Semi-related. I had to reread the Obamacare decision and was struck (I hadn’t read the dissent) by how much of a hack job the joint dissent is. Reclassifying the Individual Mandate as a tax rather than a penalty in order to sustain its constitutionality was not to interpret the statute but to rewrite it? These guys aren’t even trying anymore.

  12. Simon says:

    It’s Michael Moore. Does anything else really need to be said.

  13. Bloix says:

    As someone who has argued here that in its main outlines the ACA is “really” an adoption of Republican ideas, I think that there is a failure to communicate over the meaning of “really.” Here’s E.J. Dionne today in the WaPost, who expresses my views better than I’ve done in the past:

    “Obamacare is not a left-wing program, no matter how often conservatives might say it is. Its structure is based on conservative ideas. The individual mandate was the conservatives’ alternative to a mandate on employers. The health-care exchanges are an alternative to government-provided medicine on the Medicare model.

    “Obamacare is complex because the government is trying to create a marketplace in which people shop for private insurance and receive government subsidies if they need them. It goes to a lot of trouble to preserve the private insurance market. The system does not even include a government plan as one option among many.

    “But once conservatives succeeded in pulling the health-care debate to where they had always wanted it, they abandoned the concepts they pioneered and denounced Obamacare as a socialist scheme. It’s a classic case of heads-I-win-tails-you-lose politics: Move toward me, and I’ll just keep moving farther away from you.”

    http://www.washingtonpost.com/opinions/ej-dionne-the-resurgent-progressives/2014/01/01/3fc6c686-723c-11e3-9389-09ef9944065e_story.html

    This is, as they say, a nuanced position that is not accurately captured in the statement that the ACA is “really” a Republican proposal. Perhaps it would be better to say that the ACA is built in concepts that were advanced by Republicans in bad faith, thereby inducing liberals to abandon their own positions in order to devise a program that could be enacted. But it’s hard to put that in a few words.

    Like Michael Moore, I’m happy the ACA passed. It promises to suck a lot less than what we’ve had up until now. Just don’t tell me it’s a liberal program.

    And as to the very different argument that it’s the best that could have been done – well, we’ve had that argument to death and I see nothing new in this very long thread. I continue to believe that it’s possible that we could have better and that Obama made some mistakes, mainly due to political considerations. Prof. Lemieux thinks that Obama ran a flawless campaign, that he picked up every dime that was on the table, and that people who think otherwise are shills or fools or tricksters or who knows what – not good people, in any event.

    • Scott Lemieux says:

      This is, as they say, a nuanced position that is not accurately captured in the statement that the ACA is “really” a Republican proposal. Perhaps it would be better to say that the ACA is built in concepts that were advanced by Republicans in bad faith, thereby inducing liberals to abandon their own positions in order to devise a program that could be enacted.

      But the problem is that even in this form the argument is transparently wrong. Actually existing conservative Republicans have never favored the Medicaid expansion or the level of regulation in the ACA, even nominally. And, by the way, they also want to destroy Medicare and Medicaid, which the ACA didn’t.

      If you want to argue that the ACA isn’t “left-wing” in some absolute sense, fine. But to proceed from there to argue that it’s therefore a Republican plan is just flat-out wrong, and gives Republicans credit they certainly don’t deserve.

      thereby inducing liberals to abandon their own positions

      Which liberals “abandoned their positions” because of Republican proposals?

      I continue to believe that it’s possible that we could have better and that Obama made some mistakes

      Sorry to provoke more evasive self-pity by noting that your claim that Nelson, Lieberman, Bayh et al. would have voted for a significantly better bill remains nothing but bare assertion, for obvious reasons.

    • slightly_peeved says:

      Germany and the Netherlands also preserve the private insurance market. Maintaining a market for insurance is not a particularly Republican or right-wing idea. You could describe the ACA as a European system and be probably more accurately describing it.

      • IM says:

        Because of right-wing political influence.

        The dutch and even more the swiss system are right-wing systems.

        They only look left-wing compared to the status quo in the US.

    • RS22 says:

      There are some elements of the ACA that overlap with elements of policy proposals unseriously offered by Republicans.

      It’s a leap to go from there to defining the ACA as “really” a Republican proposal, as though that is its essence.

      I also have no idea what the metric is for deciding whether it’s a “liberal” program. It provides for a vast expansion of social insurance, the single largest in 40 years. That strikes me as liberal, and repealing this policy and throwing millions of people off of insurance would strike me as not liberal.

  14. Denverite says:

    Just don’t tell me it’s a liberal program.

    As written by Congress, it would expand Medicaid rolls by roughly 30%, and for the first time in most states, change Medicaid from a categorical eligibility program limited to EBD plus kids, to a general welfare benefit available to anyone who is poor or near poor.

    If you don’t think that’s enough — in and of itself — to make the ACA a “liberal program,” you’re crazy.

  15. scott says:

    Jesus, I wish we could have done more than ACA, but I’m done arguing about whether we could have or whether it does or doesn’t look like a Heritage plan from 20 years ago. I don’t give a solitary fuck about that but whether/how we can get to a system where we pay half to a third as much per person as we do now, ie, like Japan, Canada, Australia, and pretty much all of Europe. I would be very interested to hear about that.

    • Bloix says:

      With apologies for beating a dead horse:

      Today “Angry Bear” (Kenneth Thomas) writes that Heritage “propos[ed] Obamacare’s main components,” and cites to himself, Arik Roy, and James Taranto, as sources http://angrybearblog.com/.

      In comments here, I’ve previously cited to Uwe Reinhardt on this,
      http://thehealthcareblog.com/blog/2013/08/18/talmudic-like-studies-of-republican-health-reform-ideas/

      Paul Krugman wrote about it a couple of years ago, in a piece called “Conservative Origins of Obamacare.”
      http://krugman.blogs.nytimes.com/2011/07/27/conservative-origins-of-obamacare/?_r=0

      In, 2010, Brad DeLong wrote about “the conservative DNA of ObamaCare.” http://theweek.com/article/index/201077/the-curious-triumph-of-romneycare

      Yesterday I quoted E.J. Dionne saying the same thing.

      When you claim, in effect, that Krugman, DeLong, Reinhardt, Roy, Taranto, Thomas, Dionne, and many others (including, for what it’s worth, Nancy Pelosi) are crazy or fools or tricksters or all three, you’re not necessarily wrong. Maybe Scott Lemieux is the man Diogenes spent his life looking for. It’s possible.

      But perhaps in this case, if you want anyone who’s not already persuaded of your position to come around, it would be prudent to put the debate on substantive grounds and moderate the ad hominem attacks.

      • Scott Lemieux says:

        And yet, I’ve actually substantively responded to all of these types of arguments and explained why they’re wrong, but you continue to argue from authority rather than actually responding, so this would seem to be pure projection. To state the obvious, one can be wrong without being a crazy, fool, or trickster, particularly if they’re not aware of the details of the Heritage plan. And whining self-pity is not actually an argument.

        • Mike D. says:

          But, to my mind, you haven’t really reckoned with the extent to which this meme allowed for the passage of ACA (by giving centrist liberals an excuse to abandon their quest for bipartisan buy-in (i.e. cover)), nor (thus) the importance of accounting for your failure to point out its wrongness when it was doing that, and how that looks in light of your eagerness to do so now, when the obvious way in which the meme makes the law look less valuable now that it is passed is the main function it seems to be performing.

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