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In Conclusion, Both Sides Do It But the Democrats Are Worse

[ 173 ] March 31, 2017 |

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Great:

Vice President Pence cast a tie-breaking Senate vote Thursday to pass legislation that will allow states to withhold federal funds from Planned Parenthood and other health care providers that perform abortions.

The measure, which now goes to President Trump for his signature, dismisses an Obama-era rule banning states from denying federal funds to such organizations.

The fact that Vice President Pence views all non-related women a sex objects (who could never be friends, colleagues or proteges comparable to men) is entirely non-coincidental.

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The Twitter Life of James Comey

[ 131 ] March 31, 2017 |

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Ashley Feinberg’s search for James Comey’s Twitter presence is highly entertaining:

Digital security and its discontents—from Hillary Clinton’s emails to ransomware to Tor hacks—is in many ways one of the chief concerns of the contemporary FBI. So it makes sense that the bureau’s director, James Comey, would dip his toe into the digital torrent with a Twitter account. It also makes sense, given Comey’s high profile, that he would want that Twitter account to be a secret from the world, lest his follows and favs be scrubbed for clues about what the feds are up to. What is somewhat surprising, however, is that it only took me about four hours of sleuthing to find Comey’s account, which is not protected.

Definitely worth clicking through.

I wonder what Reinhold Niebuhr would think about the Director of the FBI violating rules and norms to publicly infer that one candidate for president was a crook based on nothing, at the risk of putting a grossly unqualified buffoon into the most powerful job in the world?

The Third Term of the Bush Administration

[ 93 ] March 30, 2017 |

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When thinking about what Republicans will do about taxes, this distinction between tax reform and tax cuts is useful:

Republican debates about tax policy are shrouded in a mist of obfuscation, since the party’s central goal, reducing taxes for the rich, is too unpopular to be described frankly. Instead, the intra-party strategy has been hashed out euphemistically, which has made the media coverage difficult to decipher. The terms “tax reform” and “tax cuts” have been thrown around almost interchangeably to describe the Republican plans. They’re very different. Tax reform is what Ryan and many of his allies say they’ll do, and possibly want to do. Tax cuts are what they will do.

Tax reform means a revenue-neutral adjustment of the tax code, which cleans out tax deductions and other preferences, and uses the revenue gained by this to reduce tax rates. The attraction of tax reform is that it avoids a drawback in Senate rules. The only kind of legislation that can pass the Senate by a majority vote, without being filibustered, is a budget-reconciliation bill. But these budget-reconciliation bills can’t increase the budget deficit after ten years. That requirement forced the Bush tax cuts to phase out after a decade. Republicans hope to avoid this fate by writing a bill that does not increase the long-run deficit. Hence their stated desire to pass tax reform rather than tax cuts.
If you’re trying to finance your rate cuts by closing tax deductions, though, you’re in a zero-sum exercise where every winner is offset by a loser. That is the dynamic that has forced Ryan and his allies to support the border-adjustment tax. The lure of this proposal is that it would, in theory, raise a trillion dollars over a decade, and the cost would be borne by the poor and middle class, who would pay more for imported goods. That would free up a trillion dollars in revenue that Ryan could use to cut taxes for the rich — the project that is the cause of his life and the central policy objective of the modern GOP.

[…]

But just as throwing millions of people off their insurance proved too difficult, the pain threshold to pass a plan that raises taxes on Middle America will be far too high for Republicans to pass. One can already see Republicans who wanted to give Ryan’s grandiose strategy a chance nervously eyeing the exits, and looking instead at a tax cut that would expire. “For ten glorious years, we could actually pass a tax bill with what we want in it,” says Grover Norquist. “I want to make them permanent. But if my choice became, ten-year-temporary or nothing? I’ll take ten-year temporary,” says Representative Chris Collins.

Tax cuts for the rich financed by borrowing are not popular, but they’re much less explosively unpopular than tax cuts for the rich financed by tax hikes on Walmart shoppers. Cutting taxes for the rich enjoys near-unanimous institutional support within the conservative movement, the Republican Party, and its lobbyists and donors. Ten glorious years of low, low taxes for the rich will be the fruit of Republican control of government.

I would be absolutely shocked if this Republican conference could pass a sweeping tax reform law that even gestures at revenue neutrality. I would be…if not quite shocked very, very surprised if Republicans can’t pass a substantial mostly debt-financed upper-class tax cut. Ryan’s grandiose plan was always very stupid politically, and when it collapses he’ll be happy to take the tax cuts because as Chait says it’s the cause to which he’s devoted his adult life and he’ll take the half a loaf.

