The [ACA’s] critics have consistently presented a much louder and more certain attack, and its supporters a more cautious and muted defense, and this has remained the case even though, on virtually every point, the critics have been wrong and the supporters right.
And what’s worse is that it’s not just people on the right who continue to repeat erroneous claims about the ACA. I see Trudy Lieberman is doing the rounds shilling for her disgracefully dishonest Harper’s story on the ACA. Now NPR listeners, and not just subscribers, will “learn” a bunch of lies: that the Medicaid expansion hasn’t reached many people because of the structure of the act itself rather than the Supreme Court and then Republican public officials, that the ACA is increasing the cost of health care rather than making it cheaper, that the current number of uninsured is the ceiling rather than the floor, that the statute passed at the behest of insurance companies rather than in spite of their fervent and expensive opposition. Particularly since the destruction of the ACA would lead to the vastly inferior status quo ante or something even worse than that, Lieberman is collaborating with the ACA’s right-wing opponents, wittingly or not.
Lieberman derides Paul Krugman as a “cheerleader” for the ACA (underlining that the point of her article is not to inform readers or to figure out a way to address the many remaining defects of the American health care system as to congratulate herself for her brave ideological purity.) Only when people read Krugman’s shorter summary of the ACA they will learn much more and what they learn will actually be true.
While we’re here, I don’t think that A.W. Gaffney’s recent Jacobin piece was nearly as objectionable as Lieberman’s. It wasn’t largely devoted to right-wing talking points about the ACA. But it’s still based on two telling related mistakes. First of all, it also yadda-yaddas the Medicaid expansion, a particularly serious problem when you’re asserting that the ACA is devoid of egalitarian commitments. The ACA is neither purely “neoliberal” nor purely left-egalitarian; it’s a compromise between these elements. Which isn’t surprising, since the Democratic coalition is, as it’s always been, a coalition of left-liberals with moderates and conservatives, and federal social programs have always reflected these tensions. Gaffney’s 2014 article is based on a similar mistake: there’s been no “turn” away from support for universal health care. In 2010 as in 1948, there were many Democrats who would have supported a more universal model, and there were Democrats who didn’t, and the votes of the latter were essential to anything passing. Had supporters of more universal care insisted on a more universal model, they would have gotten what their predecessors got under Truman and Nixon: nothing. The left wing of the Democratic Party blowing up the ACA because it was too neoliberal would not in fact reflect a greater commitment to egalitarianism (as I’m sure Gaffney would agree.)
Which brings us to this curious passage:
There are many roads to what is called, often problematically, “universal health care.” Some nations — for instance, Canada — have systems of national health insurance in which a governmental “payer” insures everyone (though the provision of care may remain predominantly private). Other nations have “national health services” — e.g., Britain — where the provision of care is a direct public service.
There is a very curious omission here: hybrid European models that 1)achieve egalitarian health care goals at least as well as British nationalization or Canadian single-payer, and 2)are far more viable endpoints for a better American health care system. If you’re trying to figure out a better path in the United States, policies passed by Westminster-style parliamentary systems is the last place you’d look. If you’re serious about better health care, as opposed to just running down the ACA, you can’t ignore institutional constraints.