Home / General / No, Minor Reform Would Not Have Been Better Than the ACA

No, Minor Reform Would Not Have Been Better Than the ACA

Comments
/
/
/
89 Views

Given how embarrassing attempts to create plausible counterfactual scenarios under which a significantly better health care bill was possible in 2010 tend to be (“threaten to primary senators who aren’t running for anything!”) people who start with the premise that the ACA was an unconscionable sellout and figure out the accompanying argument later have a new line of argument. Rather than trying to explain how Bayh, Nelson, Lieberman et al could have been compelled to vote for single-payer or a robust public option, this argument re-defines penny-ante reforms as superior to the ACA. Our own Dilan Esper has now adopted this argument:

Just because people repeat so often that this was the most liberal thing that could pass doesn’t mean it is true. We don’t know what else could have passed because the Democratic Party decided to try to pass THIS.

My best guess– but it is just a guess– is that much more anti-corporate (and thus superior) forms of healthcare reform plans could have passed, but they would not have been “universal”. (Obamacare isn’t universal either, but it is quasi-universal.) In other words, expanding S-CHIP, expanding Medicare, building public health clinics, etc., are all things that have passed in the past and could plausibly have continued to progress had that been the Democrats’ agenda. But it would have been incremental, not universal. I tend to think THAT course is more “liberal”, because I think expanding the reach of private insurance is a conservative outcome. But if you believe that the liberal goal is providing everyone with a product called “insurance”, rather than incrementally increasing the reach of public sector health care, then Obamacare is more “liberal”.

The idea that a series of fairly small-bore reforms would be preferable to the ACA is implausible in the extreme. Let me cite as my first witness Dilan Esper:

The point is, if the left is a necessary part of a coalition that Gore needs to win an election, he shouldn’t be picking right-wingers to be Vice President, and should generally be proposing more left wing POLICY (again, making “populist” speeches is not the same thing). An example: Gore was the first Democratic candidate since FDR to NOT campaign on national health insurance. Instead, he proposed only an expansion of S-CHIP. If you were an adult, and you were uninsured, you were screwed.

You can make all sorts of political arguments about how after Hillarycare, that’s a move that he needs to make to reassure centrist voters. Fine. But it’s also a fine reason for a leftist who thinks health insurance is a right not to vote for him.

OK, so it’s not surprising that Esper has only one principle for evaluating health care reform: if it’s proposed by a Democratic president or candidate for president it sucks.  But this still doesn’t tell is which of these rationalizations was right. Obviously, he was right the first time (about whether an S-CHIP expansion is preferable to comprehensive health care reform, I mean; the idea that you should want Bush to be president because Gore didn’t propose legislation that would be DOA in any case is nutty):

  • The burden on proof on someone advocating penny-ante reform instead of the ACA is huge.  You’re giving up a massive, historic expansion of Medicaid and reforms that not only make private insurance significantly more accessible but transform the individual insurance market into something but a complete fraud.  If you’re going to give up all that for reforms that will affect a vastly smaller number of people — and, in the case of a Medicare buy-in, affect people generally much better-off than the millions of people benefiting from the Medicaid expansion — there had better be an extremely compelling reason for why the massive short-term negative is worth it.
  • And, of course, the counterfactual makes no sense whatsoever.  To reiterate what I said last time, the idea that giving public insurance to a class of generally unprofitable customers is a path towards complete nationalization of the American health insurance industry (let alone a nationalization of American health care) makes absolutely no sense in theory and has proven utterly wrong in practice.  Not only are we no close to single-payer or an American NHS than we were 50 years ago, but Medicare recipients were among the people most hostile to the ACA (and why not, since they have nothing to gain and can be persuaded that they have something to lose even if they aren’t Republicans who will hate any Democratic-proposed reform immediately.)
  • The idea that an S-CHIP expansion could lead to an American NHS in any kind of reasonable time frame also betrays a massive ignorance of American political history (and, for that matter, comparative politics.)  With the exception-that-proves the rule of abolishing slavery, American reform has always involved buying off entrenched interests.  Lyndon Johnson, in extraordinarily favorable political circumstances, had to settle for cherry-picking unprofitable customers rather than doing comprehensive reform.  Other high-veto-point systems otherwise more favorable to progressive politics don’t have nationalized health care either.  If you extend the time horizon long enough it’s impossible to rule anything out entirely, but 1)trading a policy achievement that represents a major improvement for tens of millions of people for the magic beans of an unprecedented mode of reform is insane, and 2)in some hypothetical circumstance long after we’re all dead where nationalizing the American health industry would be viable, there’s no plausible reason why it wouldn’t be equally possible under the status quo established by the ACA.
  • All of this assumes that these penny-ante reforms would have passed.  If you try to do much less than the ACA and don’t even get that, the fail becomes truly epic.
  • And, finally, the fact that S-CHIP expansions have passed before is self-refuting.  If you can pass them in much less favorable circumstances than existed in 2009, why on earth would you squander a once-in-a-generation-or-two legislative context on trying to pass it?  A Medicare or S-CHIP expansion can be added on to the ACA at least as easily as they can be added on to the status quo ante.

So, yeah, the idea that substituting an S-CHIP expansion or a few public health clinics for the ACA would be a good tradeoff for progressives is so far from defensible the world’s most powerful telescopes can’t even see it.

 

FacebookTwitterGoogle+Share
  • Facebook
  • Twitter
  • Google+
  • Linkedin
  • Pinterest
  • American reform has always involved buying off entrenched interests.

    And, of course, the NHS involved stuffing the entrenched interest’s mouths with gold.

    • Oh I do like that the definition of quality in a health care reform policy is that it’s anti corporate. I hope Dilan would rephrase that more effective reforms correlate with anti corporateness, but as it stands…yech.

      A key aspect of Obamaesque pragmatism isn’t just get what you can, but care more about policy ends than means. (Not that means are unimportant, natch.) Destroying insurance companies is not itself a goal.

      • DrDick

        Actually, destroying health insurance companies is rather a goal for me, but that is separate from the argument here. I totally agree on the issue of healthcare reform. Insofar as the goal is providing high quality, affordable healthcare to as many people as possible, the ACA is probably the best that we could get through congress. It is also a huge improvement over what we had before.

        • Actually, destroying health insurance companies is rather a goal for me, but that is separate from the argument here.

          Ah interesting.

          Yeah, as long as that value is appropriately weighted (as you do), I’ve no in principle objection to it. All other things being equal, I prefer NHS style funding to the French system, but given the quality of care (I hear) I’d prefer the French system.

        • Pat

          Both sides do it!

          Both the left and the right fuel their arguments with a desire to punish those they feel are responsible for making society a worse place. The right blames the others, wanton women, people who don’t live up to their responsibilities. The left blames those who hold positions of power and take unfair advantage of those positions.

          The desire to punish those you blame frequently overrides any thoughtful discussion of pros and cons.

          • Scott Lemieux

            As Chait says, I don’t think it’s symmetrical. Dilan is an outlier on the left, but this kind of thinking is very common on the right. (It’s not a coincidence that much of Dilan’s critique of the ACA could be made by Megan McArdle herself.)

          • Pat

            I agree, it’s not symmetrical. However, inflicting punishment on wrong-doers becomes its own goal. It can become conflated with the desired outcome of legislation; in this case, insuring as many people as possible without a negative disruption in health care delivery.

            Even accepting Chait’s premise, I believe that many liberals consider working with corporations to be selling out.

  • jim, some guy in iowa

    purity trolling, doing some of the republicans’ dirty work for them. christ, when will it end?

    • PhoenixRising

      It’s not work. It doesn’t work. These are the last gasps of ‘Obamacare is lousy because…’

      Soon, everyone at both extremes who wants to offer up their better idea (single payer, paying doctors in chickens, whatever) will know someone like me who has been running a small business for years or decades who FINALLY can buy insurance that has to cover some health care. And they will realize that they are making fools of themselves and STFU. There is literally no one left complaining about the existence of Medicare, is there?

