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That Green Lantern Won’t Raise Itself

[ 96 ] January 7, 2014 |

In her “conversation” with David Brooks, Gail Collins manages to capture in two sentences how not to think about legislative change:

I’m with you on the single-payer option. If only the president had not taken the path that was touted by several generations of Republican deep thinkers.

The first problem with the “Republican thinkers” bit we’ve discussed extensively — the “generations” of “Republican thinkers” who have wanted to greatly expand Medicaid and substantially tighten restrictions on the health insurance industry don’t actually exist. But let’s imagine an alternate universe in which the Republican offer on health care has not consistently been “nothing,” and 30 years ago a lot of Republicans sincerely favored something like the ACA. What implications follow from this, exactly? Roe v. Wade had 5 Republican appointees in the majority with only 2 Democratic ones, with the two dissenters evenly split on partisan lines. Does this make Roe a fundamentally “Republican” decision Democrats should reject? Should Everett Dirksen’s support for the Civil Rights Act cause us to construe it as a sellout? John Chafee, I am assured by many commenters and people on Twitter, defined “Republican” health care policy circa 1993. So I assume that Chafee’s 1993 proposal for a federal handgun ban is also a “Republican plan” liberal Democrats should reject if it was politically viable?

Anyway, apart from the fact that it’s false and would be irrelevant even if it was true, the “ACA was a Republican plan” is a great argument.

On the second point, the argument that the choices of Barack Obama are the reason single payer didn’t pass should by all rights be a strawman, but it’s not. (In fairness, I assume that given more space to elaborate, Collins would have phrased it in the more typically weaselly manner: “I’m not saying it was guaranteed to work, but we’ll never know if stalwart liberals like Joe Lieberman and Kent Conrad and Ben Nelson would have supported single payer because Obama didn’t. even. TRY! Bully Pulpit! Overton Window on Steroids! Change the Game by Doubling Down!”) Anyway, let’s say Obama had chosen 2009 to initiate a “national conversation” on single payer. Allow me to dramatize the outcome:

PRESIDENT OBAMA: “Dammit, Harry. I know neither Hillary nor myself nor Edwards even ran on it, but I’ve decided that eliminating the American health insurance industry is the only way to go — American political institutions naturally gravitate towards optimal policy outcomes, right? I’m guessing that going public like George W. Bush on Social Security will put us over the top, but how do things look in the Senate right now? I figure that at worst, Congress would have to meet us halfway, just like Bush on Social Security and Clinton on health care.”

MAJORITY LEADER REID: “Thank you for your very serious proposal, Mr. President. I have a whip count in my desk somewhere that my intern typed on her imaginary typewriter. Let me get it for you.”

PRESIDENT OBAMA: “Great, thanks!”

[Instrumental version of "Raindrops Keep Falling On My Head" plays]

PRESIDENT OBAMA: “Hello? Is there a bad connection?”

[Instrumental version of "50 Ways to Leave Your Lover" plays]

Exeunt.

Comments (96)

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  1. andrew long says:

    *APPLAUDS*

  2. Ronan says:

    Or did the conversation go like this:

    Obama: Harry, is Newt there with you? Put me on speaker.

    Reid: yes mr president *puts on speaker phone*

    Obama: who am i speaking to here?

    Newt G: It’s just me, harry, the ceo of AIG and Scott Lemieux

    Obama: good. listen, we have to play our cards right on this one. We cant pull another 9/11. top rate tax cuts and increased corporate profits are a non starter for the forseeable future. we need to give the baying mobs something. so im planning healthcare reform based on comrade cheneys heritage healthcare plan to enrich us all.

    harry: good plan mr president

    obama: the only problem is the left will see right through it

    scott: mr president. i like to think i proved my worth during the 2001 anthrax ‘scare’. let me handle this ..

    to be cont (or probably not)

  3. joe from Lowell says:

    Why must Scott keep inventing this straw man, and publishing these arguments under pseudonyms like “Gail Collins,” just so he can punch hippies?

  4. scott says:

    As exciting as it is to argue over stuff that happened three years ago and can’t be changed, I wonder what the road forward to more affordable health care might look like, the sort that every other Western-style democracy enjoys. If not the Green Lantern, then what?

