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The AHCA and the Future of Universal Health Care

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There’s been a lot of discussion, including here, about Ezra Klein’s essay on how the AHCA has altered the political landscape. I mostly agree with it. While I don’t think he intended a hieghten-the-contradictions argument, though, I wish he hadn’t framed his argument as “if the AHCA passes, the Democratic Party will be committed to universal health care.” This will happen anyway, because even trying to pass the AHCA has revealed the Republican agenda to even the most stubborn apologists:

In fact, universal public insurance will be the consensus Democratic goal whether the AHCA passes or not.

The idea that the structure of ObamaCare would insulate it from political pushback was always based on a lie: that national Republicans would support good universal coverage as long as the market was involved. This has never been true. The Heritage Plan that is sometimes erroneously cited as the basic model for the Affordable Care Act was in fact a plan to replace Medicaid, Medicare, and employer-provided insurance with private insurance that would cover very little. Not only was it nothing like the ACA, in other words, it was an even more radically right-wing plan than TrumpCare. And while the legislation signed by Mitt Romney in Massachusetts was actually similar to the ACA, laws passed by supermajorities of New England Democrats tell us absolutely nothing about what national Republicans support.

Whatever Republicans pretend to believe when it looks like Democrats might be able to pass something, the actual Republican response to the uninsured has always been “tough luck.” The AHCA should stop the denial on this point, and make it clear that the Democrats should forget trying to pass legislation that Republicans can live with and just pass the best legislation they can, which means expanding public insurance as much as possible.

I’ve been howling into the void about this for a long time, but the idea that the ACA was based on “Republican ideas” is not just a lie, it’s an incredibly pernicious lie that has been very useful to the Republican Party. “We want what Democrats want, just with more market and a pony” has been the Republican line since the ACA was proposed. It’s finally been revealed as the bullshit it always was, but why so many liberals were happy to assist their con has always baffled me.

Stopping the AHCA is important, because progress will be a lot easier from the ACA’s Medicaid and tax baseline. Another thing to keep in mind is that while a lot of people act as if having a presidential nominee who favors universal health care is most of the battle, it’s more like 5% of the battle. Getting the consensus necessary to expand public insurance with an eye to universal health care means, inter alia, not preemptively rejecting converts:

First, supporters of universal health care need to be willing to take “yes” for an answer. Two potential Democratic nominees in 2020, Bernie Sanders and Kirsten Gillibrand, favored Medicare For All even before Obama was elected. This is definitely a point in their favor. But what is even more important is creating a norm in which every viable Democratic nominee is committed to universal public insurance. After all, a situation in which the president supports single-payer and 30 Democratic senators don’t like it will not produce single-payer. The left of the party has always favored universal health care, but it’s not enough. Major legislation requires a consensus.

If Congress is ever going to pass universal health care, or even take major steps in that direction, converts are going to be necessary. They should be accepted — and then held to their promises. Klein’s reporting suggests that more and more moderates are realizing that market-based compromises were a sucker’s bet, and this trend needs to continue.

The best outcome for universal health care would be Republicans trying and failing to gut the ACA. I’m increasingly pessimistic, but everything that can be done to stop it should be.

 

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  • Denverite

    The best outcome for universal health care would be Republicans trying and failing to gut the ACA. I’m increasingly pessimistic, but everything that can be done to stop it should be.

    I’m to the point where it’s basically a done deal that the AHCA will pass. There’s no scenario at this point where not passing the AHCA works out better for the GOP than passing it — they’re already going to be tagged with secretly drafting and proposing a hideously unpopular bill; the only thing that not passing it will buy them is a demoralized and angry base.

    The big hope at this point has to be that most of the carnage is pushed off until after 2020 so that President Gillibrand and her majorities in the House and Senate can undo a lot of the horror.

    • twbb

      “There’s no scenario at this point where not passing the AHCA works out better for the GOP than passing it”

      There are plenty of scenarios at this point where not passing the AHCA works out for specific Republican Senators, though.

      • Steve LaBonne

        I agree, I am certainly not willing to give up yet though I’ll admit I don’t like the odds. Only takes 3 who think they have more to lose than to gain.

        • And then McConnell tosses in a couple of bones and it passes.

      • Denverite

        There are plenty of scenarios at this point where not passing the AHCA works out for specific Republican Senators, though.

        Which ones? Which GOP Senators are better off if the AHCA fails than if it passes?

        • tsam

          Yeah, I don’t think we can answer that until the votes are counted in ’18, but the line that got them the entire government was vehement opposition to the ACA. Feels like that’s an article of faith among GOP voters.

        • SatanicPanic

          Maybe Flake or Heller. MAYBE.

          • Murc

            Heller is running scared and should be; he’s hideously vulnerable in 2018.

            • Denverite

              That’s one.

              • twbb

                Murkowski and Toomey are two more.

                • Denverite

                  There’s no way Murkowski or Toomey will buck the party absent a 2018 election. Hell, Toomey for sure would be primaried in 2022 if he did. Murkowski is a bit more of a wildcard since primarying her obviously isn’t a threat (they did it last time and lost anyway), but I still doubt that she’d be the decisive holdout.

                • Lurking Canadian

                  Why not Murkowski? Didn’t she run as an independent last time, after losing the primary to some Tea Party nut? Of all of them, she has the least to fear from her right, and (as I understand it) whereas the AHCA figures to be bad for all Americans, it is uniquely bad for Alaska.

                • twbb

                  As an incumbent Toomey won by less than 2% in 2016; he has more to fear from a general election than a primary one. Pennsylvania is not Alabama.

                • Mellano

                  Reportedly, Toomey is pushing to cap Medicaid ASAP in the Senate bill. Whatever the politics of 2022, he doesn’t sound like a plausible AHCA “nay”.

                  Portman is fighting a proposal from Toomey and conservative Sen. Mike Lee, R-Utah, to cut Medicaid spending by capping federal payments at a rate slower than Medicaid costs are currently expected to rise. Toomey and his supporters believe their plan would help curb the long-term costs of Medicaid. . . .