      • Aimai

        The story coming out of Kentucky, which has reduced its uninsured population by 44 percent by dint of putting a couple of hundred thousand people straight into medicaid, is that this has been done by pretending that the “new insurance” was brought by the easter bunny, or something cuddly and white anyway, and has nothing to do with that mean man in the white house or the democratic party. Its going to take about one or two more election cycles before the Republicans will be running, at least locally, on all the good they’ve done signing people up for their rightful health care options while they still excoriate those freeloading liberal welfare cheats who access Obamacare on their obamaphones.

        • James E. Powell

          and has nothing to do with that mean man [insert racist epithet] in the white house or the democratic party.

          FTFY

          • randomworker

            …democrat party.

        • Manny Kant

          I kind of hope that paves the way forward for the rest of the country. Much better Republicans taking credit than Republicans refusing the Medicaid expansion and constantly trying to fuck with the law and get parts of it thrown out as unconstitutional.

  • somethingblue

    It’s true. Dilan Esper is history’s greatest monster.

    Certainly history’s greatest monster is not Evan Bayh or Ben Nelson or Joe Lieberman or Mitch McConnell or Paul Ryan or John Boehner or Olympia Snowe or Susan Collins or Max Baucus or Scott Brown or Bobby Jindal or Ted Cruz or Rand Paul (well, okay, maybe Rand Paul gets to be history’s greatest monster once in a great while, when we can spare a minute on alternate Tuesdays from flogging some people on Twitter and some tinfoil-wearing commenters at firedoglake who are history’s GREATEST MONSTERS OF ALL …

    C’mon, daddy, tell us the one again about how Obamacare isn’t at all like the Heritage Foundation plan. We haven’t heard that one in ages.

    • sharculese

      Carrying on a conversation with a regular commenter who repeatedly shows up to respond with his own argument and has never shown the slightest sign of being unhappy with Scott taking up this argument above the fold is the greatest persecution ever because…

      I dunno, sometimes I feel like you guys are in a battle with the racists who can be the most desperate pretend victim.

      To his credit, Dilan engages in this behavior never.

      • Aimai

        He can be stupid, and he can be a jerk. But he never whines. And he is (seldom? I can’t think of an example) outright nasty.

        • The prophet Nostradumbass

          I’m pretty sure I’ve seen Dilan say that he appreciates these posts, because at least his arguments are being taken seriously.

          • Yes!

            Good form on his part. Esp since someone else was chiding Scott for the elevation.

            • Correct. I have no problem at all with Scott calling me out if he thinks I am wrong. The willingness of LGM bloggers to engage commenters and push back (even if I disagree with them on the merits) is one of the great merits of this blog.

        • He does whine (or this is how I read some of the anti snark comments). I sorts think that the “mansplaining is over/misused” schtick to be a whine as well.

          He certainly can be short tempered and insulting. But…so can we all!

          What I don’t understand is these persistent but obviously bonkers arguments then never get developed. Why bother to repeat them after their cognitive and rhetorical force is so obviously poor? I guess he doesn’t see them and cognitively impoverished.

          • postmodulator

            I sorts think that the “mansplaining is over/misused” schtick to be a whine as well.

            It kind of bugs me as well! But part of the reason is that I think mansplaining is such a cool portmanteau. When it’s used correctly, it’s really, really accurate, it gets a lot of meaning across.

            Also, it’s pretty rare that I see it misused. But of course I don’t read a lot of Tumblr idiots.

            • Aimai

              Its hard to misuse “mansplaining.” Speaking as a woman it happens to me about 99 percent of the time when a guy is speaking to me. Its not that people are overusing it. Its that it happens so damned often.

              • postmodulator

                We’re that bad?

                Also, we may be talking about two different things. To me “mansplaining” means those guys in the Pandagon comment section explaining how the world REALLY works to the poor feminists. Do you take it to mean a more general form of condescension?

                • Funkula

                  You can draw the line a few different places.

                  1. Man explaining feminism to a feminist: the Platonic ideal of mansplaining.

                  2. Man asserting he knows more than a woman about a subject in which she is well-versed and he is casually familiar: I’d call this mansplaining, since it’s assuming that gender trumps education and credentials.

                  3. Man claiming he knows a subject better than a woman, despite neither being an authority: arguably still mansplaining. It’s still using gender as the tiebreaker.

                  4. Man belittling woman for speaking on a topic he knows more about: I wouldn’t call it mansplaining, just bullying. But if there’s misogyny involved instead of just being a sharp disagreement (and there usually is), lots of people would still call it mansplaining.

                  5. A man said something I don’t like: mansplaining only if you’re a straw feminist or (possibly) a Tumblr kiddie.

                • Aimai

                  I’m with Funkula, there are many colors of mansplaining and all of them are delightful to the connoisseur. I’d say that I was joking about the 99 percent since actually I’m surrounded by people who respect me and my opinions about stuff. But I’m also old and don’t suffer fools gladly. When I was younger, certainly, I was on the receiving end of tons of condescending shit from men. Category 2 and 3 are especially typical–being lectured about your own field by someone not as expert as you are and being lectured about a field neither of you knows much about by a guy who knows no more than you do.

                • I think it’s obvious that mansplaining is whatever we men define it to be.

                • JHWH

                  I think it’s obvious that mansplaining is whatever we men bears GODS define it to be.

                  FTFY.

                  Keep it fixed, eh?

                • You know, JHWH, I just watched Noah and it reminded me that you’re pretty much a dick and always have been.

                  And for the record, bearsplaining is a lot “RRRRrrrrrrrRRRRRR.”

                • rea

                  And a special prize to postmodulator (who is a guy, to the best of my recollection) for explaining to Animai what mansplaining really means.

                • I agree that all of Funkula’s categories exist and that there’s plenty of actual mansplaining.

                  But I really have been in arguments where I have (1) been talking about issues that I know a lot about with (2) people who didn’t really answer my arguments and (3) accused me of mansplaining. And I’ve seen this happen to other people as well.

                  The best example of this I can give is a comments thread that, alas, is probably no longer available because Pandagon switched hosts. But it concerned breastfeeding advocacy. I got called a mansplainer for arguing that over-the-top breastfeeding advocacy was bad for women who didn’t want to breastfeed and put too much pressure on new mothers.

                  Seriously. That argument was labeled as “mansplaining”.

                  As I said, the phenomenon is real. But it is only a useful term if it isn’t expanded to “every time a male sets out his position to an intelligent female, even if he actually may be right”.

                • Dilan, the problem with your earlier complaint is that you claimed it was *way* overused (not that over/misuse was *possible* or even that it happened in *such and such* a case).

                  Your assertion of overuse was backed by exactly nothing but a serious of cases where you feel it was misused (primarily) on you.

                  Doesn’t that seem…unhelpful at best?

                • Bijan, I will concede “way” may have been an overstatement. I really can’t back that up without doing a study of all of its uses.

                  I have been in several situations where it has been overused. (The breastfeeding example was the one I remember because I was basically making an argument that tons of feminists have made, before and since, and was being called a mansplainer for it by women taking the “breast is best” position.)

                  So in that sense, I think Funkula’s claim that category 5 only involves “straw” feminists is incorrect. It does get overused.

                  But I’m totally open to the argument that is is correctly used 95 percent of the time and incorrectly used only a small percentage of the time, or whatever. As I said, I don’t have the data on this one– only some personal experiences and observations.

                • BTW, for what it’s worth, Kevin Drum agrees with me:

                  http://www.motherjones.com/kevin-drum/2014/04/can-we-please-ditch-splaining-meme

                • I have been in several situations where it has been overused. (The breastfeeding example was the one I remember because I was basically making an argument that tons of feminists have made, before and since, and was being called a mansplainer for it by women taking the “breast is best” position.)

                  But…using an argument made by tons of feminists doesn’t remotely inoculate you from having mansplained in that instance. Indeed, it’s a bit of a flag. (A canonical manplaining situation would be making a feminist argument to a feminist who was well aware of that argument.) I can’t tell whether it was applied correctly to you in that case since I wasn’t there, but…dude. You obviously have a strong interest in “mansplain” being false of you. You also, er, sometimes come across…a bit much or a tad condescending. Don’t you think it’s possible that, in fact, you were manplaining a bit? Or reasonably assessed as such?