    • joe from Lowell says:

      Look north.

      The Canadian single-payer system grew out of programs implemented at the provincial level.

      The single-payer systems that some states are now able to implement because of the PPACA are the seeds of a national program.

      • panda says:

        Noam Scheiber has a a good argument that one of the upsides of the ACA is that it brings so many people into the system so that as long as the system is generally functional, the pressure to smooth out the kinks will be pretty intense and will come from people politicians actually care about.

        • DrS says:

          Your link was broked. Link

        • Sharon says:

          All of those people on Medicare and a lot of the new enrollees on the exchanges, are still people that politicians don’t care about.

          The people that politicians care about are the people who were already the winners in the old individual market, the top 20% who donate to their campaigns and have employer provided health insurance and finally, close family members.

          The rest of us, covered or not, are just resource-gobbling proles.

          • panda says:

            I think this is quite exaggarated,for a couple of reasons.
            1. Let’s take Kentucky as an example. By March, there will prob. be 200,000 white working class people who will get their healtchare from Medicaid. It’s true that the republicans don’t care whether they live or die, but white working class people is the demographic that keeps Rand and Mitch in the Senate, and they are not going to cut off healthcare off 200,000 of their base voters.
            2.The exchanges are meant for people ranging from the lower-middle up to the lower reaches of the upper-middle class; again, not the kind of people one wants to upset too much.
            3. Most importantly, once the dust settles, it won’t be possible to really tell the difference between pre 2013 winners and losers on the exhchanges, as they will be just a part of life for the 10-20 million people who will use them. Given that the American political system is so status-quo biased, I really see no way in which the exchanges could be rolled back, or even seriously trimmed.

      • Hillary says:

        Who will be my Tommy Douglas?

    • UserGoogol says:

      The distinction needs to be drawn that single payer isn’t the sort of health care system that every other Western-style democracy has. Quite a lot of very respectable countries have a system where people are required to choose non-governmental health insurers, it’s just that the way these insurers operate is vastly more regulated and otherwise controlled by the government. Although you’d need a lot of reforms to get from here to France, or even Switzerland, it’s a fairly straightforward move in that direction.

      I’d prefer single payer to that, and I think Obamacare also sets up the potential for single payer to happen too, in a more indirect way. But you shouldn’t view health care policy as a sharp dichotomy of single payer or bust.

      • slightly_peeved says:

        Germany and the Netherlands use private insurers; the regulation is a bit tighter. A gradual ratcheting up of the required percentage of premiums spent on care, and removing the holes in subsidised insurance and Medicaid, would move the US even further towards those systems.

        • Manny Kant says:

          Aren’t the German and Dutch insurers non-profits? I suppose some US insurers are officially non-profits (Blue Cross/Blue Shield, I believe, most notably), but many are for-profit companies.

          • LeeEsq says:

            I don’t know about Germany and the Netherlands but in Israel everybody is required to sign up with one of the four HMOs in the country. Each HMO is required to give everybody enrolled a standard basket of services for free. Funding for these free services comes from the government. If people want supplemental services from the HMO for things like cosmetic surgery, the HMO can charge money for those services.

            • panda says:

              To be fair, the Israeli system, like many others, has fiscal problems, and one of the solutions is to push more and more services from the government basket to the privately insured basket. Someone on private insurance can, for example, choose a wder variety of doctors or skip lines for surgery. One of the tell signs of how entreched a public system becomes is that even modest amount of privatization created an enormous public anger. This is really what gives republicans such a heartburn/ragestroke over the ACA: once the principle that everyone has a right for healthcare is established, nothing can turn clock back.

    • And the NHS was preceded by the National Insurance Act of 1911, which only covered a small part of the industrial workforce.

      Gradualism can and has worked.

  5. rea says:

    If Obama had proposed single payer and somehow rammed it through Congress, the same people would be complaining that he did not go far enough.

