Anyone else totally unsurprised that the Affordable Care Act is doing what it's supposed to do and everyone hates it for that reason? And for the website, of course.

I'm shocked there hasn't been more outcry for repeal yet honestly. Ohh well there's always January when the full effect comes into play. I'll just keep my fingers crossed I suppose.

I think we'll see Obama go for a 1-2 punch plan in the course of the rest of his presidency. He'll start fighting for the grand bargain he's been talking about since he came into office which involves privatizing Medicare and Medicaid to some degree, reducing the quality of service and raising the prices. The ACA helps his efforts there by getting as many people as possible in the insurance market, moving a lot of people onto medicare and medicaid, setting a precedent for putting private middlemen between people and government services, and re-defining the citizen-government relationship as a customer-servicer relationship. These steps would make sense if his overall goal was moving as much wealth held by the American people into the control of the FIRE sector as possible, which I think it is.

Fingers crossed, 'cause damn if those poor people deserve affordable insurance, dammit!

Obamacare is a mediocre compromise that attempts to bring in some sort of competition instead of simply repealing the antitrust/collusion exemption in the healthcare industry. A single-payer public option is necessary.

I do agree with that, but the Republicans would never hear it, so they had to settle on this mediocre compromise.

I didn't say poor people don't deserve good insurance, all I'm saying is that the rest of us shouldn't have to live in fear of loosing our insurance, or have it cost us damn near double just to keep it, to make it so. The U.S. can't seem to figure out how to make the two coexist. I would, for instance, be completely on board with good 'ole Uncle Sam taking an additional 1-3% of my income in order to support something but I doubt many others would agree with me there. The problem with Americans is they all want something for free but real life doesn't afford such luxuries.

This is an Obamist lie used to shield Obama and Obama Democrats from left criticism. Obama and the Democrat leadership purposefully precluded left alternatives to the ACA from the debate before the law was unveiled and purposefully hired people from the insurance industry to write it. This was an ideological choice, not a forced concession, because it is part of their vision for changing American society in the way I described in my previous post. Republicans have their idea of what America should be like. Is it so hard to believe that Democrats have such ideas too?

I fail to see the idealism in that kind of politics.

The fuck? You're saying it's a lie that Republicans are opposed to a single-payer UHC system? These nutcases think ACA is too socialist (when it's anything but), you really think they would have preferred single-payer UHC? Give me a fucking break.

The lie isn't that the Republicans are against it. The lie is that they are the reason the Obama government had to "settle for a compromise".

Do you have any evidence for what you're saying, and that this was really their vision and not because they knew the Republicans would oppose a single-payer system from the beginning?

It occurred to me when I was done with this post that it is far too long for a FFA thread. Whatever, I already typed it, might as well post it. If the powers that be think this should be split into another thread then whatever, but I think I'm done with this topic after this post. Reading the news everyday about ACA and the millions of shocked Americans who didn't know they would lose their insurance (even though a lot of people warned this would happen way back in 2009) makes my head hurt. Actually trying to explain it (along with the tortured politics of healthcare in this country) is infuriating.



It is manifestly obvious that the bill hurts poor people. It also hurts employed people, unemployed people, the young. It doesn't even benefit the insurance industry that much, as they have effectively been turned into a public utility and as such lost some of their independence (though some of them are too stupid to realize it yet). There really isn't anyone who benefits from this unless it collapses so fast that the gap between ACA and whatever replaces it is short, and even then, whatever replaces it has to be better than what we had before 2010. The idea that people with existing medical conditions benefit from the ACA is irrelevant if a) they can't afford the coverage anyway or b) their employer can't afford the coverage and drops it, which is going to happen to a lot of people next year unless the bill gets a major overhaul or repealed between now and next October.



I agree with this, but there are better ways to deal with lack of competition even in the absence of a public option. You just mentioned one; Republican plans to allow interstate competition was another. Some combination of these with a public option attached to them would have virtually eliminated insurance collusion and ensured competitive pricing.





A couple points here:


1. Actually, behind the scenes there were (and still are) Republicans who prefer more government involvement or at least a government-derived solution to health care costs, especially compared to ACA. For one thing, depending on how the necessary taxes were levied, it could alleviate the prices that businesses pay to provide insurance to their employees, which might spur hiring (or else existing employees get a bigger paycheck). That alone would entice some big shot campaign donors to support it. The thing people have to realize is that any single-payer system done in the U.S. has to have all or most of the new taxes levied on individuals/families with an exemption for Sub-S "individuals." Although there are special exemptions, loopholes, and tax credits given to different industries, the U.S. business tax rate is one of the highest in the world if you can't take advantage of all those freebies. That means if you pay for government healthcare by raising taxes on businesses, it probably won't even be brought up for a vote. And even if it is levied on individuals/families, so many people in this country oppose taxes that even if they wanted government healthcare (which is a whole other ideological argument) they won't spring for the high taxes it requires unless other tax revenues are cut. In other words, you need to cut other programs and you need comprehensive tax reform at the same time or before you introduce single payer. And paradoxically, apart from cuts in military spending Democrats don't really support either of those, making their dream of single-payer pretty much unattainable.

