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Who Hates Obamacare?
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Krugman late to the game again
Feb 7, 2016, 2:23:24 AM2/7/16
to
Ted Cruz had a teachable moment in Iowa, although he himself
will learn nothing from it. A voter told Mr. Cruz the story of
his brother-in-law, a barber who had never been able to afford
health insurance. He finally got insurance thanks to Obamacare —
and discovered that it was too late. He had terminal cancer, and
nothing could be done.
The voter asked how the candidate would replace the law that
might have saved his brother-in-law if it had been in effect
earlier. Needless to say, all he got was boilerplate about
government regulations and the usual false claims that Obamacare
has destroyed “millions of jobs” and caused premiums to
“skyrocket.”
For the record, job growth since the Affordable Care Act went
fully into effect has been the best since the 1990s, and health
costs have risen much more slowly than before.
So Mr. Cruz has a truth problem. But what else can we learn from
this encounter? That the Affordable Care Act is already doing
enormous good. It came too late to save one man’s life, but it
will surely save many others. Why, then, do we hear not just
conservatives but also many progressives trashing President
Obama’s biggest policy achievement?
Part of the answer is that Bernie Sanders has chosen to make re-
litigating reform, and trying for single-payer, a centerpiece of
his presidential campaign. So some Sanders supporters have taken
to attacking Obamacare as a failed system.
We saw something similar back in 2008, when some Obama
supporters temporarily became bitter opponents of the individual
mandate — the requirement that everyone buy insurance — which
Hillary Clinton supported but Mr. Obama opposed. (Once in
office, he in effect conceded that she had been right, and
included the mandate in his initiative.)
But the truth is, Mr. Sanders is just amplifying left-wing
critiques of health reform that were already out there. And some
of these critiques have merit. Others don’t.
Let’s start with the good critiques, which involve coverage and
cost.
The number of uninsured Americans has dropped sharply,
especially in states that have tried to make the law work. But
millions are still uncovered, and in some cases high deductibles
make coverage less useful than it should be.
This isn’t inherent in a non-single-payer system: Other
countries with Obamacare-type systems, like the Netherlands and
Switzerland, do have near-universal coverage even though they
rely on private insurers. But Obamacare as currently constituted
doesn’t seem likely to get there, perhaps because it’s somewhat
underfunded.
Meanwhile, although cost control is looking better than even
reform advocates expected, America’s health care remains much
more expensive than anyone else’s.
So yes, there are real issues with Obamacare. The question is
how to address those issues in a politically feasible way.
But a lot of what I hear from the left is not so much a
complaint about how the reform falls short as outrage that
private insurers get to play any role. The idea seems to be that
any role for the profit motive taints the whole effort.
That is, however, a really bad critique. Yes, Obamacare did
preserve private insurance — mainly to avoid big, politically
risky changes for Americans who already had good insurance, but
also to buy support or at least quiescence from the insurance
industry. But the fact that some insurers are making money from
reform (and their profits are not, by the way, all that large)
isn’t a reason to oppose that reform. The point is to help the
uninsured, not to punish or demonize insurance companies.
And speaking of demonization: One unpleasant, ugly side of this
debate has been the tendency of some Sanders supporters, and
sometimes the campaign itself, to suggest that anyone raising
questions about the senator’s proposals must be a corrupt tool
of vested interests.
Recently Kenneth Thorpe, a respected health policy expert and a
longtime supporter of reform, tried to put numbers on the
Sanders plan, and concluded that it would cost substantially
more than the campaign says. He may or may not be right,
although most of the health wonks I know have reached similar
conclusions.
But the campaign’s policy director immediately attacked Mr.
Thorpe’s integrity: “It’s coming from a gentleman that worked
for Blue Cross Blue Shield. It’s exactly what you would expect
somebody who worked for B.C.B.S. to come up with.” Oh, boy.
And let’s be clear: This kind of thing can do real harm. The
truth is that whomever the Democrats nominate, the general
election is mainly going to be a referendum on whether we
preserve the real if incomplete progress we’ve made on health,
financial reform and the environment. The last thing
progressives should be doing is trash-talking that progress and
impugning the motives of people who are fundamentally on their
side.
Comments:
Larry Eisenberg is a trusted commenter New York City 9 hours ago
Paul Krugman, you've broken my heart,
By taking Ms Hillary's part,
Without feathers and fuss
Threw Bern' under the Bus,
A Mentor thou no longer art.
Boots-on-the-ground Ms Hillary
Will not be the first choice for me,
For Bernie I'm yearny
For an 8 year journey,
To dampen Inequality.