  6. Dilan Esper says:

    Scott cannot say with certainty that a Democratic strategy that focused on expanding public insurance but NOT pursuing universality would not result in better policy outcomes. (Medicare, Medicaid, the VA, and S-CHIP were all passed using this model.) He just assumes that the only possible thing Obama could have pursued was Obamacare.

    Now, granted, I can’t prove that expanding public insurance would have worked either. It wasn’t tried this time (though it has worked in the past). But unlike Scott, I don’t overclaim. I merely state that it is entirely possible that we could have gotten closer to a national health service (the correct solution to the policy problem), or, as a second best solution, a single payer had we gone down that route.

    Instead we went down this one, and I hope it turns out OK (but continue to have my doubts that it really will).

    • The Medicaid Expansion says:

      Now, granted, I can’t prove that expanding public insurance would have worked either. It wasn’t tried this time

      Best to ignore me.

      • Brien Jackson says:

        It’s the True Liberal way.

      • Dilan Esper says:

        I have a prediction on Medicaid expansion:

        Within three decades, the major push of American politics will be to fold Medicaid and Medicare into the exchanges.

        • Scott Lemieux says:

          Fortunately, the broader the constituency receiving the single-payer plans, the less likely that becomes.

        • joe from Lowell says:

          You have a great deal of faith in the exchanges if you think they’ll work well enough to motivate politicians to advocate for privatizing Medicare through them.

          Privatizing Medicare is toxic right now. You think the exchanges are going to change that?

          • panda says:

            It’s the big irony of the republican madness over ACA. The Ryan plan’s linchpin are basically exchanges for the elderly. The only way to make those paltable to the public, even in theory, is to make the exchanges for younger people, future medicare beneficiaries, as generous as possible, but that would be socialism..

        • Bijan Parsia says:

          Within three decades, the major push of American politics will be to fold Medicaid and Medicare into the exchanges.

          Really? That seems like a very strange prediction (even putting aside Scott’s and Joe’s points).

          Republicans are going to change their minds about the exchanges? Democrats are going to give up on Medicare and Medicaid? Anyone is going to give upon Medicare?

          And there are good versions of this, right? If we end up with the German system…hurrah!

        • junker says:

          Leaving aside everything else… how can you trust any government program if you think that politicians are going to act as soon as possible to back stab the public?

          I assume you think folding these programs into the exchanges would be bad, yes? And that therefore, it would be the consequence of politicians making decisions not in the best interest of the public?

          How, exactly, do you trust the government to run an NHS, then? You have this infuriating argument strategy of assuming bad faith and bad motives on the part of the government, but then turning around and complaining that various reforms don’t involve the government enough (you have a similar pattern when complaining about regulatory capture). “Obamacare is bad because the government can’t be trusted to administer it properly! However, what we need is a government run NHS!” Either you have faith that the government can get things done, or you don’t; you don’t get to switch back and forth depending on what is convenient to your argument.

    • joe from Lowell says:

      Now, granted, I can’t prove that expanding public insurance would have worked either. It wasn’t tried this time

      Obamacare does expand public insurance.

      • junker says:

        Damnit Joe, even though more people will benefit from the Medicaid expansion than the exchanges, it doesn’t count because it’s “conceptually severable”

        • joe from Lowell says:

          There’s a regular on the Lowell Sun’s comment pages who has spent the last five years denouncing Obamacare as “government-run health care.”

          The other day, I quoted some figures to him about the expansion of health care coverage under Obamacare, and he responded that most of them were from people signing up for Medicaid, “which isn’t really Obamacare.”

          Sigh. Kooks, whattyagonnado?

    • Scott Lemieux says:

      I can’t prove that expanding public insurance would have worked either.

      You have to be shitting me.

      we could have gotten closer to a national health service

      Nearly 50 years later, it seems pretty hard to argue that Medicare is getting us closer to nationalized health care.

      • junker says:

        Notice also his attempt to imply that because Government healthcare has passed before, that it would be possible in 2008, which conveniently omits the large scale changes in American politics since Medicare and Medicaid originally passed. Even S-CHIP was only supported by a few republican senators when it was renewed in 2009.

        • slightly_peeved says:

          It also omits that a Medicare expansion was publicly floated during the negotiations and Lieberman explicitly turned it down. They. Did. Actually. Try.