                  As for Drum, I have a big “meh”. Whatever harm the memification of “splaining” might have done, it’s highly likely to be dwarfed by the importance of calling out the phenomenon, naming it, sharing it, denigrating it. I mean, people have complained about oppressed classes whining for forever. I don’t see the value in bashing it. And if I were, as I am, a highly priviledged person, I would certainly not let my personal pique or annoyance at a term let me write a whiny, nasty rant against it.

                  I mean, *really*. The worst part is that there’s no attempt to preserve the benefit of it or acknowledge the real and ongoing bad of the phenomenon. Here’s Drum:

                  I get that it’s a useful term, but it’s gotten out of hand. Obviously we should all be careful when we talk about things outside our personal experience, and nobody gets a pass when they say something stupid. Still, we should all be allowed to talk about sensitive subjects as best we can without instantly being shot down as unfit to even hold an opinion.

                  Really, Kev? REALLY? First, that’s not what “mansplain” does! Second, why should everyone (esp. dudes like Kevbo) be preserved from being tarred as a mansplainer? How does this compare to the way marginalized people have to constantly endure their marginalization?

                  It’s just fucked.

                  The splaining meme is quickly becoming the go-to ad hominem of the 2010s, basically just a snarky version of STFU that combines pseudosophisticated mockery and derision without any substance to back it up. Maybe it’s time to give it a rest and engage instead with a little less smugness and narcissism.

                  I would let this stand as it’s own refutation, but apparently that wasn’t sufficient. Suppose his analysis is true (which I so don’t believe; he doesn’t even provide your level of paltry evidence). Isn’t the problem with that that it detracts from the *real phenomonen which he and you acknowledge exists*? But that has just disappeared.

                  This is the second big problem with your original thread which is reiterated here: Not only did you make a wildly unsubstantiated (and in the original thread, went for truly messed up “statistical” reasoning) claim, but it’s one that is fundamentally undermining of people dealing with real and pervasive problems (i.e., being mansplained to). Ok, we get rid of the term…how do we keep focus on and combat the phenomenon? (I don’t think saying that the pheonomenon which is almost certainly more widespread and damaging that being wrongly accused of mansplaining isn’t nearly as widespread as the misuse (whether directly or by implication) is a good start.)

          • sharculese

            He’s unbearably pompous, and I had forgotten about the mansplaining thing, but he never acts like he’s the victim here.

            • Er…he recently made a “because you all hate me you make crappy arguments” comment. The facade is cracking!

              • junker

                This seems to be becoming his go to move – if people refuse to accept thr brilliance of his arguments, switch over to complaining about snark or how mean people are.

                • I don’t mind people disagreeing with my arguments or calling me full of shit. I do mind, somewhat, people calling me an idiot without even bothering to answer my arguments.

                  But to be clear, this is a fricking Internet comments thread. There are no victims here. Personally, I’d rather be engaged than belittled, and I suspect that’s how most people feel. I also tend to think that people belittle other people on the Internet more often because they DON’T have good arguments than because they do. (That’s part of my critique of snark.) So I think an Internet with less ad hominem and more substance would be a good thing.

                  But I am a grown-up, not a victim. If people enjoy bashing on me, that’s their right, and I’m glad I live in a country and use an Internet where people have the freedom to do that if they want to.

              • That’s not really what I said. I said that some of the people who disagree with me move right past the argument stage to the call me an idiot stage.

                • (And to be clear, note that Scott engages me on the merits. He doesn’t call me an idiot.)

                • Was this not you?

                  Part of the problem here is that you guys hate me so much that you basically believe that it’s OK to twist my statements to make any sort of snarky point you want. If you want to argue that way, that’s fine. But it means you aren’t seriously engaging points; you are just jacking off.

                  Isn’t what I wrote a reasonably accurate paraphrase?

                • No, it isn’t. I didn’t say “people make crappy arguments because they hate me”. I said people misrepresent what I say because they hate me. Those are two very different things.

                  I really don’t react the way you think I do to crappy arguments. But I don’t like being misrepresented at all.

                  Look back at that thread. Somehow “we can’t know what would have happened to the vote count if Clinton had vetoed DOMA” (which I I actually think is a pretty uncontroversial point) was turned into a bunch of claims I never actually made.

                  At any rate, Scott isn’t arguing against straw men. He’s not using me as a foil to engage in contentless snark. He’s ENGAGING MY ARGUMENT. He’s saying why he thinks I am wrong.

                  People have the right to spend their time any way they want to. But I am saying there’s a big difference between what Scott does and what some of the commenters here do.

                • No, it isn’t. I didn’t say “people make crappy arguments because they hate me”. I said people misrepresent what I say because they hate me. Those are two very different things.

                  Well if we’re going to split hairs you said that because they hate you they twist what you say *to make a snarky point*. How is this anything but making a bad argument?

                  Anyway, my main point is this “people hate me” part is a bit of whine. So whatever “people hate me so they twist my words” is fine.

                  But I sincerely donut that people hate you. They just think what you write is silly and make fun of it. Sometimes you are unclear at best. Sometimes (as with the mansplaining) you wildly overstate (and double down on that). Still others you hold a sort of skeptical position which happens to let you get away with a fairly outrageous claim. After a while, I, for example, just don’t care to get to your exact preferred interpretation. It’s not worth it.

                  Your “uncontroversial” claim was less so than you think esp in context.

                • Oh fwiw I empathize with your allergy to misinterpretation. I’ve a bit of that myself. But I don’t think it excuses reckless speculation about people esp when there’s far more likely explanations ready to hand.

                  Cf your accusing Scott of being driven by partisanism

        • As I sort of implied in another thread just a few minutes ago, sometimes his idiocy is useful. Not always. Probably not often. But sometimes.

          • Personally, Dana, I’d have more use for you if you either (1) engaged my arguments or (2) ignored me if you think I’m an idiot.

            Repeatedly calling someone an idiot isn’t argumentation, it’s masturbation.

            • junker

              Uh oh, here comes snark police mode!

              Tell us more about statistics Dilan. We will appropriately stand in awe of your genius.

              • Junker, he has the right to call me an idiot. As do you.

                But calling me an idiot isn’t the same as refutation. If you are calling other people idiots on the Internet, it is because that sort of thing makes you feel good, rather than because you have bothered to refute their point.

                I’m not policing anything. If Dana thinks the best use of his time is to belittle a person’s intellect, nobody’s stopping him. I’m just pointing out that he isn’t, actually, proving anything by doing that.

                • If you are calling other people idiots on the Internet, it is because that sort of thing makes you feel good, rather than because you have bothered to refute their point.

                  I’ve countered this before, but maybe it’s worth reiterating: This isn’t always or perhaps generally true. Sometimes you call someone an idiot because you have already refuted their point over and over again and they’ve not taken it on board.

                  For some of these discussions I, personally, feel like you are strongly insensitive to actual strong refutations or undermining of your point (take for example the “leftism has different priors” bit). It’s not just that you don’t concede, but you don’t (to my eye) adjust to deal with the objections.

                  Now, it’s obviously possible that the problem is me and not you. I have considered that, but don’t find it wildly plausible :)

                • junker

                  The reason I don’t really take you seriously anymore is that you think that people who don’t agree it’s because they don’t understand your incredible arguments. It’s like arguing with a rock that has a stick up its butt – your arguments are flimsy, and when people call you on that, you accuse them of not getting it or not answering or whatever. When faced with this I, and others, choose not to take you seriously anymore.

                  Then you respond with stuff like this – obviously it can only be true that reason people don’t take you seriously is because they don’t get it and have no way to refute your brilliant points. So you move into policing the debate mode, complaining about how people insult you and twist your arguments.

                  There are a lot of people on this board that I am happy to engage with. You, I think, are a dishonest hack and so I skip the pretenses because it’s not worth it.

                • You guys have every right not to take me seriously. You guys have every right to think I am an idiot. And you guys have every right to call me an idiot.

                  And further, take note that Bijan’s comment, rather than calling me an idiot, identifies specific things that he thinks are wrong with my comments.

                  All I am saying is that “you’re an idiot” isn’t an argument. That doesn’t mean there aren’t actual arguments, even good ones, against the positions I take. “You’re an idiot”, though, is not one of them. You can still say it if you want (and Dana, in particular, seems to love to say it). But it’s not an argument.