Reply 448Recommend
NYT Pick
Robert Prentiss San Francisco 8 hours ago
Larry, you're still one of the good guys,
No matter your Bernie ties,
Just don't expect to have your own facts,
When you don't have the same knacks,
Of Paul Krugman's well-earned Nobel tracks.
In Reply to Larry Eisenberg Reply 168Recommend
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Len Safhay New Jersey 8 hours ago
"Trash-talking" the progress that was made under the ACA may or
may not be productive, but it's both intellectually honest and
*very* productive to point out that the ACA is remarkably
complex, incomprehnsible, unwieldy, and unacceptably limited in
its scope. It's a camel - a horse designed by committee; a
kluge. And it continues to beg a core ideological and ethical
question, to wit, are all people in this country entitled to
health care, the way they are entitled to vote or breathe, or
are they not? As long as the health care system in this country
remains a for-profit enterprise, the answer to that question
must inevitably, inherently be no and the ethics problematic.
Nor is it counterproductive to argue that we can and must aspire
to do more, do it better and more efficiently, do it more
fairly; to use the ACA as a starting point, not an end to be
merely tinkered with around the edges.
And it is disingenous in the extreme to characterize the
position of anyone who makes such arguments as advocating for
dismantling the ACA; clearly the way forward does not require
doing away with the ACA until a superior construction is ready
to be implemented, and I know of no call on the left to do so.
This column smacks of undisinterested advocacy, Mr. Krugman, of
casuistry. It's a bit disappointing coming from you.
Reply 882Recommend
NYT Pick
Paul G Knox Philadelphia, Pa 7 hours ago
We liberals supported the ACA because the prospect of doing
nothing about our wasteful, bloated healthcare system that left
millions of Americans without basic care was morally
unacceptable. We also believed it was a step towards the fiscal
sustainability and sanity of a single payer model.
We settled, we compromised , we were "realistic". And we were
promplty spat upon for adopting an extremely flawed, private
health insurance model with Conservative origins.
Lesson learned I say.
The best analogy I can think of regarding ACA is it's a compact
fluorescent bulb to an LED. It's a stopgap. A bandaid to stop
the bleeding.
Campaigning to replace it with a a single payer framework is
appealing, sensible and ultimately economically responsible.
The realists in this case are those who recognize the
unsustainability and , frankly, the shameful moral failing of
our current healthcare model , the ACA included.
Reply 747Recommend
NYT Pick
james stewart nyc 7 hours ago
What I fail to see from Obamacare opponents is a viable
alternative, is it perfect? No, so what would you replace it
with? What I haven't seen said is the fact that we, the general
public. are paying for peoples health care anyway. When a
seriously ill person shows up at the hospital with no insurance
and no money, who do you think is going to pay for it? We are.
Had they had insurance or better yet, universal health care, it
may not have gotten to the catastrophe stage. As with a diabetic
who had no idea they were diabetic until they needed to be
hospitalized.
Reply 336Recommend
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Bay Area HipHop San Francisco, CA 6 hours ago
PK understates the impact of the ACA. Its main accomplishment
has been to expand Medicaid and provide catastrophic coverage
for more people. For anyone who isn't poor, they have now been
forced to buy insurance, but with such high deductibles that
they effectively can't use it for health maintenance or chronic
disease care. Yet it's precisely these things that people need
and couldn't get before the ACA. Since PK is an economist, I can
only assume that he is willfully ignoring the observations of
numerous health care economists that health care spending was
already trending downward before the ACA and there is debate
across the political spectrum as to how much the ACA has
affected health care costs. So we should be glad that more poor
people now have health care [unless they live in Red states],
but don't celebrate the ACA as some wonderful, revolutionary
improvement of our health system. If PK wants to criticize
Sanders as being unrealistic for trying to get a single payer
system enacted, that's OK -- it's proabably politically
unrealistic in this current climate, but don't try to do this by
pretending the ACA is so great.
FlagReply 261Recommend
http://www.nytimes.com/2016/02/05/opinion/who-hates-
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will learn nothing from it. A voter told Mr. Cruz the story of
his brother-in-law, a barber who had never been able to afford
health insurance. He finally got insurance thanks to Obamacare —
and discovered that it was too late. He had terminal cancer, and
nothing could be done.
The voter asked how the candidate would replace the law that
might have saved his brother-in-law if it had been in effect
earlier. Needless to say, all he got was boilerplate about
government regulations and the usual false claims that Obamacare
has destroyed “millions of jobs” and caused premiums to
“skyrocket.”