          • Dilan Esper says:

            Not as a stand-alone.

            The question is what happens if we just try a standalone Medicare expansion, or even just building public health facilities open to all, without the exchanges and the mandate.

            Previous health care bills that did similar things passed.

            • Scott Lemieux says:

              The question is what happens if we just try a standalone Medicare expansion

              Nobody’s saying that a Medicare expansion as a stand-alone would have been impossible. I am saying that it would have been a terrible idea.

              Previous health care bills that did similar things passed.

              And, fortunately, little has changed about the partisan composition of American politics since 1965.

              • Bijan Parsia says:

                Nobody’s saying that a Medicare expansion as a stand-alone would have been impossible. I am saying that it would have been a terrible idea.

                I’ll say that I don’t see that it’s particularly more likely than the ACA.

                Let’s say that Obama gets on board with it…what Republicans does he attract? Does he not alienate the large segment of the Democrats who watched everyone campaign on comprehensive health care reform (not to mention those interested in bending the cost curve).

                Why didn’t anyone else put this on the table? (Frankly, I would have probably been strongly against it on the above two grounds.)

                If the left came on board, why would it be so much more compelling to Lieberman?

                I’m prepared to here a story, but again, I’ve not heard a story but mere assertion.

      • Anonymous says:

        Idk, there were a fair number of people who supported expanding or even universalizing Medicare this time around. They lost — this time.

    • Hogan says:

      So if we just did around half of what the PPACA does, it would get us closer to nationalizing two major industries instead of just one? Oh wait, it’s only “entirely possible.” Ah.

      • Dilan Esper says:

        Actually, the slow expansion of public healthcare provision certainly does get us closer to nationalization. Because every such program OTHER than Medicaid (weirdly, the one program Obama chose to expand) works better than the private sector.

        • Scott Lemieux says:

          Actually, the slow expansion of public healthcare provision certainly does get us closer to nationalization.

          There is absolutely no evidence for this and very substantial evidence for the opposite.

          weirdly, the one program Obama chose to expand

          When your analysis of health care politics is essentially the same as Megan McArdle’s, I suppose it’s hard to understand why providing health care to the most vulnerable citizens would be a priority. If you’re actually on the left of the political spectrum, it’s not difficult at all.

  7. Incontinentia Buttocks says:

    But let’s imagine an alternate universe in which the Republican offer on health care has not consistently been “nothing,”…

    Come on, Scott! Trying to make it much more difficult for patients to sue their doctors for malpractice isn’t much, but it’s not “nothing”!

    (On a more serious note, Medicare Part D was, in fact, a Republican offer on health care, for whatever that’s worth.)

    • rea says:

      Trying to make it much more difficult for patients to sue their doctors for malpractice isn’t much, but it’s not “nothing”!

      Okay, you’re right: Less than nothing, then.

    • LosGatosCA says:

      Actually, Bush moved the Overton window on Medicare/health insurance when they passed Medicare Part D.

      It really cut the legs off the Republicans during the early parts of the Obamacare debate.

      Until Max Baucus gave them tine to get their legs back – but by then it was too late.

      • Incontinentia Buttocks says:

        In general, in trying to analyze the actual partisan context in which health care reform was debated in 2008 and enacted in 2009-10, we ought to be talking more about Medicare Part D and the effects it did — and didn’t — have on the debate, while worrying a lot less about comparisons with the quite different, decade-and-a-half-old non-proposal from Heritage.

        • FlipYrWhig says:

          Seems like the effect was a fixation on making sure that the next wave of health care reform would be paid for — which is part of what made the needle difficult to thread. It would have to cater to the deficit-hawkery (or deficit-wankery) of Democrats like Mark Warner and Kent Conrad. Not that they’d ever have been easy to woo with an unfunded program for reform, but getting it all properly paid for would have to be an obsessive concern. And it was.

    • Scott Lemieux says:

      I should have more precisely said that the Republican offer to the uninsured is nothing.