                  The intense disagreement has also included Sen. Tom Cotton (R-Ark.), who is allied with Toomey, and who recently engaged Portman in a frank and lengthy exchange.

                • twbb

                  Well that’s just idiotic. Maybe Toomey will vote yay but he really shouldn’t if he has any sense of self-preservation.

                • humanoid.panda

                  “There’s no way Murkowski or Toomey will buck the party absent a 2018 election. Hell, Toomey for sure would be primaried in 2022 if he did.”

                  Toomey is to the right of the median GOP senator on healthcare and just got reelected. He is a yes vote. Murkowski is the only GOP I’d put money on voting no for this thing.

                  [As for Toomey’s thinking: he is a) a true believer – former head of Club for Growth. b) if Trump wins in 2020, he is a goner in 2022 no matter what happens now, and if Trump loses in 2020, he is probably a winner no matter what happens..]

    • Alex.S

      Marco Rubio was the figurehead for a failed immigration bill. It might have been a big influence on if he made the leap int the Presidential primary, but it did not hurt him when he was running for re-election.

      A lot of the damage from previous Republican ACA-repeal bills was overlooked because they didn’t pass. They would be better off if this bill failed to pass.

    • Whirrlaway

      If the senate passes a bill, agree that’s a bad thing as far as it goes but it won’t be the house’s AHCA and there will still be some glorious reconciliation to do. Pieface says he wants to get health care off his plate, but with luck they’re just moving on to another fool argument. Seems if he really wanted to sweep it out of sight, he would assign it to committee and let them bioturbate. He’s got plenty of scope to mess with taxes already.

      • nemdam

        You are much more optimistic than me that they can’t reconcile the two bills. If absolutely necessary, the House will pass the Senate’s bill if they need to, and Trump will sign it. There’s no reason to go on the record for a vote if the goal is to not pass it.

    • nemdam

      I’m not optimistic either, but if Democrats are successful in actually forcing a public debate about the both the bill and the secrecy in which it is being written, I actually like their chances. This is how Trumpcare died the first time around because people actually both knew the debate was happening and how terrible the bill is. The problem is even if the Democrats raise holy hell about this*, the media may still decide to shrug or “both sides” it. To me, it basically comes to down to whether or not the media will do its job. Normally, I would be pessimistic but they basically did their job the first time so this fight still has a chance.

      *And it is such a relief that Democrats are actually doing this. Also, if you live in a state with two Democratic Senators, make sure to call them to support withholding consent to force a debate. Most of the pressure has been applied to Republican Senators, but this is your chance to apply pressure to Democratic Senators too.

  • The fact that the Dems put in over a hundred amendments to the ACA to entice the Republicans and they still unanimously voted against it should have been a dead giveaway that the Republicans have absolutely no desire to actually pass meaningful healthcare. Maybe people dying by the thousands who would have lived under the ACA will make that point, but I doubt it.

    • tsam

      It sure didn’t bother them when they voted against it and lied their stupid asses off about it for the last 6 years. The problem is that as long as their voters aren’t the ones doing the dying, no problem. Hell, among them, I’ll bet half would stoically ride their pride into the grave just to be seen not taking a government handout.

      • Yep. And I would be perfectly ok with that if they wouldn’t be taking a lot of good people with them.

      • rlc

        Most of the Trump voters I know take any government handout they can get, including my parents. They really don’t have any principles other than more money for us, fuck you.

        • Linnaeus

          The way this gets rationalized, IME, is through one or more of the following:

          1. I’m one of the good ones who doesn’t abuse it.
          2. I’ve earned it (this is kind of a corollary to #1).
          3. I’ve already paid for it, so why not take advantage of it?

          • so-in-so

            We already had one wingnut congress critter opine that he grew up on Social Security and nobody ever helped him!

        • Rob in CT

          My mom’s the same way.

          The government is an malign, alien entity that takes stuff from you and otherwise hassles you. If you can claw something back, you do it to the full extent possible. This is just you getting something back of what They took from you, the bloodsuckers. Also, she earned it, whatever it is.

          It’s a worldview that makes a certain amount of sense if we were living in, say, medieval Europe.

          • twbb

            Does she allow other people the same latitude for that?

            • Rob in CT

              Other people?

          • It’s a worldview that makes a certain amount of sense if we were living in, say, medieval Europe.

            Give it time. The Trump administration is still young.

          • guthrie

            As an amateur medievalist, not it doesn’t. That really isn’t how people back then saw things. There was just as much of a sense of justice then as now. Especially since there wasn’t as much of a social safety net.

            • Rob in CT

              I wasn’t going for “how did people back then think.”

              I, for one, see a difference between governance by the local noble & his feudal lord the King and a representative* democracy. Thus, viewing things that way (whether people actually did or not) makes a bit more sense than my mother’s view of government here & now.

              * yes, I know. Imperfectly representative.

  • NewishLawyer

    Semi-related to healthcare and corporate accountability but the Supreme Court just made much, much harder to hold corporations accountable especially in the realm of mass torts and/or class actions. They just came down with the 8-1 decision in BMS v. Superior Court (Sotomayor dissenting).

    The case involved a pharma litigation over Plavix (disclosure: I am involved with the plaintiff-side on this case). California’s Supreme Court held that they have special jurisdiction over BMS for the non-Resident plaintiffs and the Supreme Court decided otherwise despite BMS having research and development facilities in California (though nothing suggests that Plavix was developed in California according to the majority opinion).

    There is a certain issue of “respectability” that I’ve been grappling with and mulling about over the past few years and that many people on the center-left seem okay with and/or agree with. This is the dark-side of neo-liberalism which lends itself too much to corporationism. The idea seems to be that working for a large corporation in some capacity or form is good to great but trying to hold corporation’s accountable is nothing more than being a gadfly and this includes the plaintiff’s bar. Until people need the plaintiff’s bar. A lot of non-profit lawyers don’t necessarily help because they can often get funding from the big corporate defense firms and/or consider plaintiff’s lawyers to be grubby because they work within the profit-motive framework.