                • All I am saying is that “you’re an idiot” isn’t an argument. That doesn’t mean there aren’t actual arguments, even good ones, against the positions I take. “You’re an idiot”, though, is not one of them. You can still say it if you want (and Dana, in particular, seems to love to say it). But it’s not an argument.

                  And no one ever has claimed that it is. But you don’t merely claim that you claim that people offer these non argument because they don’t have arguments. My point is that folks like junker (and me!) are saying that that’s not the reason (at least in our cases). Why you keep insisting that this is true, I’ve no idea. It looks silly and doesn’t make it less likely that people will stop reacting that way.

                  (And really, did you think either junker or I think snark is argument? This was exactly a non responsive answer that I think is very problematic on your part. I used to find it a bit enraging, but I’ve mellowed a bit. Now I just cluck my tongue and shake my head.)

              • junker

                This. Your very constant refrain “You’re not debating me, it’s just masturbation” implies that the reason people snark you is because they can’t handle your brilliant arguments and towering intellect. I do it because I no longer think you’re worth engaging with intellectually.

                Also, I can’t say I’m a fan of your new strategy – the put upon victim. This whole “you can call me whatever you want, all I want is for people to debate me” doesn’t suit you well. The victim thing only works when you haven’t established yourself as a grade a horse’s ass.

                Also also, your other strategy – try to identify reasonable commenters and set them up as opposed to people like me. Scott and Bijan and basically every regular on this board has snarked you hard at this point dude. Scott did it in this very thread. I’m not sure why you think it would effective to try and puff up some of these commenters as reasonable people who engage when pretty much everyone has done what you claim to deplore.

                • junker

                  Whoops, this was meant to go in the longer subthread after Bijan.

                • Yeah, and an interesting thing: The fact that I “identif[y] specific things that he thinks are wrong with my comments.” gets me bubkas. Not even a reply :)

                  So, why *shouldn’t* just snarkply from now on?

    • jb

      My guess is that the reason that Scott focuses much of his ire on Naderites and people like Dylan is because, in great measure, the criticism is coming from his side of the political spectrum.

      We expect people like the Blue Dogs, Joe Lieberman John Boehner, Ted Cruz, the Republican party et al, to come up with breathtakingly stupid arguments, and to obstruct and oppose anything even mildly liberal. Those guys are lost causes, and it is pointless to expect anything better from them. But when people who are basically on the same end of the spectrum that Scott is, and who really should know better, start attacking the ACA and the Democratic Party it becomes rather harder to take. It is often quite frustrating because I actually agree that the ACA is not exactly the ideal health care reform, and that the Democratic Party and (and American politics in general) are too conservative. But the loudest criticisms from this quarter seem to be completely unaware of the various constraints that the American political system imposes on the President and the Democratic Party, and the alternatives they suggest for how a better reform could actually get passed are completely unrealistic.

      In short, people generally expect their political enemies to oppose them and take potshots at them, but when those shots come from their allies, people tend to be especially upset. It is much harder to take an erroneous or stupid argument from someone who is frequently on point, and who claims to be on your side, than it is to take one from someone who you know is an idiot.

      • jb

        By the way, this is not by any means exclusive to the center-left, or to the Democrats. The split between the “establishment” Republicans and the Tea Party people is astoundingly bitter, and one will often hear them denouncing each other as ferverently, or even more ferverently, as they denounce the Democrats. This is especially remarkable given that there are no significant policy differences between them!

        • I rarely giggle. But yesterday, reading Palin’s attack on Ryan…

          • Aimai

            You giggle? That sounds kind of…horrifying.

            • And they all moved away from me on the Group W bench…

            • JHWH

              To mortal ears, it’s indistinguishable from bearsplaining: “RRRRrrrrrrrRRRRRR.”

              Well, maybe a bit more in the tenor range.

      • jb

        Sorry, there should be a comma between Lieberman and Boehner.

    • Scott Lemieux

      Evan Bayh or Ben Nelson or Joe Lieberman

      I’d have to say that if anything is true of this series of posts, it’s that these gentlemen are never blamed for anything.

      • Malaclypse

        We’ll never know, because you Never. Even. Tried.

      • I blame them for the bus service in Albany.

        • Lee Rudolph

          I thought that was the fault of the Centralists?

        • Pat

          Why not blame Canadians?

          • Lee Rudolph

            Perfidious Albany!

            • N__B

              Very nice.

        • Glenn

          I’m pretty sure the problem is DeBlasio stuck in the undercarriage.

        • Scott Lemieux

          If Joe Lieberman ran the CDTA there would be one bus that ran between Niskayuna and Clifton Park* twice a day.

          *For those unfamiliar with the area, these are actual suburbs, as opposed to the urban areas well-served by public transportation that N_B considers suburbs for incomprehensible reasons.

          • N__B

            Your experience of the CDTA and mine differ.

            • Scott Lemieux

              Well, it’s a fact that a bus runs down Central every 15 minutes during peak times and every 30 well into the night. If you’re saying that it’s difficult to get to some neighborhoods from others at certain times, this is true of all transit systems. Try to get from Astoria to Park Slope after 11 some time; bring lots of reading material.

              • N__B

                It’s a fact that on multiple occasions I’ve waited over an hour for that every thirty minutes. They don’t keep their schedules.

                • Scott Lemieux

                  Have you used the new stop-by-stop app? Do you know that if you’re going to Central and Quail there are three bus lines that get you within easy walking distance?

                • N__B

                  No. Yes.

                  I don’t drive and I don’t like taxis, so I walk and take mass transit everywhere I go. I have had consistently worse experiences with the CDTA than with any other small-city transit.

                  Like I said, your experience with this and mine are different.

                • Manny Kant

                  I demand more flame wars over public transportation in various state capitals!

  • smarks

    Re: the millions of people who have insurance (or better insurance, e.g., me) because of Obamacare vs. S-Chip expansion only, you need to HEIGHTEN THE CONTRADICTIONS!

  • wengler

    Can we possibly hope that ‘ACA isn’t the Republican plan!’ posts have permanently displaced the ‘Nader is history’s greatest monster!’ posts?

    • Aimai

      Gosh, I hope not, because I love tradition.

      • pete

        More dead horses!

    • James E. Powell

      I was hoping the Nader posts would be permanently replaced by first round pick running back posts.

    • We can always hope that Nader goes on a tear about how the ACA proves that there’s no difference between the parties since the dems just pass corporate oriented Republican plans while ignoring the opportunity to expand civil liberties by joining forces with marginalized but principled Republican figure like Rand Paul.

      • DrDick

        I keep hoping Nader will incapacitated by a coronary. In the early 70s, he was saying important things, but has rapidly descended into self parody and now represents the worst form of political concern troll.

  • PhoenixRising

    Shorter Dilan: It would have been better for my cancer to be not quite treated than for my individual (ACA-compliant) insurance policy to pay for my care at an NCI clinic that does research. If that cut 5-35 years off my life, well, it would be worthwhile to heighten the contradictions.

    Dilan, let me be the first self-employer customer of the conservative private insurance system you would prefer to leave unregulated to say it: Grow up.

    Also, you just failed Public Policy 210. Please write ‘A program for the poor is a poor program’ on the board until your arm hurts, or until you understand how that most fundamental maxim (one might even say ‘cliche’) of political science applies to SCHIP and public health clinics.

    • DrDick

      The living embodiment of that maxim is the Indian Health Service (full disclosure: my son was born in one of their hospitals).

    • If you guys stop touting the Medicaid expansion, I will stop talking about S-CHIP. They are both programs for the poor.

      And I’ve never denied that health insurance pays for some needed treatments. On the other hand, there are horror stories of people who thought they were insured until they needed it. Forcing more people into private insurance is likely to increase that problem (especially given that many of the Obamacare (not ACA, it’s Obamacare, even the President calls it that– if you must use an acronym, it’s PPACA) policies have narrow networks).

      • Scott Lemieux

        If you guys stop touting the Medicaid expansion, I will stop talking about S-CHIP. They are both programs for the poor.

        Except, of course, that none of us oppose S-CHIP, while you do in fact oppose a Medicaid expansion that will cover many more people until the Magic Pony Act of 4545 comes along.