  8. Incontinentia Buttocks says:

    “Dammit, Harry. I know neither Hillary nor myself nor Edwards even ran on it…”

    That’s the point, isn’t it? Single-payer will happen if and only if we elect people to state legislatures, governor’s mansions, Congress and the White House who support single-payer. By and large, we haven’t. Expecting people who’ve run on plans other than single-payer to abandon the plans they’ve run on in favor of single-payer is the most foolish kind of wishful thinking.

    • DrS says:

      This. We often have a hard enough time getting politicians to vote for the progressive things that they actually say they want to do.

    • Ronan says:

      I always thought your name was intercontinental,as in you travelled a lot

    • Bijan Parsia says:

      There needs to be support for it throughout the party structure and in the public. Which, by and large, there isn’t. If there were significant (realisable) support, someone plausible would stake that out in order to get an edge in a primary or election.

      (Yes, the ACA polls a bit low because of people who think it didn’t go far enough, but it’s hard to see that people have strong support for replacing wholesale the current health care system with a single payer one:

      A 2001 article in the public health journal Health Affairs studied fifty years of American public opinion of various health care plans and concluded that, while there appears to be general support of a “national health care plan,” poll respondents “remain satisfied with their current medical arrangements, do not trust the federal government to do what is right, and do not favor a single-payer type of national health plan.”

      Decent employer based coverage entangled with compensation (i.e., people think that “great” benefits is part of their compensation, thus earned, thus both feel like they have something to lose and that other people are going to get something unearned and thus undeserved) really makes more radical change difficult. (Putting aside the big employer joy.)

      • Incontinentia Buttocks says:

        I don’t think such support just happens. It would have to be the result of years–probably decades–of political organizing. There’s been precious little such organizing for long-term goals on the “left” in recent decades. Instead, the “left” has often been dominated by a weird alliance of wishful thinkers who think that progressive change is inevitable, Green Lantern-types who think that it’s just a presidential speech away, cynical “realists” who think that it’s more or less impossible, and those who take the Panglossian attitude that whatever the Democratic Party is doing at any moment is the best that could possibly happen. (In contrast, it’s not surprising that the areas in which we have seen the swiftest and most radical recent progressive change — gay rights and marijuana-law reform — are sites where there has been such decades-long, single-minded activism.)

  9. Anonymous says:

    Exactly what purpose does Gail Collins serve?

    • Lee Rudolph says:

      On many issues of local (NY, Northeast) politics I think she’s quite good; forcing her to collaborate regularly with that nitwit David Brooks brings out the worst in her, as it does in E. J. Dionne—partly I think because she gets roped in, by politeness, to seeking a “middle ground” with him, “centrist” style, something she isn’t really that into when she’s just writing her regular column (or so I think I remember).

  10. Alan in SF says:

    This dispute is getting really tedious. Could we just stipulate that progressives wish Obama could have advocated for single payer, knowing full well that it didn’t have a chance, in hopes of making it part of the national conversation (instead of being totally unmentionable, as it is now)? Can we at least speculate upon the counter-factual that the public option might have been able to get 50 votes in reconciliation, thus creating a path to single payer?

    • Malaclypse says:

      You do realize that there are actual rules for what sort of bills can be passed through reconciliation, right?

    • rea says:

      Better yet, let us speculate upon the counterfactual that the public option plus ponies for everyone would have got 50 votes in reconciliation!

    • djw says:

      (instead of being totally unmentionable, as it is now)?

      This post links to a column in which single payer is advocated by a national columnist with a reputation as a centrist in the New York Times. It’s perfectly mentionable, it’s just not passable.

    • joe from Lowell says:

      Could we just stipulate that progressives wish Obama could have advocated for single payer, knowing full well that it didn’t have a chance, in hopes of making it part of the national conversation

      Not as long as the “progressives” in question keep insisting the opposite of the bolded part.

    • Paula says:

      So … You wish for elected officials to bet on losing propositions to make yourselves feel better?

      I guess people can consider your terms if you admit that your first priority isn’t actually helping people get access to health care in this country.

      • ericblair says:

        So … You wish for elected officials to bet on losing propositions to make yourselves feel better?