One of the few times Donald Trump has ever told the truth is in his criticisms of the Bush administration. So it’s something like rain on your wedding day that the likely core end product of the Trump administration will be massive upper-class tax cuts with a 10-year sunset and neoconfederate judges, granting that the foreign policy will involve fewer ground troops and even more indiscriminate bombing. Let’s just hope the second-term thing doesn’t happen again.

Chelsea Clinton’s Scheme to Impose Neoliberalism On the Democratic Party Becomes More Nefarious

[ 192 ] March 30, 2017 |

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First, she wins a meaningless award from a Hollywood trade magazine,* shattering the innocence of Middle Americans. And now her perfidious grasping ambition becomes even more perfidious and grasping:

But in an interview with Variety, Chelsea put an end to rumors that she’s gearing up for a congressional run.

“I am not running for public office,” she said.

She went on, “I really am constantly surprised by the stories of me running for, fill in the blank — Congress, Senate, City Council, the presidency. I find this all rather hysterical, because I’ve been asked this question a lot throughout my life, and the answer has never changed.” Which doesn’t leave much room for interpretation.

Plainly, this is just the beginning of an elaborate plot to RIG the 2020 Democratic Primaries to produce a Hillary/Chelsea ticket, with a promise that Bill will be Secretary of State and receive the first Supreme Court appointment.

I keed, and yet:

Yes, the only more compelling evidence that Chelsea Clinton is seeking public office than when she does nothing to try to attain public office is when she actively denies trying to seek public office. (At least these obsessive preemptive strikes against imaginary threats to American meritocracy are coming from someone who has surely never benefited from family connections.)

*I love this hypothetical campaign ad from Hogan:

a pair of hands opening a letter, and then crumpling it up. “You needed that Variety Magazine/Lifetime Channel vanity award, and you were the best qualified. But they had to give it to a Clinton so they wouldn’t get murdered and dumped in Fort Marcy Park. Is that really fair?”

When Clinton mounts her inevitable assault on the New Rochelle school board, Barro can finance the ad!

This Is How You Do It

[ 111 ] March 30, 2017 |

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Tom Perriello shows how it’s done:

In 2010, as a freshman congressman, I stared down the same threats that many Republican representatives face today, and I had to balance what I thought was right versus what I knew was politically advantageous. I was a Democrat representing a red Virginia district. Back then, a vote backing the Affordable Care Act — which Republican strategists had already branded “Obamacare” — meant facing millions of dollars in right-wing attack ads and almost certain defeat at the polls that fall.

My critics were right: I did lose my seat. But I never regretted my vote. Not once.

Since then, hundreds of Americans have reached out to tell me how the ACA has helped them personally: parents who obtained life-saving treatment for their adult children because they were able to keep them on their insurance plans; workers who left dead-end jobs to pursue their dreams, secure in the knowledge that they could buy insurance on newly created exchanges.

The arguments that periodically surfaced — and not all from the right of the party — that Democrats should have abandoned the ACA were always genuinely terrible on multiple levels. Even on their own terms they made no sense — it is implausible that trying and failing to major comprehensive health care reform would have been better politically, and even if it would have been marginally better it is implausible in the extreme that control over any federal veto point would have changed had Dems given up. But even if the political argument was right, it’s still wrong — the whole point of getting elected is to do stuff.

Make sure to read Clare Malone’s profile of Perriello at 538 — he’s very impressive and I hope he succeeds.

Paste — It’s What’s For Dinner!

[ 68 ] March 29, 2017 |

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Commenter Justin Runia brings our attention to this penetrating insight from Walker Bragman, the H.A. Goodman for people who want fewer YouTube plugs:

Former Obama aide and Hillary Clinton booster Jim Messina sent out a tweet soliciting donations for a former Obama staffer who is currently facing a serious health issue, and potential bankruptcy  [note: nothing the the funding appeal suggests potential bankruptcy] under the Affordable Care Act (ACA)

Yes I am outraged that Jim Messina is asking for help for a sick friend. Wait, what?

Well, Messina, a former aide to Montana Senator Max Baucus, served as Deputy White House Chief of Staff for Operations under President Obama where he became the unofficial enforcer for the neoliberal elements within the administration. He was a key player in ensuring the Affordable Care Act included neither a single-payer plan or even a public option.