      • DrDick

        I like both. S-CHIP is the only reason large numbers of children here in Montana get medical care. I would be happier still if their parents could, but our (Democratic) governor is on the fence about it. Single payer (or better still NHS) would be far superior, but no way the Republicans or Democratic tools of the insurance industry were going to let that happen.

      • junker

        On the other hand, there are horror stories of people who thought they were insured until they needed it. Forcing more people into private insurance is likely to increase that problem

        Yeah, what I would have done is designed a strict series of regulations that mandate things like what’s covered, the maximum required payment for a year, etc. Oh wait, you mean they did that?

        (especially given that many of the Obamacare (not ACA, it’s Obamacare, even the President calls it that– if you must use an acronym, it’s PPACA) policies have narrow networks).

        Dilan: I’m not the debate police. However, I am going to try and set the terms of the debate and also complain when you use phrases or words I don’t agree with.

        • This new “don’t use ACA” bit really cracks me up. Seriously, Dilan, this has to be one of the most silly and pointless moves you’ve ever made. There’s absolutely nothing at stake and yet you are completely in the wrong. “ACA’ is in common use. Deal dude.

  • I work in the healthcare trenches, and from my perspective the ACA will make an enormous difference to many of the kids I take care of. The most dramatic improvement I see is for the population of families who made too much money to qualify for Medicaid but were still quite poor.

    Also, the old Medicaid covered children, the disabled (which included many elderly), and pregnant women. Under the new Medicaid low income, non-disabled adults can be covered, too. This is huge.

      • Aimai

        Yes, absolutely huge. I am not shocked to discover that a whole lot of people–especially right wingers–have always believed that medicaid was covering, basically, everyone (the moochers!) rather than being an example of state by state brutality, covering a very limited number of people for strictly limited amounts of time. You’ve got to love covering “pregnant women” as though they cease to have health needs just as they burp out that cute little baby! And no coverage for general impoverished single men and women.

        Online I’ve often encountered people who have just sunk to the level of needing medicaid who are completley shocked to discover there’s no safety net. They were sure it existed. They were told it was generous. Like those right wingers who say that we pay 50 percent of our taxes in foreign aid and welfare transfer payments. These are people who are innumerate and couldn’t be bothered to ask themselves how likely these outlays were given the kinds of people we have been voting for all these years.

        • I have encountered many, many families under the old system in which the kids had healthcare via Medicaid but the parents didn’t have any health insurance at all. Well, the mother did — as long as she stayed pregnant.

    • The prophet Nostradumbass

      What I do know is that I now qualify for Medi-Cal, where, before the ACA, I couldn’t get any goddamn insurance at any price.

      • anonymous

        Are you still awaiting acceptance? Mine finally came through as of 4/1. I applied for Covered-California in December, was defaulted based on income (yeah poverty) to Medi-Cal and have had to wait for my county to process me for managed care. My first visit to a doctor in years happens Monday.

        • Aimai

          Blessings on you. Hope it goes well.

      • My business went in the NY exchange (named the “New York State of Health” to encourage vomiting) and came out the other end with better coverage, lower deductibles, and a 15% reduction in cost. We had been offering a pretty good plan before and now we’re offering better.

        Makes it, you know, easier to hire and retain good people.

      • junker

        DocAmazing usually pops up in these threads to complain about how much Californians got screwed by the ACA. Glad to see that’s not universal.

    • Amen. The bridge too far for social reform in America since before the New Deal was covering the “able-bodied poor.” Unemployment Insurance, Social Security, Medicare, Disability Insurance/Worker’s Comp, Medicaid, AFDC, EITC – all of these programs excluded “able-bodied” adults without children. The one exception is Food Stamps, hence why that program has increased dramatically.

      But with ACA, in any state that agrees to the expansion, the able-bodied poor and near-poor now have health care as a right.

      That’s epochal.

      • Also, it’s quite possible that over the years, a lot of people will have been covered by Medicaid, especially when they were in their 20’s. People just out on their own, often living with roommates or still at their parents (but not covered by their parents), I expect a lot of people will be covered by Medicaid for a year or two before they’re earning more. So over time, the fact that people currently on it include a lot who are working will change the perception, especially as more people look back at a time when they were working and were themselves beneficiaries of Medicaid.

        • N__B

          Unfortunate counter anecdote: Craig T. Nelson.

        • Pat

          Let Paul Ryan be the exception to your rule.

        • Absolutely – I am one of those people.

  • TT

    All of this assumes that these penny-ante reforms would have passed.  If you try to do much less than the ACA and don’t even get that, the fail becomes truly epic.

    It is simply impossible to emphasize this point too much. If you really believe that McConnell (like Dole ca. ’93-’94) would all of a sudden have decided to help Obama, Reid, and Pelosi pass a couple of small-bore healthcare reforms in exchange for abandoning the ACA, then you probably also believe that it really and truly was Santa who ate the cookies and milk you left out for him on Christmas Eve.

    • Lee Rudolph

      That’s cookies and whiskey, kid.

    • Pat

      No, you would be Rahm Emanuel.

  • different anon

    I don’t really understand what he’s saying. The Democrats did in fact try to extend the reach of public sector health care, did they not? Medicare did expand. The House bill included the public option, which may have been the beginning of the end of private health insurance companies – is that anti-corporate enough? But Obama gambled away his 60th vote in the Senate by appointing John Kerry Secretary of State and with the election of Scott Brown the House bill was dead.

    I think it’s fair to criticize Obama for that. But is Dilan saying that after the Dems lost the ability to break a filibuster in the Senate they should have focused on pushing through the most left-wing/anti-corporate parts of their proposals, and that they would have passed? That the 2010 Republicans would have been more receptive to this than the ACA or the House bill? That’s not even wrong, that’s a fundamental misreading of the political situation, of what actually happened and what was actually possible.

    • different anon

      Oh wow, I completely misremembered what happened. The election was for Ted Kennedy’s seat, not John Kerry’s. Disregard that!

      (But the point remains that the Democrats lost their 60th vote with Scott Brown’s election.)

      • Aimai

        Also the holding up of Al Franken’s seating. The whole debacle was as close to a coup as I had ever seen IMHO. The refusal to seat Franken was like a complete attack on the Democrats and you knew the republicans weren’t going to give an inch.

        • It’s worse than just Franken wrt the supposed 60th Democratic vote. Franken wasn’t seated until, iirc, May. For much of 2009 either Kennedy or Byrd was sick and unable to make it to the floor to cast a vote. Specter started out the year as a Republican. Ben Nelson was a POS, especially after the student loan bill took away a bunch of jobs in Nebraska related to screwing over student loan debtors. And when every Democrat was there, after Franken was seated and Specter switched and even if Ben Nelson was on board, the 60th vote wasn’t by a Democrat, and not by someone who even supported Obama in the election. It was held by a jerk who publicly supported John McCain for president.

          I know most people here know all this, but I find it still slips peoples’ minds just how tenuous it all was, how getting even what we got required everything to be in place, and how small a window there was for getting the ACA passed. I think the number of days when there actually were 59 votes + Lieberman was only around 100 days, and that included days there was no business happening in the Senate.

          The Senate Dems in 2009 not reforming the filibuster was probably the biggest unforced error by Dems since LBJ escalated Vietnam. [I don’t blame Reid for that, btw, but the institutional conservatives, like Byrd, Inuoye, Levin, Leahy, etc.] But if you stipulate the need for 60 votes, the fact that the ACA got through is nearly miraculous.

          • Scott Lemieux

            he 60th vote wasn’t by a Democrat, and not by someone who even supported Obama in the election. It was held by a jerk who publicly supported John McCain for president.

            This can’t be emphasized enough. Because of Connecticut’s unusual election laws, a blue-state senator did substantially more damage to the bill than any red-state Democrat did.

      • Yeah, i’d blame the Grim Reaper and Martha Coakley for that one. Though it did ultimately get Elizabeth Warren in.

        There was some worry when Obama appointed Kerry, but it turned out all right; we ended up with Ed Markey in the Senate, which I think was actually a step up from Kerry.

  • Manju

    Yeah….this was just a colossal failure. Spectacular even.