        It’s the negotiation theory that if you demand X you’ll end up with at least X/2, for any value of X. In practice, the opposing party has some idea what the negotiation space actually is, and tends to either ignore you or abandon negotiations if you keep demanding one million dollars in gold bullion in exchange for a 1994 Honda Civic.

    • catclub says:

      “50 votes in reconciliation”

      in the House, or Senate, or combined?

    • witless chum says:

      If we want single payer to be part of the national conversation, we’ve got to make it happen, not politicians.

  11. mds says:

    Why are we still talking about supposedly-needed health insurance reforms, anyway? Temporarily stymied by the AMA, Harry S. Truman took his case to the presidential electorate, won re-election, and therefore met no subsequent resistance in the Democratic-controlled Senate to his universal health coverage plan. So we’re already all covered under the Truman Plan, right?

  12. Anna in PDX says:

    Scott, did you mean to say “national conservation” or “national conversation”? (Final para of this post)

  13. Dumb says:

    Obama made a political choice that was fairly clear to both insiders and outsiders that he was going to push Obamacare (as we understand that program) rather than a more functional and/or progressive solution, BECAUSE HE WANTED A BROAD CONSENSUS BEHIND IT. The liberal complaint (at least the one I’m aware of) is that Obama made a huge political mistake by assuming that this course of pushing a center-right solution developed by Heritage and implemented by Gov Romney in MA, and railroading Ds behind it, would actually lead to a consensus. Of course, the Rs all started calling it socialism, communism, etc.

    Obama could have pushed for some version of single payer (probably starting for some subset of Americans, such as those currently uninsured) at the very least as a way to get Rs to come to the bargaining table. It was inevitable that Rs like Collins would want their pound of flesh just to take home to their constituents, so whether you started far left or center-right, this was going to happen.

    Your argument paints a pretty asinine picture of the politics, on which Obama very clearly lost. Given the strong dissatisfaction w/ health care in this country and the huge number of uninsured Americans, the popular momentum behind HC reform was far greater than it was in 1993 and the Hillary Care debacle. That Obama was only able to get a half-assed quasi-Republican solution into place, and one that alienated tons of voters in the process, pretty clearly speaks to what a disaster this approach was.

    • Davis X. Machina says:

      Obama could have pushed for some version of single payer (probably starting for some subset of Americans, such as those currently uninsured) at the very least as a way to get Rs to come to the bargaining table.

      Which assumes that there were terms and conditions under which R’s were going to the bargaining table.

      This argument is basically “Obama lost the wrong way, dammit.”

    • Amon-Jennie-Ra says:

      The liberal complaint (at least the one I’m aware of) is that Obama made a huge political mistake by assuming that this course of pushing a center-right solution developed by Heritage and implemented by Gov Romney in MA, and railroading Ds behind it, would actually lead to a consensus.

      So in other words, the liberal complaint that you’re aware of is based on easily disprovable assertions.

      It was inevitable that Rs like Collins would want their pound of flesh just to take home to their constituents, so whether you started far left or center-right, this was going to happen.

      Right, because going home to their constituents with a story about how you stopped an absolutist proposal is something that Republicans hate to do, as demonstrated by their practice of obstructing any and all Democratic initiatives.

      Your argument paints a pretty asinine picture of the politics, on which Obama very clearly lost.

      Well, except for actually getting universal health care reform through Congress, which everyone else who ever tried over the past century failed to do, Obama’s political effort was clearly a failure.

    • Scott Lemieux says:

      Obama could have pushed for some version of single payer (probably starting for some subset of Americans, such as those currently uninsured) at the very least as a way to get Rs to come to the bargaining table.

      Hahahahahahahahaha, oh mercy.

    • RS22 says:

      This is so deeply disconnected from reality, I’m not even sure how to respond. You think the public was clamoring for the destruction of all of their existing health insurance arrangements with an entirely new, government-run insurance system in the spring of 2009? They were clamoring for someone to save the economy. It took a meaningful amount of political guts for Obama to pursue this, and the polling at the time and since has borne that out.