For the record, job growth since the Affordable Care Act went
fully into effect has been the best since the 1990s, and health
costs have risen much more slowly than before.
So Mr. Cruz has a truth problem. But what else can we learn from
this encounter? That the Affordable Care Act is already doing
enormous good. It came too late to save one man’s life, but it
will surely save many others. Why, then, do we hear not just
conservatives but also many progressives trashing President
Obama’s biggest policy achievement?
Part of the answer is that Bernie Sanders has chosen to make re-
litigating reform, and trying for single-payer, a centerpiece of
his presidential campaign. So some Sanders supporters have taken
to attacking Obamacare as a failed system.
We saw something similar back in 2008, when some Obama
supporters temporarily became bitter opponents of the individual
mandate — the requirement that everyone buy insurance — which
Hillary Clinton supported but Mr. Obama opposed. (Once in
office, he in effect conceded that she had been right, and
included the mandate in his initiative.)
But the truth is, Mr. Sanders is just amplifying left-wing
critiques of health reform that were already out there. And some
of these critiques have merit. Others don’t.
Let’s start with the good critiques, which involve coverage and
cost.
The number of uninsured Americans has dropped sharply,
especially in states that have tried to make the law work. But
millions are still uncovered, and in some cases high deductibles
make coverage less useful than it should be.
This isn’t inherent in a non-single-payer system: Other
countries with Obamacare-type systems, like the Netherlands and
Switzerland, do have near-universal coverage even though they
rely on private insurers. But Obamacare as currently constituted
doesn’t seem likely to get there, perhaps because it’s somewhat
underfunded.
Meanwhile, although cost control is looking better than even
reform advocates expected, America’s health care remains much
more expensive than anyone else’s.
So yes, there are real issues with Obamacare. The question is
how to address those issues in a politically feasible way.
But a lot of what I hear from the left is not so much a
complaint about how the reform falls short as outrage that
private insurers get to play any role. The idea seems to be that
any role for the profit motive taints the whole effort.
That is, however, a really bad critique. Yes, Obamacare did
preserve private insurance — mainly to avoid big, politically
risky changes for Americans who already had good insurance, but
also to buy support or at least quiescence from the insurance
industry. But the fact that some insurers are making money from
reform (and their profits are not, by the way, all that large)
isn’t a reason to oppose that reform. The point is to help the
uninsured, not to punish or demonize insurance companies.
And speaking of demonization: One unpleasant, ugly side of this
debate has been the tendency of some Sanders supporters, and
sometimes the campaign itself, to suggest that anyone raising
questions about the senator’s proposals must be a corrupt tool
of vested interests.
Recently Kenneth Thorpe, a respected health policy expert and a
longtime supporter of reform, tried to put numbers on the
Sanders plan, and concluded that it would cost substantially
more than the campaign says. He may or may not be right,
although most of the health wonks I know have reached similar
conclusions.
But the campaign’s policy director immediately attacked Mr.
Thorpe’s integrity: “It’s coming from a gentleman that worked
for Blue Cross Blue Shield. It’s exactly what you would expect
somebody who worked for B.C.B.S. to come up with.” Oh, boy.
And let’s be clear: This kind of thing can do real harm. The
truth is that whomever the Democrats nominate, the general
election is mainly going to be a referendum on whether we
preserve the real if incomplete progress we’ve made on health,
financial reform and the environment. The last thing
progressives should be doing is trash-talking that progress and
impugning the motives of people who are fundamentally on their
side.
Comments:
Larry Eisenberg is a trusted commenter New York City 9 hours ago
Paul Krugman, you've broken my heart,
By taking Ms Hillary's part,
Without feathers and fuss
Threw Bern' under the Bus,
A Mentor thou no longer art.
Boots-on-the-ground Ms Hillary
Will not be the first choice for me,
For Bernie I'm yearny
For an 8 year journey,
To dampen Inequality.
Reply 448Recommend
NYT Pick
Robert Prentiss San Francisco 8 hours ago
Larry, you're still one of the good guys,
No matter your Bernie ties,
Just don't expect to have your own facts,
When you don't have the same knacks,
Of Paul Krugman's well-earned Nobel tracks.
In Reply to Larry Eisenberg Reply 168Recommend
NYT Pick
Len Safhay New Jersey 8 hours ago
"Trash-talking" the progress that was made under the ACA may or
may not be productive, but it's both intellectually honest and
*very* productive to point out that the ACA is remarkably
complex, incomprehnsible, unwieldy, and unacceptably limited in
its scope. It's a camel - a horse designed by committee; a
kluge. And it continues to beg a core ideological and ethical
question, to wit, are all people in this country entitled to
health care, the way they are entitled to vote or breathe, or
are they not? As long as the health care system in this country
remains a for-profit enterprise, the answer to that question
must inevitably, inherently be no and the ethics problematic.