    And the irony is too much to bear. Kennedy, in his final years, does something decent. Standing up to Hillary Clinton’s “southern” strategy, he endorsing Barrack Obama. His greatest wish becomes the the new president’s signature issue.

    Kennedy dies and the incompetence that follows is so jaw dropping that you figure Dems tried about as hard to win as Ted did to save Mary Jo’ s life.

    In an apparent nod to the John Stennis faction (Brown v. Mississippi ) they choose a former prosecutor with no sense of decency. Satanic fucking ritual abuse!? Hey, lets run Mike Nifong! People trust him!

    So predictable Cloakley looses and what’s the repercussion? HCR is in full debate and that seat represent the final vote needed to overcome the filibuster.

    John Stennis indeed.

    • Manju

      i meant to reply to “different anon”.

    • Aimai

      Actually–the Top Line Dems approached Kennedy’s wife and begged her to run but she wouldn’t. They did not want Coakley but she put herself forward and no one with better name recognition came forward. The placeholder they had put in for Kennedy had pledged not to run in his own right (that was a typically grand gesture that backfired). Coakley sucked but the Republicans were running an entirely spite filled national election while the Mass dems were complacent. Not the fault of the Senate Dems or Obama.

      • Wasn’t just Coakley. Emily’s List had a big role in all of that too.

        • snarkout

          Emily’s List has flubbed some things pretty dramatically over the last few years (I’m thinking particularly of funding Nikki Tinker to run against Steve Cohen in Nashville in 2008), but I’m not sure Coakley can be laid at her door. As the gubernatorial race in Massachusetts going on now shows, she’s very strong in primaries, despite being the single worst campaigner in a major race I’ve seen since Kathleen Kennedy Townsend.

          • Pat

            You have to remember that no one has a perfect winning streak. Emily’s List does very good work, but they will occasionally pick a lemon. Be realistic.

          • They backed her, which affected her fundraising and the fundraising of her primary opponents. They shouldn’t be blamed at all for her crappy campaign–I know they had people trying desperately to get that campaign going in the right direction before it was widely known she was in trouble–but they played an important role in her ending up the nominee.

            • Aimai

              This seems like a weird complaint. Yes, people who are engaged in politics tried to pick a candidate they could rally behind in what appeared to be a shoe in election. I preferred Capuano, myself, but he was about to run a campaign based on a very parochial, penny ante,almost big city pol style “friends of friends” model. I don’t think anyone local could have overcome the burning desire of MA independents and republicans to see themselves as waging the last chance in a holy war against the Kennedys and Obama and the Dems. It was like a perfect storm of MA democratic voter complacency and spite voting rage on the right. Coakley was awful but the headwinds were very strong against any democratic candidate in that election because the right wing cared more. They had literally nothing else to care about.

              • Where did I say or imply it was a “complaint?”

                And it took a spectacular failure by Coakley and a nearly perfect campaign by Brown to pull that off. Capuano would probably have won the general easily.

          • Sarcastro the Munificient

            (I’m thinking particularly of funding Nikki Tinker to run against Steve Cohen in Nashville in 2008)

            Memphis

      • Manju

        They did not want Coakley but she put herself forward and no one with better name recognition came forward.

        This is remarkable. A refractively safe Senate seat in a famous bastion of liberalism and no one with more gravitas than Coakley is around to claim it?

        Pull Dukakis out of retirement. Kitty even. Bill Weld could’ve switched…he’s a Rock Rep. Tom Brady, i don’t care…anyone! How could the bench be so shallow?

  • Dilan Esper’s argument doesn’t make sense on its face – the ACA has massively expanded public health care, in the form of the Medicaid expansion of ~15 million people (which would have been 21 million if not for the Supreme Court).

    But SCHIP? SCHIP is not as radical as Esper seems to think it is – SCHIP is structured as a block grant, not a categorical program. This flexibility means that in only 7 states, 5 territories, and D.C is SCHIP a straight expansion of Medicaid – in 15, it’s a separate program, and in 28 states a joint program; only about 28% of SCHIP enrollees are in Medicaid – many of the rest either have subsidized private health insurance or public-private partnerships.

    So I don’t see why SCHIP is more progressive than Medicaid expansion.

    • Aimai

      Its not. Maybe Dilan thinks that the community hospitals which were actually IN the ACA because of Bernie Sanders were not in there?

    • Hogan

      Yes, but the Medicaid expansion was not the essence of the ACA, because reasons.

      • junker

        Oh God I forgot about that. Conceptually severable. I’m dying over here.

    • Hey, Steven, can you direct me to something that clearly explains how SCHIP works, and why there are all those variations?

      • DrDick

        It is a block grant, so the states get to set up their own guidelines and policies, within broad parameters.

      • The Wikipedia page handles it pretty well – basically, making SCHIP a block grant to the states was the GOP’s quid-pro-quo for allowing passage, and block grants allow states to design whatever program they want. There are certain standards for coverage, etc. but how you get there is up to the state.

    • Scott Lemieux

      So I don’t see why SCHIP is more progressive than Medicaid expansion.

      Because it wasn’t Barack Obama’s policy. There’s really nothing else there. Esper himself didn’t believe this bullshit as of a year ago.

      • junker

        I’d like to call attention also to the fact that Dilan says he’d be happy with minor incremental improvements to the healthcare system while also complaining that Obamacare is only an incremental improvement on the old healthcare system.

        Notice that he judges Obamacare against the metric “Does this reform provide free healthcare for everyone?” while ignoring that metric when talking about an S-CHIP expansion.

  • Anonymous

    Believe me, Obama knew what he was doing. He wants national healthcare aka single payer. Ocare is designed to suck and eventually fail, paving the way for a single payer system. If it didn’t suck, the individual mandate wouldn’t be necessary, because even though republicans lie about it, 7 million have it and they will eventually talk about it, and people will believe their neighbours who actually have the insurance over politicians who lie and say it sucks. Then more people will have it, and talk about it, and eventually most everybody will have it, because it doesn’t suck. However, if it sucks, the only way to get people on it is to force them by mandating they have insurance and removing better options.

    • witless chum

      Or the mandate was about buying off the insurance industry hacks in the Senate.

    • junker

      The mandate is about people in my cohort – young and foolish. You can’t have an insurance system without some kind of mandate.

      • panda

        Right. The only thing better than a really good and cheap insurance, is no insurance at all with a guarantee you will have one when you get sick. Has to be a mechanism to obviate that in any system.

      • IM

        public insurance systems tend to be mandatory too.

  • ThesEus

    Obama could have had single-payer if only he had been willing to Lead with the Power of Leadership.

    • junker

      It has so much more gravitas with italics. If only Obama knew how to speak in italics.

  • Anonymous

    Sure, he could have went straight to single payer, but mid right and center resistance would have been a little stiffer, and mid left and center support would have been softer. This way, you create sucky Ocare, republicans resist like hell, Ocare fails after implementation, dems blame republican resistance, say single payer is what they want and everything that sucks about Ocare is republicans fault because the sucky parts were concessions to them.

    • ThesEus

      It doesn’t matter how stiff are Republicans or how soft are Liberals. He could have triumphed over even the most throbbing resistance regardless of how flaccid the support was on his left flank. Then, at least, he could stand erect and swollen with pride.

      All he had to do was touch rings with Michelle and say “Leadership Powers, Activate!”. Boom! Single-Payer DONE AND DONE.

      • Pat

        heh heh. +1

      • IM

        He is dependent on Michelle?

        What a beta-male.

  • joe from Lowell

    But if you believe that the liberal goal is providing everyone with a product called “insurance”, rather than incrementally increasing the reach of public sector health care, then Obamacare is more “liberal”.

    Dilan’s got you there, Scott. You seem to think that getting people health coverage, rather than expanding the scale of government for its own sake, is some sort of liberal goal.

    Sellout.

    • Basically, I do believe that all of our problems in the health care system are caused by people making a profit. Communism is the correct policy in this area, because of all the market failures involved.

      • Scott Lemieux

        That’s nice, but since you would have to be a complete idiot to think that an unprecedented total nationalization of the American health care industry is going to happen in the foreseeable future, among the relevant alternatives you favor much less regulated insurance profiteers and many fewer people covered by public insurance. So, and not for the first time here, your argument is self-refuting.

