Krugman draws some conclusions from California, where the ACA was permitted to work as intended:
So it now appears that most of California’s uninsured — 58 percent of the total, or well over 60 percent of those eligible (because undocumented immigrants aren’t covered) have gained insurance in the first year. Considering the complexity of the scheme, that’s really impressive, and it strongly suggests that next year, once those who missed out have had a chance to learn via word of mouth, California will have gotten much of the way toward universal coverage for legal residents.
But there’s something else the Kaiser report drives home: most of those gaining coverage are doing so not via the exchanges (although those are important too) but via Medicaid. And that’s important as an answer to critics of Obamacare from the left.
There have always been critics complaining that what we really should have is single-payer, and angry that subsidies were being funneled through the insurance companies. And in principle they’re right; the trouble was that cutting the insurers out of the loop would have made the plan politically impossible, both because of the industry’s power and because of the unwillingness of people with good coverage to take a leap into a completely new system. So we got this awkward public-private hybrid, which I supported because it was what we could get and despite its impurity it dramatically improves many people’s lives.
But it turns out that many of the newly insured are in fact being covered under a single-payer system — Medicaid.
All of which functions as a good intro to this
shorter verbatim Lambert Strether:
I believe there should be equal access to health care for all, and so the fact that ObamaCare helps some people is just proof that it doesn’t help all, equally. Why is the random delivery of government services considered praiseworthy?
If a government policy cannot provide everything, we should not care if it helps anyone. Got it.
At this point, it’s probably superfluous to note that Lambert also refuses to criticize the irrational and immoral Halbig decision, while implicitly defending it with idiotic Republican talking points. Why shouldn’t he? His critique is for all intents and purposes incidental to the Republican one. Both would happily strip millions of people of health coverage to demonstrate their obsessive opposition to Obama. To both, no legal argument that could damage the ACA and strip people of insurance could possibly be too specious. Both would rather have a Republican in the White House (Obama, says Lambert, is the “more effective evil” because some people will purchase private insurance, and of course the whole industry would have spontaneously combusted without the ACA, and better millions of people go uninsured than any rentier make a profit.) That one side tries to cover up their cruelty by theoretically supporting bad alternatives they have no intention of enacting and the other tries to cover up their cruelty by theoretically supporting good alternatives that have no chance of being enacted is a distinction without a difference.