    Maybe it is the semi-bohemian in me but I’ve never been able to determine why working for a corporation is inherently respectable but many people think it is including celebrations of when a corporation does anything vaguely progressive. PG&E has a large Pride banner on their corporate HQ, I saw it on my way to work this morning. These gestures could be not really translate to relevant action but they always seem to earn big businesses lots of benefits.

    I suspect corporate accountability might be hard for the Democrats to pull off as we get more and more professional voters fleeing the Republicans.

    • LeeEsq

      1. A big complaint of the De Boer/Old Left part of the Left is that corporations often use a thin veneer or even a thick veneer of social liberalism and anti-racism/sexism/homophobia to cover up for their exploitation and other issues.

      2. There is a similar unspoken tension between the not-for-profit immigration lawyers and the private bar immigration lawyers like myself. I guess it comes down to private bar real person lawyers, whether in torts, matrimonial, immigration, criminal or anything else can be seen as exploiting people that need help. Never mind that without private bar lawyers, most vulnerable people would never get any legal help because there isn’t enough money for the not for profits.

    • Denverite

      Grrrr. Longer comment has been eaten several times.

      Anyway, the holding that “R&D presence in the state unrelated to the sale of the drug at issue isn’t enough to convey specific jurisdiction” is hardly unexpected, and I’m a bit surprised that Sotomayor dissented.

      There’s also a huge undercurrent here of SCOTUS slapping down the California Supreme Court for being batshit crazy on personal jurisdiction issues in the past decade.

      • NewishLawyer

        I think Sotomayor realizes what a big gift this decision is to corporate defendants because it does make it harder (though not Three Colors level hard) for plaintiffs to hold corporations liable for smaller-damages injuries.

        But you don’t address my main contention which is that a lot of liberals lawyers still seem to think Big Law is respectable, no-money work is respectable, but being a private practice lawyer engaged in real-person law is kind of gross. Even the best cases are stuck with a veneer of “ambulance chasing/blackmail.”

        I’d like to change these notions of respectability.

        • Denverite

          But you don’t address my main contention which is that a lot of liberals lawyers still seem to think Big Law is respectable, no-money work is respectable, but being a private practice lawyer engaged in real-person law is kind of gross. Even the best cases are stuck with a veneer of “ambulance chasing/blackmail.”

          TBH, I think a lot of this is that a lot of the well-pedigreed liberal lawyers first exposure to “real person” law (at least on the litigation side) involves less-than-savory plaintiffs’ lawyers — i.e., lawyers who don’t really know or care about the law, who don’t have the same shiny baubles on their resumes, and who’s main “legal” strategy is to just get a sympathetic plaintiff and/or unsympathetic defendant before a jury and let emotion take over from there. It’s just a different world from which they were educated and trained, and I imagine they get disillusioned and find it all a bit distasteful.

          [ETA: In case I’m not clear, I’m not saying this reaction is a good thing, necessarily. I’m also not saying that you fall within that less-than-savory plaintiff’s counsel designation. Just trying to generalize what the aforementioned “liberal lawyers” might be thinking.]

          • LeeEsq

            I’m an intellectual type of knows and cares about the law but the people who retain me want results and not abstract lectures about the majesty of the law. I imagine that people who manage to get a not for profit lawyer want results to. No client of any lawyer has ever said “its fine that I lost my case because you demonstrated knowledge and love of the law and that’s what is important.”

            • Denverite

              Oh, sure. I’m just trying to explain why — say — a fourth year associate out of Northwestern who clerked for a federal district court judge for a couple of years before joining Mayer Brown might feel the way she does about “real person” lawyers.

              • LeeEsq

                I suppose so but this type of thinking grinds me because it can end up doing a lot of harm against real, vulnerable people when they actually need the Courts and the law.

        • John F

          ” but being a private practice lawyer engaged in real-person law is kind of gross.”

          That depends on the type of private practice- for instance there really are ambulance chasers out there and they are kind of gross. (not all personal injury lawyers are ambulance chasers of course, which may be your point that they all get tarred with the label though)

      • John F

        I think SCOTUS has started reigning in jurisdiction for a lot of courts, not just California- East Texas for instance was allowed to became patent troll central due to some pretty dubious jurisdiction/venue rules that SCOTUS only recently got around to looking at.

    • Maybe it is the semi-bohemian in me but I’ve never been able to determine why working for a corporation is inherently respectable but many people think it is including celebrations of when a corporation does anything vaguely progressive.

      Because Apple makes really cool stuff, and so if you work for Apple you’re really cool too.

      • NewishLawyer

        The funny thing is that I am not that much of an anti-Capitalist and don’t necessarily mind large corporations/economies of scale. But I always preferred working at smaller companies/firms and also working for individuals as a lawyer.

    • Jon_H11

      The professional classes have thoroughly internalized the norms of meritocracy, consumerism, and individualism. “Respectable” institutions: Fed/state Gov., business corporations, Universities, etc. are like Pavlovian machines that evolved to elevate the oxytocin levels of the managerial/professional class by tweaking the neural receptors for these norms the same way Disney’s aesthetic is fined tuned to send children into manic fits of consumption.

      People fear losing access to the “respectable” nexus the way a Heroin addict fears withdrawal. I bet the brain scans of either look remarkably similar. It’s really frightening to see how some people react to not having a known brand restaurant to go to (I use to think this was just children, but I’ve encountered it with full grown adults), let alone not having a known brand corporation/institution to work for.

      • NewishLawyer

        To be fair, I have some of this to because I went to a brand name undergrad and do like that people know it. So I can get defensive when people (often here) suggest I could have gotten just a good an education at a Big flagship university or perhaps any state university.

        I went to a SLAC. I like that I did and I like that people recognize the name of my SLAC. So I convinced myself that my alma mater is where I needed to go and I would have flunked out of large state university. Whether this is true or not is another story.