      • But…this is a super stupid belief which is belied by the NHS, and basically all the other Eu systems (eg the French or German).

        And I understand that many of our problems (runaway costs) are more complex. Someone posted a link to a series that tries to identify where the money goes and what can get clawed back and it’s really not easy.

        (The NHS is not a fully nationalised system. Notably, GPs.)

  • Joe

    Meanwhile, those helped by the expansions that are not covered by the more limited advancements cited by DE would be as noted screwed. Why this isn’t a tad bit cruel is unclear to me. On balance, I don’t see the value of hurting people in that fashion. If net, a weaker set of reforms would be better, fine, but as Scott et. al. suggests, not seeing it.

    It is not like w/o the whole law (PPACA — I just saw that LBJ play .. you know what? He didn’t help pass LBJ-care … making this a damn PARTISAN thing is stupid & that is what using a label like “Obamacare” does … it also takes Congress out of the conversation for some reason … it is all about “Obama”) various other negative stuff that came with the law would not be in place in some form.

    And, with bitter comes sweet … the reverse is true … with sweet comes bitter. You aim lower and you get less (including less messiness with websites etc.) on both ends.

    Finally, one thing DE repeatedly has expressed is his distaste with Medicaid. He finds it a crummy system. See also, a discussion on a blog called BTC News — notably there, the guy relied on Medicaid. He has various beefs with it. But, if the alternative (as it will be for lots of people) is NOTHING — that is, if Dilan Esper’s “let’s go with a much smaller expansion” plan came to pass — what then? Crummy or not, if you need care, getting it matters. And, “crummy” here is a matter of perspective, as many can tell you.

    Anyway, I appreciate that he welcomes such replies from Scott, a reply that is well warranted.

    • junker

      Generally his retort to this is that the ACA is so bad that people woulf have been better off with nothing. He has also consistently shown that either doesn’t understand how the exchanges work or he’s lying abiut then to prove his point (e.g. Acting as though the only plan is the bronze tier with no subsidies)

      • There are higher level plans. But even “gold” plans hit you with huge co-payments. Nothing is close to the British ideal of free health care for all.

        • junker

          Surprise! You don’t know what you’re talking about.

          http://www.healthpocket.com/individual-health-insurance/gold-health-plans#.Uz2KhvldWSo

          However, it is a little bit rich to both complain that we should have killed the ACA in favor of incremental improvements to the healthcare system, and then also complain that the ACA is only an incremental improvement on the healthcare system. Ask the multiple people in this thread who have said that the ACA are getting them care they would otherwise have missed out on whether or not a half a loaf is better than nothing.

          • At this point, Dilan, I feel that you saying this is disingenuous. People have pointed out many times the subsidies for cost sharing measures as well as the fact that preventative services (many, at least) are free.

            Dig up something on average cost sharing burden which takes these into account and you’ll have a point. Otherwise this is exactly the sort of comment that merits nothing more than snark. I mean, how many times must one refute the same false, easily checkable fact?

            (I didn’t redig up links cause writing from phone on train.)

        • Scott Lemieux

          Nothing is close to the British ideal of free health care for all.

          You know what would be even less close to the British ideal of free health care for all? An S-CHIP expansion.

        • Ummm…no. I’m looking at my Silver card right now: Primary Care $10, Specialist Visit $20, XRay/Lab Work $20, ER $50.

          Guess how much it cost me out of pocket when I had to walk myself into the ER pre-Obamacare? $800.

          I think my co-pays went down.

    • Scott Lemieux

      it also takes Congress out of the conversation for some reason … it is all about “Obama”

      Not that I particularly care — policies get identified with presidents like it or not — but Dilan’s demand that people call the ACA “Obamacare” summarizes the many things he fails to understand about American politics perfectly.

      • Greg

        Even if he wasn’t the single most important person involved in passing it, it’s implementation has been and will continue to be most important thing his administration does in his second term. It should be called Obamacare.

        • “ACA” is way easier to type, typically unambiguous, and common parlance.

          Obamacare is fine too. No worries there.

          PPACA is used by almost no one in my experience and is hard to read.

          This is a hill to fight on? Make fun of, sure. But seriously make a repeated point of?

          Whether intended or not this is a kind of trolling.

  • Anonymous

    Young people get sick too. Lots of young people want insurance. If Obamacare is so great, young people will buy it. A lot of young people are on their parents insurance or subsidized as well. And why is it so important to force the youth into health insurance they may not need? If they are not going to use it, why do they have to pay the same as someone who uses the crap out of it? Unless they have to pay in and not use to support the system. If your system requires you to force people to buy something they neither need nor want in order for it to function, it sucks.

    • junker

      Obviously a single payer system requires people to pay for something they might not need or want. This is the only way public health care can work. Everyone has to pay into the system. If only sick people are in the system it collapses.

      Young people and some other types have a delusion that they’ll never get sick or hurt. With no mandate they choose not to buy into the system until they need it,and if everyone does that it collapses. This is why you need a mandate – otherwise everyone waits to buy in until they have to.

      I think you will find it impossible to name a healthcare system that both provides affordable care to everyone and also let’s people wait to opt in until they’re sick.

    • Aimai

      These anonymous complaints are so weird.

      People are not good judges of their own risk, and tend to value some costs more highly than they should. Your first sentences are correct:

      Young people get sick too. Lots of young people want insurance. If Obamacare is so great, young people will buy it. A lot of young people are on their parents insurance or subsidized as well.

      So what follows

      And why is it so important to force the youth into health insurance they may not need? If they are not going to use it, why do they have to pay the same as someone who uses the crap out of it?

      Makes no sense. They will need that insurance, if not by surprise then as they age. The error that you are making, that a lot of people as dumb as you make, is thinking of health insurance premiums as though they are supposed to have a one to one correspondence with a specific health care purchase. Like: why pay for a car when you are a walker. That’s the analogy you are using. But purchasing health care insurance is not purchasing a thing. Its more like paying the mortgage on a house. Doing so entitles you to slowly take over the entire value encoded in the house, over a number of years. It makes you an owner of the house. When you need to sell the house it is your mortgage payments prior to the sale which entitle you to sell the house and recoup the original payments.

      Another way of thinking about it is to say that paying into the system at a young age entitles you to draw from the system at an older age when you definitely will need the coverage. Rather than forcing people to pay into a system they won’t use we are permitting people (with some inducements and sweeteners) to buy into our system at a beginner’s rate. Sure, its higher than it used to be under the older system–but its not higher than it has to be to ensure that when Invincible Youth Moron A ages up even slightly, discovers a tumor, or is in a car accident the money is there to pay for those unforseen events.

      I don’t give a flying fuck about the mandate and in reality most people don’t either. Its just a convenient maguffin or a stick to send the dogs chasing after. But there could conceivably have been other ways to handle it–like sweetening the pot for people who were early adopters, converting it to a new medicare style tax on everyone,with no caps for the wealthy. Things like that. But this hysteria over the mandate is just silly. People who refuse to purchase health insurance are not proposing to never use health care. They are not going to be able to afford to pay for it since they are not part of the insured cohort with the bargaining power of the insurers–but they are not going to stop clogging up our ERs. So absent a willingness for non mandate/non purchasing people to agree to be tatooed and forbidden to suck up our health care, there has to be some way of getting everyone to sign up. Until signing up just becomes mandatory to eliminate the problem of free riders.

      • N__B

        It’s K. Meth- induced comments are going to be weird.

    • Scott Lemieux

      And why is it so important to force the youth into health insurance they may not need?

      For reasons that are entirely obvious if you understand 1)what insurance is, and 2)the free rider problem.

      • Free Rider Problem

        And what if he doesn’t understand me, tough guy? What are you gonna do about it?

  • Anonymous

    Yes, its called the free market. People who want insurance can get it and pay for it. If people can’t afford it, the government can subsidize it for them. Forcing people is not necessary if the insurance offered is better. Nobody doesn’t want health insurance. Many cannot afford it. That was supposedly the problem. Making people pay into a system they may not need until they are 40, and may not be able to afford if they fall through the subsidy cracks is not going to help them at all. And yes, pure socialized medicine involves people paying for healthcare directly through taxes. Obamacare is forcing everyone to pay the insurance companies, then the insurance company takes their cut, then they (might) pay for your healthcare. That drives up the cost of healthcare, because when everybody has to have it, companies can charge more for it, and take a bigger cut, and you can always go without health insurance, if you can afford to re-country.