I see. Jim Messina was a “key player” in “ensuring” that Congress did not enact single payer or a public option. (By the way, one perennial feature of this particular brand of derp is to treat “single payer” and any “public option” as similar.) Again, let’s review the right end of the Democratic Senate caucus. Remember, each and every one of these votes was necessary to pass anything:

Max Baucus D Mont.
Evan Bayh D Ind.
Robert C. Byrd D W.Va
Kent Conrad D N.D.
Byron L. Dorgan D N.D.
Kay Hagan D N.C.
Tim Johnson D S.D.
Mary L. Landrieu D La.
Joseph I. Lieberman ID Conn.
Blanche Lincoln D Ark.
Claire McCaskill D Mo.
Ben Nelson D Neb.
Mark Pryor D Ark.
John D. Rockefeller IV D W.Va.
Jon Tester D Mont.
Jim Webb D Va.

Yes, clearly each and every one of these senators was totally a viable vote for singlepayerorevenapublicoption. But Jim Messina stopped them. How did he do this?

As The Nation reported back in 2011, Messina used his influence to place his old boss at the center of the health care debate, helping to secure his “gang of six” senators to write the legislation which would eventually become the Affordable Care Act. In retrospect, this move was widely viewed as a misstep as it slowed the process down, and opened it up to the influence of industry. And yet, while this was going on, Messina took on the role of bully-boy to shield Baucus from progressive critics and scuttle efforts to reform the bill by groups like Health Care for America Now (HCAN).

So Jim Messina stopped single payer by allowing the chair of the Senate Finance Committee to have substantial influence over the content of legislation, which he would not have had otherwise. And then he “scuttled” attempts to “reform” the bill into something Max Baucus and his allies didn’t support, which they would all then vote for. How could this have happened, you ask? Well, Jim Messina could have called Kenny Loggins and collaborated on a single, “Single Payer, Or Even A Public Option (Or Bern It Down),” which totally would have forced the senators who opposed single payer (or even a public option) to vote for single payer (or even a public option). But He. Didn’t. Even. Try.

Or let’s say Kenny was unavailable. Messina could have just put a single-payer proposal on the table and done this:

Guys, look. This is not a discussion. This is not a debate. You have no choice but to vote for this bill.

It is unpossible for this to have failed! Alas, neoliberals like Harry Reid, Nancy Pelosi and Barack Obama will never have the keen parliamentary acumen of Young Master Bragman, so the Bayh-Liberman-Baucus Single Payer And Nationalize The Banks While We’re At It Act that was within our grasp was never realized.

How Trump Won

[ 383 ] March 29, 2017 |

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Very interesting stuff from Nate Cohn:

In the aftermath of the 2016 presidential election, many analysts suggested that Hillary Clinton lost to Donald J. Trump because of poor Democratic turnout.

Months later, it is clear that the turnout was only modestly better for Mr. Trump than expected.

To the extent Democratic turnout was weak, it was mainly among black voters. Even there, the scale of Democratic weakness has been exaggerated.

Instead, it’s clear that large numbers of white, working-class voters shifted from the Democrats to Mr. Trump. Over all, almost one in four of President Obama’s 2012 white working-class supporters defected from the Democrats in 2016, either supporting Mr. Trump or voting for a third-party candidate.

[…]

Ultimately, black turnout was roughly as we expected it. It looks as if black turnout was weak mostly in comparison with the stronger turnout among white and Hispanic voters.

This was part of a broader national pattern. Mr. Trump’s turnout edge was nonexistent or reversed in states with a large Hispanic population and a small black population, like Arizona. His turnout advantage was largest in states with a large black population and few Hispanic voters, like North Carolina.

What was consistent across most states, however, was higher-than-expected white turnout.

The increase in white turnout was broad, including among young voters, Democrats, Republicans, unaffiliated voters, urban, rural, and the likeliest supporters of Mrs. Clinton and Mr. Trump. The greatest increases were among young and unaffiliated white voters.

For this reason alone, it’s hard to argue that turnout was responsible for the preponderance of Mr. Trump’s gains among white voters. The turnout among young and white Democratic voters was quite strong.

But the turnout was generally stronger among the likeliest white Trump supporters than among the likeliest white Clinton supporters.

[…]

If turnout played only a modest role in Mr. Trump’s victory, then the big driver of his gains was persuasion: He flipped millions of white working-class Obama supporters to his side.