      • NewishLawyer

        Also I am bourgeois enough to have said I need to find a way to earn a decent living because I am not enthused about the idea of roommates forever and was willing to find away around that problem.

    • Dilan Esper

      I wish this blog would say something about the Slants case. I recall getting a ton of shit here for saying that Dan Snyder was likely to win his claim over his racist trademark.

  • Murc

    While I don’t think he intended a hieghten-the-contradictions argument, though,

    To be fair, it is really hard to make the statement “if our political enemies demonstrate that our compromise position of X is unacceptable, we’ve no reason to not simply go balls-out and try for the much more far-reaching, no-compromise position of Y instead” in a way that isn’t at least heighten-the-contradictions adjacent.

    I wish he hadn’t framed his argument as “if the AHCA passes, the Democratic Party will be committed to universal health care.” This will happen anyway

    I don’t think we can be so sanguine about this.

    I mean, I agree that the current trajectory makes it very likely that this will happen. I’d love it to happen. But I don’t think we can just assume it as a fact. Democrats in the 70s were committed to universal health care, to the point that Ted Kennedy and labor leaders killed a Nixon initiative because he was sure we could get better than what Tricky Dick was offering, especially since Nixon was imploding at the time.

    Turns out that we then put a conservative Democrat to the right of his Congress in the White House at the same time the country was lurching to the right in ways that caught the Democrats flat-footed, and then came Reagan, and then the Health Security Act, a dramatically less ambitious program, died in Congress in no small part due to Democratic fuckery, and then we only got the ACA, an even less ambitious program than what we tried for in the 90s, only passed by the skin of its teeth, again, in no small part due to Democratic fuckery.

    In my mind, “committed to universal health care” means “when the party controls all the relevant veto points, they enact it.” And we totally punted on that in the 70s, the 90s, and aughts. I think there’s a decent chance we fail again if we get another bite at the apple in the 20s. We’ll really, really need to work hard at it. You can never be sure when the political winds will shift and in what direction.

    • LeeEsq

      This. Klein wasn’t making a heightening the contradictions arguments. He was conceding that if our political opponents are going to be opposed to any universal health care legislation than you might as well go the full hog and ignore them.

      • Rusty SpikeFist

        That should have been obvious to everyone already in 2008.

        • sibusisodan

          I’m coming to the conclusion that the Senate is always between 8-10 years behind the times.

          • LeeEsq

            Same with certain wonky pundits and politicians.

  • NewishLawyer

    I don’t necessarily think it is a heighten the contradiction argument but it is a sign that the center-left especially the more wonkish elements are becoming cynical about the GOP.

    One of the better criticism that Sanders/Populists have is that the Vox-crowd can often be too in love with being too clever by half with all sorts of policies that are designed to just “nudge” people into better decision making. The biggest problem with the Health Care Market is that most people don’t want to sit down and price shop for a new plan every year and wonder if they have to change their doctors because of the “network” etc. But the Vox/Wonk crowd seemed to love the market exchanges and wanted people to sit down and analyze this stuff every year.

    The other issue is that the Vox-crowd is the most Pollyannaish about the ideas of bi-partisan consensus and when Klein gets radicalized and cynical, it is interesting.

    • Prof. Poirot

      This.

    • Murc

      But the Vox/Wonk crowd seemed to love the market exchanges and wanted people to sit down and analyze this stuff every year.

      Well, it’s like you say. The ACA, in abstract and in 2008, really seemed like it was the compromise plan of everyone’s dreams. It used a market mechanism! It forced people to take responsibility for choosing their own health care and being aware of costs every single year. It bore no small resemblance to a plan that a Republican Governor of a liberal state put his signature on. It was even revenue-neutral, in fact it would drive down costs over time. Surely this would garner conservative support, it hits everything they claim to care about.

      And well… turns out conservatives were liars. They’d been lying about wanting people to have health care. They’d been lying about everything related to the government providing health care.

      This walloped a lot of folks upside the head and has been taking awhile to sink int.

      • bender

        I thought the ACA was a dog’s breakfast when it passed.

        A dog’s breakfast beats starving to death.

    • Rob in CT

      Yup.

    • Denverite

      There’s also the simple facts that (1) it’s very unlikely that a future Democratic Senate will need a veto-proof majority to apss what it wants, and (2) most of the big Democratic veto points in the Senate last time are no longer in the Senate.

    • LeeEsq

      Exactly. Vox/Wonk crowd wants people to basically see one doctor as indistinguishable from another doctor as a form of cost control. They forget that people form personal relationships with their doctor and tend to trust their doctor over other doctors even if the actual services are at the same level. Continuity is important to many people in these matters.

      • guthrie

        And thus demonstrating why market failure is a real thing, and Homo economicus isn’t.

      • GFW

        I believe it’s been studied and shown that such continuity improves health outcomes! Hardly surprising – a doctor’s history with a patient is deeper than the information charted.

        • bender

          It certainly improves my temper in the examining room not to have to do the same intake interview every three months with a new resident less than half my age. Especially when they haven’t even skimmed my chart. Not fuming at the doctor probably improves the quality of my care.

    • Alex.S

      The ACA was built around three basic ideas–

      1. Don’t mess with employer-provided insurance or the current government programs.

      2. Get buy-ins from the major players in health care, to avoid a massive opposition campaign. This would be the insurance industry, health care industry, and health care providers.

      3. Establish a base-line level of insurance, then provide subsidies or funding for that.

      ———–

      The marketplace was created to get the insurance industry onboard. Without them, the insurance industry could have potentially run a campaign against the ACA (probably by saying it would kill employer-provided insurance somehow).

      People are incredibly risk-averse when it comes to health care, which has killed multiple health reform bills in the past and is the thing that is killing the Republican attempt at reform (removal of pre-existing conditions protection). If it does die, the lesson the Republicans will take away is that they can’t touch existing health care benefits and have to make fights around funding and taxes.

      • ExpatJK

        Also, messing with #1 would have created massive opposition among the general public.