      The issue of a dysfunctional health care system was, in fact, a big deal in the early 90s; its potency was demonstrated by Harris Wofford’s special election victory in the Pennsylvania Senate race. Nonetheless, the proposal to alter existing health insurance arrangements met with popular disapproval and was legislatively blocked. Republicans did not “come to the negotiating table.”

      Why is it that some of the same people who insist that Republicans can’t be negotiated with and Obama shouldn’t try feel so comfortable turning around and insisting that they’ll negotiate on favorable terms if he just tries harder?

  14. Sly says:

    DougJ at Ballon Juice had it right; the only good thing that could ever possibly come out of a NYT feature with Gail Collins and David Brooks is a murder-suicide.

  15. lawguy says:

    I do so enjoy these essays by Scott about how smart he is to understand the true nature of American politics unlike those to his left. Also, I enjoy being told that whatever it was Obama and democrats did was just right and there is nothing else really that could have been done.

    Keep up the good work.

    • joe from Lowell says:

      In what universe is Gail Collins to Scott Lemieux’s left?

      There is an answer, of course: in a universe in which one’s leftism is measured by one’s hostility to the person of Barack Obama.

    • Scott Lemieux says:

      unlike those to his left.

      Assumes facts that are exceedingly not in evidence.

      Also, I enjoy being told that whatever it was Obama and democrats did was just right and there is nothing else really that could have been done.

      Well, if you have a plausible scenario by which Ben Nelson could have been made to vote for single-payer, we’re all ears!

      • Manju says:

        Well, if you have a plausible scenario by which Ben Nelson could have been made to vote for single-payer, we’re all ears!

        Threaten to expose his toupee? Surely Lyndon Johnson would’ve at least tried.

  16. RS22 says:

    I would add that the black-and-white distinction these leftist critics draw between the ACA and single payer is kind of arbitrary. Single payer, after all, is not some platonic socialist ideal. It’s socialized health insurance, not socialized medicine, as it leaves in place all private health care providers, from high-earning physicians to billion-dollar pharmaceutical companies — the providers who are more responsible for increasing health care costs than insurers.

    So you could argue that embracing single payer rather than a British-style National Health Service is also a sellout to profit-making interests, and that if you really want to shift the Overton Window, blah blah blah, you should embrace an NHS system. That argument would seem odd to the “single payer if only you would have fought for it” critics — perhaps just as odd as their argument, nicely skewered here by Scott, seems to the rest of us who live in reality.

  17. [...] plan” is to be completely blind to the historical context of its proposal. As I said yesterday, it’s as much a “Republican” proposal as Chafee’s proposed federal handgun [...]

  18. Anonymous says:

    If the green lantern wanted badly enough to raise itself, then it would. Clearly it just isn’t trying hard enough.

  19. drs says:

    ‘I assume that given more space to elaborate, Collins would have phrased it in the more typically weaselly manner: “I’m not saying it was guaranteed to work, but we’ll never know if stalwart liberals like Joe Lieberman and Kent Conrad and Ben Nelson would have supported single payer because Obama didn’t. even. TRY! Bully Pulpit! Overton Window on Steroids! Change the Game by Doubling Down!”’

    Ah, ridicule, the first resort of those who don’t have an actual argument.

    I agree it’s likely that single-payer wouldn’t have passed that Congress. But it’s also true that if it’s unlikely to get something you ask for, it’s even less likely to get it if you don’t even ask for it. It’s also true that in general, jumping to a compromise position is poor bargaining. For liberals, the public option was the compromise in lieu of single-payer; Obama started compromised and then gave up even that.

    Mocking the Overton Window doesn’t show that it’s wrong.

    There wasn’t much popular demand for single-payer, but there was zero popular demand for Obamacare and hey, we got it anyway. Popular demand has little to do with what laws pass, it’s not like we’re a democracy a la Switzerland.

    Also, IIRC, popular support depended a lot on framing. “single-payer” didn’t poll well, neither did “create a government run health insurance program”, but “extend Medicare to all” did much better. And there’s obvious PR and political differences between “create a brand new ‘single-payer’ program” and “get to enjoy the same program your elderly parents are happy with”. The results of actually campaigning on the latter… well, we’ll never know, will we?

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