A few points:

  • Despite her high personal negatives and her generally negative and character-based advertising, Clinton was able to mobilize the Democratic base about as well as could have been expected. Obama’s only significant advantage was with African-American voters, and it was obviously unrealistic to think that the unusually high African-American turnout in 2008 and 2012 could be replicated, whether Clinton or Sanders or Biden was the nominee.
  • The data is not consistent with assertions that Sanders substantially harmed Clinton by endorsing her too late, or too grudgingly, or whatever. Sanders’s core primary constituencies showed up in the numbers that could have been expected or higher and voted for Clinton by the margins that could have been expected. (Stein’s failure to get off the canvas is another indication that Sanders didn’t harm Clinton by not dropping out earlier.)
  • The decisive shift of older, higher-income whites without college degrees to Trump is much more plausibly about Trump/Romney than about Clinton/Obama. If Obama had some special appeal to the white working class that Clinton lacked, it certainly wasn’t evident in the 2008 primaries. I could see Biden mitigating some of the defections; Sanders I’m much more dubious although of course nobody knows.
  • As I’ve said, assumptions that Trump was a particularly terrible candidate and a generic Republican would have won easily are becoming increasingly problematic. I don’t think it’s safe at all to assume that Rubio or Cruz or Jeb! would have Trump’s particular appeal to white working-class voters.  If the United States had a democratic system for choosing the president, then Trump’s unusual weaknesses would have made him a bad candidate. But in a system that accords undue weight to a few states which had a disproportionate number of voters Trump had a particular appeal to…he wasn’t a weak candidate at all. I’m becoming more and more convinced that a Clinton/non-Trump race would have meant a better popular vote showing but an Electoral College loss for the Republican Party.

The Health Industry Rentiers You Don’t Know About

[ 29 ] March 29, 2017 |

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Really terrific piece by Dayen:

“I get a prescription, type in the data, click send, and I’m told I’m getting a dollar or two,” Frankil says. The system resembles the pull of a slot machine: Sometimes you win and sometimes you lose. “Pharmacies sell prescriptions at significant losses,” he adds. “So what do I do? Fill the prescription and lose money, or don’t fill it and lose customers? These decisions happen every single day.”

Frankil’s troubles cannot be traced back to insurers or drug companies, the usual suspects that most people deem responsible for raising costs in the health-care system. He blames a collection of powerful corporations known as pharmacy benefit managers, or PBMs. If you have drug coverage as part of your health plan, you are likely to carry a card with the name of a PBM on it. These middlemen manage prescription drug benefits for health plans, contracting with drug manufacturers and pharmacies in a multi-sided market. Over the past 30 years, PBMs have evolved from paper-pushers to significant controllers of the drug pricing system, a black box understood by almost no one. Lack of transparency, unjustifiable fees, and massive market consolidations have made PBMs among the most profitable corporations you’ve never heard about.

Americans pay the highest health-care prices in the world, including the highest for drugs, medical devices, and other health-care services and products. Our fragmented system produces many opportunities for excessive charges. But one lesser-known reason for those high prices is the stranglehold that a few giant intermediaries have secured over distribution. The antitrust laws are supposed to provide protection against just this kind of concentrated economic power. But in one area after another in today’s economy, federal antitrust authorities and the courts have failed to intervene. In this case, PBMs are sucking money out of the health-care system—and our wallets—with hardly any public awareness of what they are doing.

Read the whole etc.

The Ongoing Adventures of Paul Ryan, International Man of Seriousity

[ 123 ] March 28, 2017 |
An outtake from the Paul Ryan photo shoot that was inspired by his Facebook photos showing him working out with P90X creator Tony Horton

An outtake from the Paul Ryan photo shoot that was inspired by his Facebook photos showing him working out with P90X creator Tony Horton

An excellent summary:

In a sense, Ryan was being too easy on himself. Yes, “doing big things” is difficult in Washington. The Capitol dome is practically designed to bottle up and suffocate dramatic change. But whatever growing pains they may have experienced, fractious Democrats still managed to execute an ambitious agenda in the early Obama years without a major legislative collapse the likes of which we all witnessed this week. The rollout of the American Health Care Act, by contrast, was a mystifying debacle. And as much as anything, its demise is an indictment of Paul Ryan that should shatter what’s left of his myth as competent policy thinker or political leader.