  • revrick

    Whether the ACHA passes or not, the GOP has set a precedent for the legislative process that pretty much guarantees that when Democrats regain control of all three branches, they will adopt some form of universal health care coverage. In essence, the GOP is moving our parties to something more akin to parliamentary parties.

  • Srsly Dad Y

    And by the way? At this important time, with millions standing to lose their health insurance, the Washington Post — which as we know from numerous LGM comments is SO much better, bolder, and more liberal than the New York Times — comes out editorially against single payer. Or at least, against ever hoping to try to pass single payer. “But the government’s price tag would be astonishing. … There are many options short of a disruptive takeover.” It’s never quite clear with neoliberals, of course, whether it’s a good goal that’s politically unpossible, or a bad goal that shouldn’t be politically possible.

    As the millenials say on Twitter, this is honestly so important, fam.

    https://www.washingtonpost.com/opinions/single-payer-health-care-would-have-an-astonishingly-high-price-tag/2017/06/18/9c70dae6-52d2-11e7-be25-3a519335381c_story.html?utm_term=.b360ecc1f49c

    What’s that? No one reads editorials? I can just skip that page, and every George Will and Richard Cohen column, and still consider it a great paper? You don’t say.

    • mpowell

      Who said WaPo is more liberal? I think it won a TON of credibility over the NYT in the last two years, but it is still representing a right-of-center political viewpoint. It’s perfectly possible to have those political views without engaging in the non-stop dishonesty of the right wing.

      • humanoid.panda

        It has a very good newsroom, but a crappy op-ed page. One does not negate the other.

        • humanoid.panda

          One could even argue that outside the politics beat and the op-ed page, the Times is still a splendid newspaper, and still wish that the politics newsroom of the Times was swallowed by a black hole, without being a bad person.

          • Srsly Dad Y

            One could argue as much, yes. One would then be mocked by several of the LGM regulars. One might then be touchy and write intemperate comments of one’s own.

            • Q.E.Dumbass

              One would then inveigh against advocating any action beyond “don’t read” to signal disapproval. One would also have to ignore how much this is similar to “I find you offensive for finding me offensive,” and how this this even more eminently mockable than his initial position. Presumably, one would realize the previous and more judiciously articulate the initial position in the future.

              But before that, one would have to Google the reference in the second above sentence, after which one would be – perhaps fatally – torn between whether to die laughing or cry in a fire.

      • Pete

        “WaPo . . . won a TON of credibility over the NYT in the last two years, but it is still representing a right-of-center political viewpoint.”

        Not my perception. Where do you consider the center of U.S. politics to be located. (This interests me because I’ve been on the fringes of a twitter dispute with Shaun King and some lefties asserting HRC was center-right.)

    • What is incorrect in that editorial? I don’t care if the Washington Post editorial board is sufficiently progressive, I care about whether they’re liars.

      • Q.E.Dumbass

        Given how long Srsly has been throwing temper tantrums to the effects of “arguments that the NYT have fallen below replacement value are inherently illegitimate” and “said critics should never be allowed to effectively demonstrate their disapproval, ever,”, I would legitimately not be surprised if it turned out this account was Arthur Sulzberger Jr.’s sockpuppet.

        • Srsly Dad Y

          I wish. Name a place in the DC area and I’ll meet you there, dumbass. I try and fail to save some of our regulars from their own stupidity, cuz I’m just that kind of guy.

          • OK, I understand that you’re upset about how people talk about the Times (for some reason), but that really isn’t justification for threatening another commenter.

            • Srsly Dad Y

              You are 100% correct and I didn’t mean it that way, just that I would prove I’m not a sock puppet. I would buy Q.E. Dumbass a drink.

              • sibusisodan
              • Q.E.Dumbass

                Welp, that display of Internet Tough Guy-itude certainly convinced me that “temper tantrum” was a completely unfair description.

                Seriously though, if the only suggestion you won’t object to for those upset at Pinch’s chickenfucking this cycle is “not read the political section,” then what the hell would the Times have to do to merit boycotts? Have Fred Hiatt for the editorial page? Morph into the Andrew Sullivan TNR? Duranty 2.5?

      • Srsly Dad Y

        For starters, is “$32 trillion over ten years” a lot of money or not? What if you learned that U.S. GDP over the same period will be about $200 trillion, so $32 trillion works out to … hey, what do you know, about 1/6 of GDP — which is what we all know health care costs us TODAY! So hold up, that means the Urban Institute thinks we can FREEZE the increases in health care costs by going to single payer? That would be interesting to note, wouldn’t it! But no, the Post prefers to play Dr. Evil and throw around the triiilllllions of dolllllars.

    • bender

      Single payer is not the only way to achieve universal health care coverage. It might not be the best way. Back when the ACA was being debated, somebody aired a documentary comparing the health care systems of various First World countries, and the ones that looked the best to me had most people getting coverage via highly regulated not-for-profit insurance companies. I think Germany’s system is like this, and it’s not the only one.

      From the patient’s POV, the experience was similar to single payer; you could count on being seen by a qualified physician, you didn’t have a lot of paperwork, and you didn’t worry about the cost.

    • Brien Jackson

      I mean…it’s not wrong. Single payer advocates in America, especially the Berniecrats, legitimately seem unaware of how much the cost difference reflects big differences in pay to doctors and hospitals, and none of the plans can really go so far as to drastically reduce those payments. So single payer in the U.S. really would be VERY expensive for at least a decade or two.

  • Karen24

    Tangential to this, can we please have a thread devoted to the idea that the world will not end if Jon Ossoff loses tomorrow? That is NEWT GINGRICH’s OLD DISTRICT. Clinton barely won it and Price won in a landslide. There are 74 more Democratic-friendly districts where we can win in 2018 if we don’t give up.