Nor is it counterproductive to argue that we can and must aspire
to do more, do it better and more efficiently, do it more
fairly; to use the ACA as a starting point, not an end to be
merely tinkered with around the edges.
And it is disingenous in the extreme to characterize the
position of anyone who makes such arguments as advocating for
dismantling the ACA; clearly the way forward does not require
doing away with the ACA until a superior construction is ready
to be implemented, and I know of no call on the left to do so.
This column smacks of undisinterested advocacy, Mr. Krugman, of
casuistry. It's a bit disappointing coming from you.
Reply 882Recommend
NYT Pick
Paul G Knox Philadelphia, Pa 7 hours ago
We liberals supported the ACA because the prospect of doing
nothing about our wasteful, bloated healthcare system that left
millions of Americans without basic care was morally
unacceptable. We also believed it was a step towards the fiscal
sustainability and sanity of a single payer model.
We settled, we compromised , we were "realistic". And we were
promplty spat upon for adopting an extremely flawed, private
health insurance model with Conservative origins.
Lesson learned I say.
The best analogy I can think of regarding ACA is it's a compact
fluorescent bulb to an LED. It's a stopgap. A bandaid to stop
the bleeding.
Campaigning to replace it with a a single payer framework is
appealing, sensible and ultimately economically responsible.
The realists in this case are those who recognize the
unsustainability and , frankly, the shameful moral failing of
our current healthcare model , the ACA included.
Reply 747Recommend
NYT Pick
james stewart nyc 7 hours ago
What I fail to see from Obamacare opponents is a viable
alternative, is it perfect? No, so what would you replace it
with? What I haven't seen said is the fact that we, the general
public. are paying for peoples health care anyway. When a
seriously ill person shows up at the hospital with no insurance
and no money, who do you think is going to pay for it? We are.
Had they had insurance or better yet, universal health care, it
may not have gotten to the catastrophe stage. As with a diabetic
who had no idea they were diabetic until they needed to be
hospitalized.
Reply 336Recommend
NYT Pick
Bay Area HipHop San Francisco, CA 6 hours ago
PK understates the impact of the ACA. Its main accomplishment
has been to expand Medicaid and provide catastrophic coverage
for more people. For anyone who isn't poor, they have now been
forced to buy insurance, but with such high deductibles that
they effectively can't use it for health maintenance or chronic
disease care. Yet it's precisely these things that people need
and couldn't get before the ACA. Since PK is an economist, I can
only assume that he is willfully ignoring the observations of
numerous health care economists that health care spending was
already trending downward before the ACA and there is debate
across the political spectrum as to how much the ACA has
affected health care costs. So we should be glad that more poor
people now have health care [unless they live in Red states],
but don't celebrate the ACA as some wonderful, revolutionary
improvement of our health system. If PK wants to criticize
Sanders as being unrealistic for trying to get a single payer
system enacted, that's OK -- it's proabably politically
unrealistic in this current climate, but don't try to do this by
pretending the ACA is so great.
FlagReply 261Recommend
http://www.nytimes.com/2016/02/05/opinion/who-hates-
obamacae.html
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Cruzing to the White House, Trumping the Libs
Feb 7, 2016, 6:51:08 PM2/7/16
to
"Krugman late to the game again" <sycop...@democrats.org> wrote in
news:d2918a710ac3efe8...@dizum.com:
>
>
Lying scum.
--
"...And what country can preserve its liberties, if its rulers are not warned
from time to time, that this people preserve the spirit of resistance? Let
them take arms. The remedy is to set them right as to the facts, pardon and
pacify them. What signify a few lives lost in a century or two? The tree of
liberty must be refreshed from time to time, with the blood of patriots and
tyrants. It is its natural manure."--Thomas Jefferson, Nov. 13, 1787
news:d2918a710ac3efe8...@dizum.com:
>
>
Lying scum.
--
"...And what country can preserve its liberties, if its rulers are not warned
from time to time, that this people preserve the spirit of resistance? Let
them take arms. The remedy is to set them right as to the facts, pardon and
pacify them. What signify a few lives lost in a century or two? The tree of
liberty must be refreshed from time to time, with the blood of patriots and
tyrants. It is its natural manure."--Thomas Jefferson, Nov. 13, 1787
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