Aside from the occasional PowerPoint, it’s really not clear what the man is good for.

Journalists often describe Ryan as a “wonk”—or if you’re CNN, a “legendary wonk“—mostly because he has sold himself as one. It’s Ryan’s #brand, which he’s nurtured with a stream of lofty white papers and interviews with credulous reporters. But in truth, he’s always been far better at playing a policy nerd on TV than at doing the hard work of crafting legislation that could ever conceivably pass Congress or be implemented without causing mass havoc to the poor. First and foremost, the man is an ideologue who can competently dress up his Randian fantasies with some numbers, and an occasional magic asterisk where key details should be.

That became painfully obvious with the AHCA, a nonsensical piece of legislation that despite his lame attempt to sell it with a slide deck presentation, somehow achieved the distinction of being panned by policy experts from the left, right, and center, without actually attracting the support that a normal, if unsatisfying, political compromise might. Ryan initially took Obamacare’s basic structure, then defunded the things that made it work in order to pay for massive tax cuts. The bill only became more preposterous and unworkable as Ryan and the White House bargained away necessary regulations for support from hardliners. Now, it’s possible this is not truly a reflection on Ryan’s aptitude as a policy thinker; the inherent contradictions of the Republican Party may have made it impossible for anybody in leadership to craft a coherent health reform bill. But then, after making last minute changes that would have fundamentally reshaped the entire individual insurance market, the speaker attempted to bring it to a floor vote Friday without any kind of score from Congressional Budget Office. The man pushed legislation with little to no clue as to what it would actually do to the country. Generally speaking, wonks care about that sort of thing.

The thing is, “policy wonk” and “legislative leader” are different things, and an effective leader needn’t be a wonk. (I wouldn’t say the description fits either Pelosi or Reid.) It’s just that Ryan’s reputation as a wonk is a ludicrous sham, and by all appearances he has no particular abilities as a legislative leader. What he does well is convey the impression that he’s a policy wonk, which is not the same thing at all.

The Heritage Plan *Was* the Conservative Alternative to the ACA. It Was Much Worse Than the AHCA.

[ 157 ] March 28, 2017 |

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Not this again:

Ah, yes, “durr, Obamacare was the Heritage Foundation plan, durr” — the go-to for anyone who doesn’t know what they’re talking about and for whatever reason wants to imagine American conservatism as being much better and/or American liberalism as being much worse than they are. Anyway, this is an absolutely absurd characterization. To summarize, the Heritage Plan was to end Medicare and replace it with a voucher system, end Medicaid and phase out employer-based insurance, and require everyone not eligible to Medicare to purchase largely de-regulated catastrophic insurance with ungenerous subsidies.  It is, in other words, radically different than the ACA. Saying the ACA is “based on” the Heritage Plan is like saying George W. Bush’s plan to privitize Social Security was “based on” FDR’s Social Security legislation. The only thing they have in common is the requirement to carry insurance, a banal recognition that insurance requires a broad pool to work that was hardly invented at Heritage.

As you know, at this point people strongly committed to the utterly false claim that the ACA was the “Republican plan” invented by the Heritage Foundation will generally add the second and third cards to the 3-card monte.  First you compare the ACA to the decoy plan introduced by a senator from Rhode Island who favored a national handgun ban in 1993. The obvious problems with this comparison are that 1)the plans aren’t that similar (no Medicaid expansion) and 2)you have to be the most gullible rube in the world to the think federal Republicans have ever favored anything like the Chafee plan and would ever enact anything like it.  The typical next move is to compare the ACA to the plan enacted by veto-proof majorities of Massachusetts Democrats, which has the advantage of being a reasonable policy comparison but the fatal disadvantage of being completely irrelevant to national Republican health care policy preferences. (If only the Republican governor who signed the legislation after multiple overridden vetoes had been the Republican candidate for president so we could have seen if he would maintain support for this health care policy as a national Republican!)

Another variant of this argument is to say that Trumpcare failed because Obamacare was the Republican/conservative alternative for universal coverage. But this is also completely false. The Heritage Plan is the conservative alternative to the ACA.  If you combine Paul Ryan’s Medicare and Medicaid proposals with Trumpcare as amended by the Freedom Caucus, that’s basically the Heritage Plan with a clumsier and less effective mandate.  Here’s a handy guide for people who are for whatever reason delusional about the actually existing American political spectrum:

  • The conservative alternative to the ACA is to privatize Medicare while increasing the eligibility age, while ending Medicaid and employer-based insurance and replacing them with a de-regulated private market much less generously subsidized than the ACA.
  • The center-right alternative is to accept the political reality of mostly preserving Medicare while block granting Medicaid and gutting the private insurance market.
  • The Affordable Care Act, a plan to substantially expand Medicaid while increasing public expenditures and regulation on the private market is a compromise between the left and moderate wings of the Democratic Party that Republicans have always vociferously opposed.