    Same for the AHCA. Yeah, they may pass something and it will be a nightmare, but we can’t let that demoralize us. We are fighting for the right side of history guys; we can’t give up. One thing that we need to do regardless of how the next couple of weeks play out is to brag constantly and loudly that a moral victory is a real victory. On AHCA, say this and only this: The Republicans passed a bill without letting anyone see it before hand, without budget analysis, and without any Dem votes or amendments. (If possible, avoid mentioning the latter and stick to “they hid it from everyone.”) Answer questions about the damned weather with that sentence. No nuance, no technical discussion, no “we hope to make things better.” Just “this bill so godawful terrible, and they knew that, that they didn’t let anyone read it first.” Over and over and over and over.

    On Ossoff: “This is a deep red district. Karen Handel barely won and did so by running as far from Trump as she could. Please note that she refused to hold a rally with the Vice President, choosing instead to hold a fundraiser with a bunch of rich out-of-district donors.” No postmortems, no “woulda shouldas,” and for God’s sake not one single syllable of Bernie-v-Hillary. “She barely won and did so by staying away from the President. Even his own party hates him.”

    Please do this, guys.

    • John F

      The problem is that at this point, a loss in GA-6 will feed the narrative that the Dems can’t win.

      • mds

        Which is literally what Karen24’s comment advocates pushing back against. The narrative doesn’t mysteriously feed itself. The “Dems can’t win” fable is enhanced when Democrats go along with it.

        • humanoid.panda

          And in the real world, within a week from election, GA-6 will be forgotten…

      • What are the actual effects of such a narrative? I can’t recall a single national election where the postmortem analysis was that one side lost because they gave up over earlier losses.

        • so-in-so

          538 has a good bit on the race, and the likely “dumb” takes coming from it. Also notes that a win or loss might serve to improve/lower the morale of the Congressional GOP.

      • Karen24

        The Narrative is, quite literally, the stories we tell. I advocate telling stories that make us look good.

    • ForkyMcSpoon

      (One note at the beginning: Trump barely won GA-06 last year. Clinton did not actually win it. But there isn’t a huge difference between a Clinton -1.5 loss and a Clinton +1.5 win. In terms of this special election, that is.)

      While I certainly agree that we should pursue more flattering narratives, the problem is that GA-06 is legitimately a pretty decent pickup opportunity for the Democrats. That being true will make it easier for the GOP to push a negative narrative.

      However, it is, as you say, not actually the most vulnerable GOP seat. If Ossoff loses narrowly, the mitigating factors are that Romney and Price both won the district by >20 pt margins. It might be that Trump is especially unpopular for a Republican, but the voters there judge him as distinct from the average Republican, and so are not yet willing to abandon the GOP over him (this might change by 2018, however). But as mentioned… a 1.5 pt victory vs. 1.5 pt loss shouldn’t make a huge difference in the interpretation, although it will.

      Hopefully, we won’t need to parse it that finely (because Ossoff wins by a healthy margin).

  • Rob in CT

    OT:

    https://www.voterstudygroup.org/reports/2016-elections/political-divisions-in-2016-and-beyond

    Via a Chait post.

    Seems relevant to our ongoing arguments re: tactics.

    It’s an interesting read.

    • Srsly Dad Y

      It is interesting. In a sense, it’s only logical. If one party coalesces around white identity, this should have at least two effects. One, it will drive nonwhites into the other party, even if they don’t support that party’s goals across the board. (Thus, black voters are the most loyal Democrats, but also among the most conservative on many dimensions.) Two, it will attract to the white party some whites who don’t share that party’s traditional goals, either. (Racists who want their Medicaid and Medicare big time.) It makes sense that class would become less important, except that the rich will continue to pull the levers of both parties, because that’s what they/we do.

      • Srsly Dad Y

        A similar dynamic applies to LGBTQ voters, but as far as we can tell at this point in history, they are a fairly small part of the electorate (not the 10% we expected in the 1970s).

    • sibusisodan

      That’s very interesting indeed.

      Perhaps it’s an artefact of the analysis, but it seems weird that the sample was all over the social axis but basically only over 2/3 of the economic axis.

      Seems to imply that the economic centre of gravity is much further left than I expected.

      • Srsly Dad Y

        It probably is an artifact of how they define the left/right spectrum. Some people will cop to being virtual communists, but few if any people will say they want no state regulation of the economy at all.

    • ForkyMcSpoon

      So, if you were trying to get some takeaways about what the Democrats or Republicans are doing or need to be doing for the next election, I would say:

      -Democrats should adopt a more skeptical stance on trade. This is a policy shift that would seem to have little downside with any large constituency (you might lose a few free-traders, but with Trump at the head of the GOP, where can they go? if you’re losing them they were already closer to the GOP on other issues)
      -Democrats positions on economics might need work on messaging and such, but the divide in the party is not as big as it seems from the Twitter shrieking. It’s Republican voters who are divided on those issues.
      -Democrats’ establishment-outsider disaffection issues may be ameliorated over time as the GOP is in control. Either way, it doesn’t seem to me that there’s much of a long-term way to win off the back of anti-politics, and it’s less clear what Democrats can do to soothe those types anyway. (Because “establishment” Democratic politicians resigning en masse ain’t gonna happen, and shouldn’t.)

      -Republicans are courting destruction with their economic agenda. The Obama voters Trump won over care about social safety net programs and economic inequality, and thought that Trump did too. That’s being revealed as the total con that it was. The Congressional GOP seems committed to pushing the populist faction to their limits on economic issues, and Trump is tying himself to that agenda as well.

      -There are probably some interactions on those issues that can’t be teased out from that analysis. Those with high racial resentment might support the social safety net in theory, but the idea that blacks are freeloaders may limit Democrats’ ability to win them over by making the safety net more generous.

  • Dilan Esper

    I love how Scott pretends the only point Ezra was making was about universality.

    In fact, he was saying AHCA increases the probability of PUBLIC national health insurance. Which it does. Only by pretending nobody on the left opposes insurance companies does Scott’s argument work.

    • Scott Lemieux

      I would recommend reading the column before commenting, but I doubt it would help.

      • Dilan Esper

        My comment was about your post, not your column.

        If you deliberately excluded commentary about Ezra’s actual point (which was about government provided insurance) from your post even though you addressed it in your column, that says something too.