    • DrDick

      Have you ever visited the real world?

    • junker

      Do you actually understand how the ACA works? People who can’t afford insurance get subsidies under this system. Also, there are a number of controls in place to keep costs down.

      Wait, why am I still engaging with you?

  • Bruce Webb

    What the FirePups never seem to grasp is that the Fail Points for ACA tend to enable Single Payer.

    For example perhaps the biggest potential problem with ACA is that insurance companies will simple abandon certain markets, especially rural ones. In that case ACA already has three programs still in place that can be expanded at whatever pace necessary to fill the gap: Medicaid, Medicare, and SCHIPS. As private insurance moves out Single Payer moves in. Leaving maybe only the Bosses and the Bankers still covered in a way that allows them to get their care Concierge style or in major hospitals in the State Capital. Even as everyone else in small town America is more likely to get their care at the federally funded Community Clinic.

    Now the Public Option would have allowed this in a more direct fashion but then to on a more direct conflict/competition model. Under ACA the government has a mechanism to just backfill those markets which BigInsurance is happy enough to abandon. And to the degree that this leaves the Upper 20 or Upper 10% long term in the employer paid private insurance model so be it. And it is a hell of a lot better than simply abandoning those in the 10-80% bands to the current system as you increment.

    Cover with ACA then convert to Single Payer at the Fail Points.

    • laura

      Excellent analysis.

  • This is what you get when you take quotes out of context.

    I am not saying, and have never said, that Democrats ought not to have the GOAL of universal health care. Gore’s rejection of that goal, in his primary race against Bill Bradley, was a pretty significant step to the right.

    I am saying that the incremental expansion of health care programs may be a better way of achieving that goal than forcing every American to give money to some of the most rapacious corporations on the planet and telling them its for their own benefit.

    As I said in the post Scott quoted, Obamacare is not ACTUALLY universal. It’s quasi-universal. A lot of people still have no health insurance under Obamacare, and this will continue to be the case. But a lot of the people who DO have coverage under Obamacare have it because they have been forced by the government to buy it, and the people selling it to them are not trustworthy actors. So what we are actually arguing about isn’t Gore giving up the goal of universal coverage. Universal coverage isn’t on the table. Obamacare isn’t universal coverage. It’s quasi-universal coverage, and you can’t assume that it will get us to the ultimate goal more effectively than incrementally increasing public coverage.

    • Hogan

      I am saying that the incremental expansion of health care programs may be a better way of achieving that goal than forcing every American to give money to some of the most rapacious corporations on the planet and telling them its for their own benefit.

      “Incremental expansion of health care programs” has been going on for decades. How long are you willing to wait for it to start working?

    • Scott Lemieux

      1)Your attempt to skate away from this contradiction speaks for itself. The policies you now advocate you considered a disgraceful sellout as of last year; nothing is taken out of context. The ACA is at least as comprehensive as Clinton’s proposal, which you count, so that won’t fly.

      2)The ACA increased public coverage far more than the quarter-assed alternatives you propose. And for reasons explained in detail and unrebutted by you the idea that an S-CHIP expansion or minor expansion of Medicare would be a path to an American NHS is transparently wrong.

    • Anonymous

      I am saying that the incremental expansion of health care programs may be a better way of achieving that goal than forcing every American to give money to some of the most rapacious corporations on the planet and telling them its for their own benefit.

      Yes, it totally makes sense that very small expansions of health insurance will cover more people than very large ones.

      Wait…

      And I don’t know whether it’s out of ignorance or mendacity, but you never seem to acknowledge that the ACA has rendered some of the insurance industry’s worst excesses virtually toothless. Do guaranteed issue, minimum standards, and medical loss ratios mean anything to you?

      As I said in the post Scott quoted, Obamacare is not ACTUALLY universal. It’s quasi-universal. A lot of people still have no health insurance under Obamacare, and this will continue to be the case. But a lot of the people who DO have coverage under Obamacare have it because they have been forced by the government to buy it, and the people selling it to them are not trustworthy actors.

      Your argument is incoherent.

      Dilan Esper: Obamacare sucks because it’s not universal!
      Real World: Until the Supreme Court got hold of it, it would have raised the coverage rate to the high 90s.

      DE: It’s the Dems’ fault for relying on Medicaid.
      RW: But your preferred alternative would have covered far fewer people.

      DE: But insureds in the exchanges don’t count as covered because CORPORATIONS!
      RW: They have health insurance where they didn’t before, whereas you would prefer that they hae nothing at all.

      DE: Untrustworthy actors!
      RW: The ACA abolished pre-existing conditions, policy recission, establishes minimum coverage requirements, and requires that all insurers spend at least 80-85% of their revenue on health care.

      DE: MAN DATE!!!!!!
      RE: Where do you think the revenue for single-payer or natinal health services comes from? Taxation is an individual mandate.

      It’s almost as if you have no actual knowledge of Medicaid, SCHIP, the ACA, or life without health insurance in general.

    • panda

      But the major point of the ACA is that it transformed the insurance company business model completely. Previously, in order to make money on the individual market, what they needed to do is to weed out sick people, and then find ways not to pay people when they got sick. Now, when those options are out the window, their goal is to a) draw customers by lower premiums and b) squeeze efficiencies out of the providers. While the former function is definitely a free market one, the latter is basically exactly healthcare bureaucracy’s job is in a single payer system. Now, there is a good case to be made that insurance companies are not as efficient in that task as centralized bureaucracies, but as long as regulation remains strong and the ACA is not watered-down, that is a difference in size, not kind.

      • Scott Lemieux

        Right. As someone said in an earlier thread, insurance companies used to profit by not providing health care and now have to make profits by providing health care. That’s not a trivial difference.

    • “forcing every American to give money to some of the most rapacious corporations on the planet and telling them its for their own benefit.”

      Oh, come on. To begin with: most Americans are already covered by health insurance, either through Medicare/Medicaid/Tricare/SCHIP/etc. or through employer-based covered. Moreover, half of the people covered under the ACA are covered through a public program.

      Finally, the ACA puts hard limits on said rapacity.

  • Anonymous

    Ok, how is there not money from other people in the system who actually need and use it? Why wouldn’t even a young, healthy person who has no insurance not want Obamacare if either he can afford it or its subsidized for him? Why does the system shovel the burden of taking care of sick people on to the healthy? If the only way to support a system is to force people in to it who must pay into it without using any benefits is bound to fail. This is because when these brazen insane youth, who before were content to roll without insurance will try to milk every possible benefit out of it that they can now that they have to pay either way.

    • Anonymous

      Why does the system shovel the burden of taking care of sick people on to the healthy?

      “Hi there!” said every system of insurance ever. “I don’t think we’ve met.”

    • Why does the system shovel the burden of taking care of sick people on to the healthy?

      Why do the living have to bury the dead?

  • Anonymous

    The problem is that healthcare costs so much. Insurance companies managed to cover people without forcing everyone to get insured. How did they do it? Sure, everyone wasn’t covered, but in some instances thats totally ok. The only reason it was not ok is because healthcare costs too much, and individuals can’t pay for their own doctors, because its too expensive. How is forcing everyone to have insurance going to solve the problem of health insurance costing too much?

    • DrDick

      How did they do it?

      By systematically excluding those who need it most or minimizing how much they would pay out. Do try to visit reality someday.

    • Malaclypse

      Because the rest of us remember things like subsidies, and medical loss ratios, and minimal credible coverage. We’ve tried pointing this out to you over and over, but you are either too stupid to understand, or too stoned to remember.

      I vote both, myself.

    • As somebody up to my ears every day in the healthcare biz, this sort of comment makes me want to tear my hair out.

  • Anonymous

    Insurance companies dropping people who paid has very little to do with why the insurance costs so much to begin with.

  • Anonymous

    I fail to see how tearing your hair out will help, but go ahead and try anyway.

    • That’s it? That’s all you’ve got for witty rejoinders?

It is main inner container footer text