2. Any single-payer system in the U.S. will require some element of decentralization/localization in the way health care is administered. There's just no way around this; most countries with single-payer are geographically small (relatively) with populations ranging from 5 million to 65 million people. The U.S. has the geography and demographic variety of an entire continent and a population north of 300 million people. Hell, my understanding is that Canada's single-payer system is largely executed at the provincial level and there's sometimes major differences between each province---and your population is around 1/10th ours. We actually have an excellent institutional arrangement for doing something similar to Canada's system---50 states with a large degree of autonomy and a good idea of what their citizens want---but the primary supporters of single payer in the U.S. are Democrats and they tend to frown on delegating anything to the states. They want British NHS or get the fuck out. So again, the Democratic party is its own obstacle apart from Republican opposition.

4. Generally speaking, Republicans do not favor comprehensive approaches to anything because a) they already feel government is screwing things up, so any miscalculated attempt to comprehensively reform an industry is thought more likely to comprehensively screw it up and b) American government was designed to make comprehensive solutions hard so that majorities couldn't overrun minorities. In other words, when it is obvious Congress can help, they favor piecemeal approaches. Republicans wanted (and proposed) solutions to getting healthcare to the uninsured, which they viewed as a discreet problem; the primary reason they objected to healthcare reform in the first place is because Obama made clear he wanted a large law that dealt with things other than the uninsured.

5. inhumanist is entirely correct: the Democratic party did not have to compromise with Republicans at all. They had a filibuster-proof majority in the Senate for the entirety of 2009, as well as a majority in the House. The "obstructionist Republicans" card was fabricated so they could have a boogeyman to run against in 2010; they just figured the law would be so popular by then that accusing Republicans of trying to stop it would win them elections (which was hilariously wrong). It was mathematically impossible for Republicans to prevent the law from passing until Brown took his seat in early 2010. They only needed to negotiate with themselves and the various medical industries. The reason a public option would not have been passed had little to do with Republicans; there weren't enough Democratic senators who supported a public option even before Brown won his seat. So, yet again, the Democratic party can't overcome its own obstacles.




Ah, here you're wrong. Nothing to do with ideology, it was done purely for campaign reasons. Most Democrats have their hearts in more government involvement in health care, but if they had actually passed a public option or even full-blown single payer they would have lost the 2010 midterms even more badly then they actually did. And if the law went into effect before November 2012, Obama could have easily lost the election if the implementation went badly. Obama really miscalculated; he thought he was elected to reform healthcare and he needed to do it pronto. He wasn't: he was elected to fix the failing economy and get us out of Iraq. He should have worried about healthcare in his second term, when he wouldn't have to worry about getting reelected. Presidents tend to compromise less when they don't need to worry about staying in office.

As it is, I do think Obama hoped his law would lead into bigger and bolder reforms. It was perfectly obvious from the start that ACA was designed to make health insurance so burdensome and expensive that eventually the public just demanded some sort of government relief. Obama may have said that people could keep their insurance if they liked it, but the White House admitted in 2010 (less than six months after the law was signed) that a minimum of 96 million people had plans which would be "not compliant" with ACA rules. Translation: about 1/3rd of the country would lose the health plans they already had and have to find new (often more expensive) insurance; and the White House knew it. I just don't think they expected the backlash to happen this fast.



Also, just as a side note, I was going to say that anyone who seriously thinks the Democratic party would vote to privatize Medicare or Medicaid---especially after running against the Ryan plan for 18 months and winning the presidency and some legislative seats in the process---has to be as misguided, isolated and uninformed as a communist. But then I remembered who you are.

Scrollin' scrollin' scrollin'

Threadhide!

That was by far the worst joke I've heard all day, but I did some serious chucklin'.

.....it was so bad I had to reread it 3 or 4 times after you called it a joke before I noticed it. Well done, I guess.

What happened to number 3?

Lambert Strether has articulated some ideas I share.

Evidence of purposeful censoring of single-payer from the debate by Democrats:

http://www.nakedcapitalism.com/2013/10/46940.html

The linked article contains links to articles on the individual instances mentioned in the text of this quote.



Speculation on the ideological nature of Obamacare.



It is not unreasonable to think that Obama would believe in such an ideology. He keeps people from the finance and insurance sectors, which will theoretically most significantly benefit from this kind of new model of delivering government services and have great opportunities for deeply integrating themselves into the state structure itself, as his closest friends and advisers. He has repeatedly stated his belief in the efficacy of their leadership and governance in various roles in his government and in general, and we know that individuals and institutions from that section of the economy have financed and supported him politically for his entire political career. It makes sense for him to personally believe in them and this new model and to transmit that throughout his party which had incredible aspirations for him from the beginning of his first presidential campaign.

The fact that the markets and market actors and private/public integration and various czars that Obama has repeatedly expressed his faith in have repeatedly catastrophically failed in the economic field and now with the ACA fallout, and the bungled website which was supposed to have been a technocratic silver bullet, does not seem to have shaken his faith in his ideology. Rather, we've seen him double down and reject suggested alternatives, insisting that we stay the course to its final end. Is it all that likely that Obama has been sitting on a shrewd, secret backup plan that will resolve the problems he's created with the policies he's carried out his entire presidency that he chose not to implement earlier when, as Earthcubed pointed out, he had a poltical opportunity to at least try passing anything he wanted?