  • DAS

    The idea that the structure of ObamaCare would insulate it from political pushback was always based on a lie: that national Republicans would support good universal coverage as long as the market was involved.

    But was the idea that the structure of ObamaCare, being “based on” (or so it was claimed) RomneyCare/the Heritage Foundation plan, that it would actually insulate the ACA from political pushback or rather that it would make such political pushback look silly?

    • NonyNony

      I seem to recall that the actual insulation was that insurance companies would be a major factor in the new marketplace and that they would influence Republicans to leave it alone.

      That has turned out not to be the case. Mostly because Republicans really don’t care about big business as much as they always claimed to, they just care about lower taxes. And so do insurance company CEOs.

      I think a lot of these kind of political ideas run afoul of the fact that corporate CEOs, when given a choice between something that hurts their company but helps them personally vs. something that helps their company but hurts them personally will, being mostly a class of mercenary scumbag pirates, choose the former. It took me a while to realize it, and it really shouldn’t have, because of course to become a mercenary CEO of a giant corporation you pretty much have to be a greedy dirtbag (as opposed to someone building a corporation themselves, which involves a different skillset).

      • Scott Lemieux

        Another problem is that the idea that insurance companies love the ACA is just wrong. They strongly opposed it! The pre-ACA status quo was very good for them! Now that it’s passed they would prefer continuity all things being equal, but they’re not going to oppose AHCA like they would Medicare For All.

        • tsam

          It’s really strange that they opposed having the government pick up anywhere from 10% to 100% of the tab for sick and/or poor people. I get that it causes some administrative issues, but if the government is backing your clients, that’s not the worst position to be in.

        • Rob in CT

          I thought that the insurance industry grudgingly accepted the ACA. Like, they weren’t thrilled but they also didn’t go all-in against it.

          Now, they’re not all-in on repeal/passage of the AHCA, but neither are they fighting to preserve the ACA.

  • Terok Nor

    After my mom was in the hospital last year, she was in rehab for two months. Medicare paid for the first but not the second (her secondary didn’t cover it either), so it was $3500 out of pocket. I’d like it if the people who chant “Medicare for all” would acknowledge realities like that.
    It would also be nice if they’d stop pretending that “Every other advanced industrial democracy has universal coverage” is the same thing as “Every other advanced industrial democracy has single payer.”

    • mds

      While there is certainly a (noisy) subset that declares “Medicare for all” the solution to our problems, I think it’s actually more prevalent as the likeliest next move, not the whole game. I endorse the Medicare for all approach as one possible strategy not because Medicare is perfect, but because (1) it already exists; and (2) is popular.

      On the other hand, expanding Medicare would lead to pushback based on “those people” using the Medicare that you paid for and deserve. On the gripping hand, a Democratic Congress and White House that were pursuing this route would presumably also be trying to fully fund Medicare and improve it, rather than sabotage it at every turn. And on the remaining spare hand grafted on for the purpose, any universalization of health coverage would have to be paid for, and would thus be vulnerable to the “lazy blacks and illegals are stealing my stuff” mindset of so many economically-anxious whites. So there’s no point worrying about that part.

      But yeah, get more people invested in Medicare and fix its shortfalls. Maybe even chew gum at the same time.

      • humanoid.panda

        I think Medicare for All is a great slogan, but obviously the actual program will be very different than Medicare.

    • Linnaeus

      I can see the appeal of “Medicare for all”, because it frames universal health care coverage in terms of a familiar and generally popular program and makes it seem less like an alien socialist nightmare. As you point out, doing it will not be so easy, but getting people on board with the idea is a start.

    • Alex.S

      The benchmarks in “Medicare for All” proposals tend to be slightly better than Medicare, for those reasons.

      My general expectation is still that the eventual draft legislation will be “People can buy into Medicare also here are subsidies”. Maybe with an opt-out instead of the current opt-in.

  • humanoid.panda

    Speaking of healthcare, we should talk a bit about the infuriating turn the single payer advocates in California are taking. They are proposing a system that
    is a) more generous than anything in the world
    b) relies on the feds letting California to take all the Medicare/Medicaid, etc health payouts and apply them to its own system
    c) Has no obvious funding mechanism
    d) Has no obvious cost controls beyond “negotiate prices”.

    And when all this crashes, they get to scream about corporatist neolibral sellouts..

    • twbb

      Wow, I got a little worried when I first heard their plan but this sounds beyond stupid.

    • addicted44

      To be fair, a lot of the single payer advocates who are using it as a stick against “centrist Dems” (and because it needs to be said, this does not include Sanders…but probably does include many of his followers) are as clueless about a real plan that works as the Republicans.

      The difference is that the Republican plan enriches a bunch of rich people and people in the media, while the leftist one doesn’t. So the odds of success are dramatically different.

    • nemdam

      I am shocked, SHOCKED that a single payer proposal has tried to hide its costs and therefore will be hugely unpopular and fail when the details (i.e. tax increases) are revealed. It’s almost like this has been tried before both on the state and federal level and has spectacularly flamed out every time. It’s almost like we got Obamacare because single payer isn’t actually popular in this country. And who knew that writing down a healthcare wish list and calling it “single payer” won’t magically solve all of our healthcare problems?

  • Robespierre

    As a Sanders fan, the idea that he is a possible 2020 candidate is a lousy idea. He was too old already in 2016. 2020 is just idiotic.

  • addicted44

    There’s also the little matter of hundreds of thousands of lives that will be significantly worsened if the AHCA passes until the Dems next have control of the Senate, House and Presidency.

  • nemdam

    The article is good, but I must point out that the Democratic Presidential candidate for 2016 was committed to universal healthcare so it’s not like this is a new position or that somehow Bernie Sanders moved the party to this position. It’s not new, but in light of the Trumpcare debate finally revealing that the right has no healthcare plan, Democrats should be more bold about it.