Trumpcare didn’t fail because the ACA was the “conservative alternative.” It failed because only a politically suicidal party would enact any conservative alternative to the ACA. The ACA survived because it’s much harder to take away benefits tan it is to stop them from going into effect — but Republicans would always have done the latter if the had the power to do so. It’s really not complicated. And pretending otherwise is both false and politically worse-than-useless.

 

 

 

Today in the Derp State

[ 71 ] March 28, 2017 |

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Let’s check in on that House oversight function:

And now, the House Intelligence chair has provided one more reason for the public to think he’s working to undermine his committee’s investigation: On Monday, Nunes admitted that he had been on White House grounds the night before his big disclosure.

“Chairman Nunes met with his source at the White House grounds in order to have proximity to a secure location where he could view the information provided by the source,” the lawmaker’s spokesperson, Jack Langer, told NBC News. “The Chairman is extremely concerned by the possible improper unmasking of names of U.S. citizens, and he began looking into this issue even before President Trump tweeted his assertion that (Trump Tower) had been wiretapped.”

The House Intelligence Committee has its own secure room in the Capitol, where Nunes reviews classified material on a daily basis. There is no intuitive reason why Nunes would need to go to the White House to securely view his source’s information — unless he wished to keep that information “secure” from his fellow committee members.

If Donald Trump shot up a nursery school, Nunes and Chaffetz would respond by opening an investigation into Hillary Clinton’s role in the murder of Seth Rich.

The Left Saved the ACA

[ 76 ] March 27, 2017 |

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To amplify Erik’s recent point, this is exactly right. Sometimes, popular mobilization works:

The fallout from the collapse of Trumpcare has left most of the blame, or credit, on the House Freedom Caucus. President Trump has pointed his finger at the restive right-wingers, and news coverage has taken their central role (“the ultraconservative GOP lawmakers who stymied Trump on health care ”) as a given. It is true that the House Freedom Caucus made life difficult for Paul Ryan and the Trump administration. But it overlooks the main cause of Trumpcare’s failure, which is the revolt it generated from the left.

The left, not the right, was the source of public pressure, like large-scale rallies, inundating Congress with phone calls, and swarming town hall meetings. It was also the source of the opposition from doctors and hospitals, which stood to lose billions of dollars in business from customers who could no longer afford to pay for regular medical care.

[…]

Perhaps the most fatal barrier faced by the bill was the opposition of the Senate. Trumpcare was dead on arrival in the upper chamber, in part due to the opposition of a handful of arch-conservatives, but mostly because upwards of a dozen Republicans deemed its coverage inadequate. Some vulnerable House Republicans might have risked their seat to pass a bill slashing coverage to finance upper-bracket tax cuts. None of them were going to do it just to see their handiwork die in the Senate.

The most telling statement about the bill’s defeat came from Senator Bill Cassidy, a Louisiana Republican and an unexpected source of opposition. “There’s a widespread recognition that the federal government, Congress, has created the right for every American to have health care,” Cassidy told the New York Times.

The last point is also crucial, and is an illustration of why claims that either the ACA specifically or the Obama administration in general constituted a neoliberal repudiation of the New Deal/Great Society tradition is so deeply misguided. The ACA could not be more squarely within this tradition, in both its achievements and its compromises. The original Social Security was if anything even further from a model of what a public pension should look like (say what you will about the ACA, but racial ,minorities disproportionately benefited from it rather than being disproportionately excluded.) But a flawed compromise establishes a baseline public expectation that both entrenches the program against opposition and provides the basis for expansion.

The ACA could one day serve as the basis for European-style comprehensive health care (I think it is far more likely to follow the hybrid models than the single-payer ones, but which endpoint is more likely isn’t terribly important right now.) In the meantime, the public insurance programs can be expanded and the subsidies for private insurance made more generous. But to move down the path you have to get started. And both sides of the Democratic coalition in 2010 deserve credit for getting it done.

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