    • Srsly Dad Y

      Fair enough, but look at this Clinton fact sheet. It’s way too complicated and talks about “more work to do” that “starts by” improving the ACA, which will “get us closer to the day [sic] when everyone in America has access to quality, affordable health care.” That’s too mealy-mouthed. How about health care is a human right, everyone must have it.

      https://www.hillaryclinton.com/briefing/factsheets/2016/07/09/hillary-clintons-commitment-universal-quality-affordable-health-care-for-everyone-in-america/

      • nemdam

        As Hillary has said many times, healthcare is complicated, and she wasn’t going to lie to people by saying a slogan can fix everything.

        But note that I am merely saying she is committed to it and therefore a Democratic Presidential candidate being committed to it is hardly a new position (though the entire caucus being committed to it may be). But there is certainly an argument that Democrats could message it better, especially in light of Trumpcare, as I noted in my last sentence.

        • Srsly Dad Y

          Well, I think this illustrates a legitimate difference of opinion. I want the “commitment” to be to do the thing. You prefer to “commit” to pursuing steps that will get us closer to doing the thing, and you say committing to doing more than that is “lying” or promising to “fix everything.” I just disagree. I think every political party promises what they will do **if the other side doesn’t stop them.** If the Democrats ever have a free lane, I want “single payer” [through insurance companies as fiscal intermediaries, mind you] at the end of it. Not tweaks to the ACA that move us in a direction so that someday blah blah.

          • nemdam

            Hillary Clinton said she supports universal healthcare and she outlines the (complicated) steps she planned to take us there. This is indisputable.

            What you are arguing about is that you want Democrats to support a specific kind of universal healthcare. There’s no problem with this but it’s a different demand than what the article, and my post, is talking about which is merely the principle of universal healthcare.

            I also find it strange that you call your plan “single payer” yet it leaves the insurance companies in place. My understanding is “single payer” means getting rid of the insurance companies but whatevs. I’m not saying you don’t have a clear idea what “single payer” means, but I’m starting to dislike the term since it seems to be losing any actual meaning and becoming an empty buzzword for “my preferred healthcare plan”.

            • Srsly Dad Y

              Is Medicare a single payer plan? __ Yes __ No

              Perhaps you are familiar with Medicare fiscal intermediaries?

              All this talk that “single payer” will spell the end of the insurance industry is just false.

              Not to mention that employers could offer supplemental plans as benefits.

              • Denverite

                Don’t be too hard on nemdam. Medicare (and Medicaid) administration is enormously complicated even for those of us who have worked in that sphere.

              • nemdam

                I’m familiar with all of this. I would say what you have described is not a “single payer” system given that my understanding of the term is this means the government pays for all healthcare costs. But it could mean a third thing to a third person. I’m starting to dislike the term because it now seems to simply mean “my preferred healthcare system different from what the Democrats want to do”.

                • Denverite

                  I would say what you have described is not a “single payer” system given that my understanding of the term is this means the government pays for all healthcare costs.

                  nemdam — a “fiscal intermediary” for all intents and purposes is an administrator of the Medicare (or where applicable, Medicaid) programs. They frequently — but not exclusively — are insurance companies. Essentially, when you are covered by Medicare and go to the doctor, and the doctor bills for the service provided to you, she doesn’t send that bill to “Medicare” (or CMS or whatnot). She sends it to a “Medicare fiscal intermediary.” That is an entity that contracts with Medicare to receive claims, review them, and if everything is kosher, pay them (with Medicare dollars). It’s still “single payer” — the government is paying for the health care — it’s just administered by a private contractor.

                  There are also Medicare/Medicaid MCOs (also known as “Medicare Advantage” in the Medicare context), which is basically where instead of signing up for traditional fee-for-service Medicare or Medicaid, you can sign up for a private insurance plan. Notably, the government pays for that coverage (usually on a capitated basis), so it’s still “single payer,” but otherwise you’re still on a private insurance plan with all that entails.

                  Srlsy Dad Y’s point is that even under a bona fide “single payer” system, insurance companies will still have huge a huge roll in everything.

                • nemdam

                  Yup, yup, agree with everything. A “single payer” system in practice will probably still have insurance companies like Medicare and Medicaid. But the term “single payer” often gets used to mean “remove the insurance companies and government pays for everything” which is why I don’t really like using it. It’s a term which is rapidly losing any meaning which is the only point I’ve been trying to make. And because it’s lost almost all meaning, I think it’s silly to in any way conflate support for “single payer” with universal healthcare. Which is why I thought it was important to state that Hillary supports universal healthcare and that this isn’t a new position for Democrats.

                • Denverite

                  But the term “single payer” often gets used to mean “remove the insurance companies and government pays for everything” which is why I don’t really like using it.

                  I’ve never understood it to mean the “remove the insurance companies” part (but definitely on the “government pays for everything” part). Now, I’ve independently heard people say that the government can administer a hypothetical single payer regime more efficiently than private fiscal intermediaries and thus we should structure the regime to do without them, but that’s independent of the “single payer” status.

                • ProudChristianProg

                  My favorite thing about the term “universal healthcare” is that it is so ambiguous. The Bernouts will think you mean single payer and they will vote for it, when you really are proposing something more sober, centrist and in line with American values like the ACA.

              • were-witch

                Is Medicare a single payer plan? __ Yes __ No

                No, it’s not, if you give it even a moment’s thought. But your reply indicates you’d like us to thoughtlessly check Yes. Why are you feigning as though Medicare is single payer? And why with such blistering hostility?

                • Srsly Dad Y

                  Simply google “Medicare for All single payer system” to see how incorrect you are. The stakeholders consider Medicare the quintessential single payer system. I get snippy because I tend to confine my LGM comments to subjects on which I have some basis of knowledge, and I’m disappointed that others don’t extend the same courtesy to me.

  • ProudChristianProg

    It is making me uncomfortable that being a Dem in modern times means signalling that you are okay with socialist measures like Single Payer. People need to pay for their own healthcare. I support the free market.

    • MAJeff

      I support the free market.

      And you know nothing about health care.

      • so-in-so

        He isn’t really a “Prog” either, whatever his nym.

        • MAJeff

          True.

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