"The Second Best Plan"

By Big Tent Democrat, Section Other Politics
Posted on Mon Jun 06, 2011 at 02:12:51 PM EST
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Paul Krugman:

By the way, defenders of the G.O.P. plan often assert that it resembles other, less unpopular programs. [. . .] I’ve been seeing claims that Vouchercare would be just like the system created for Americans under 65 by last year’s health care reform [. . .]

[. . .] First, Obamacare was very much a second-best plan, conditioned by perceived political realities. Most of the health reformers I know would have greatly preferred simply expanding Medicare to cover all Americans. Second, the Affordable Care Act is all about making health care, well, affordable, offering subsidies whose size is determined by the need to limit the share of their income that families spend on medical costs. Vouchercare, by contrast, would simply hand out vouchers of a fixed size, regardless of the actual cost of insurance. And these vouchers would be grossly inadequate.

(Emphasis supplied.) Let me make 2 points in response - (1) The exchange/subsidies reform created by ACA do not forward us towards the best plan - Medicare for All. They take us toward the path of VoucherCare. What's more realistic? That Medicare will be made to resemble the exchange/subsidy reform or that the exchange/subsidy reform will be made to look more like Medicare? I think the former. (2) The size of the subsidies under ACA will be much more dependent on defeating the "Austerity Now! crowd than on the affordability of insurance on the exchanges. The reality is ACA will likely end up looking like VoucherCare when it is all said and done. Krugman's critique of VoucherCare is spot on. But he has a blind spot on the weakness of the exchange/subsidy reform in ACA, which likely will become VoucherCare.

Speaking for me only

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"The Second Best Plan" | 38 comments (38 topical)

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Yep (5.00 / 1) (#1)
by MO Blue on Mon Jun 06, 2011 at 02:18:57 PM EST

The reality is ACA will likely end up looking like VoucherCare when it is all said and done.

It will force people to purchase "junk insurance" that fills the industry's coffers and leaves individuals with less money and no way to afford actual health care.

"First, Obamacare was (5.00 / 1) (#6)
by KeysDan on Mon Jun 06, 2011 at 02:57:47 PM EST

very much a second best plan, conditioned by perceived political realities." True, the first and the last reason--molded or stipulated to by perceptions, not by attempts or efforts. Indeed, the best model was not even taken out for a spin around the block before the "Edsel" was purchased, with the remaining considerations being undercoating, to be or not to be.

Of course, even now, what should be perceived as being the politically unrealistic "Yugo", Vouchercare continues to be discussed as a starting point for Medicare reforms. And, these reforms are "urgent" in the sense of never miss a chance to exploit a crisis, real or not, to achieve reforms, substantive or ideologic.

Is the thought here really (none / 0) (#15)
by AngryBlackGuy on Mon Jun 06, 2011 at 05:43:01 PM EST

that Obama and the dems didn't fight at all on ACA and healthcare. That they just took whatever the GOP wanted and signed it.

It's like we're living in a universe where 15 months of fights and battles and Xmas signings and negotiations and town halls and death panels and socialist calls and Hyde Amendment theatrics and destroyed political capital and Scott Brown and every other thing that happened during that period to stop the dream of single payer did not occur.

Bottom line: If ACA is a conservative dream plan, they sure as hell didn't act like it was and still don't.

In all of this rubbish about how ACA is simply a step towards a voucher system and a pay off for the GOPs constituency, we repeatedly lose the fact that the GOP fought the plan tooth and nail and would repeal it tomorrow if they could.

So either the plan is net good or it's net bad. If we decide that it's a net negative, then let's all join up with the republicans to repeal it because I think they'd welcome our votes.


There (5.00 / 2) (#19)
by Ga6thDem on Mon Jun 06, 2011 at 06:11:12 PM EST

was no fight. It was Obama spending 15 months chasing after the GOP for votes and them constantly saying no and then him moving further to the right to please them and them still saying no until we got Bob Dole's healthcare plan.

The only fight on the issue seemed to come from Pelosi.


Style Points (none / 0) (#24)
by AngryBlackGuy on Mon Jun 06, 2011 at 07:33:43 PM EST

Don't count much for the actual legislation. I think that healthcare was a massive fight and even if you don't think Obama was throwing blows and taking hits, it's clear that Reid and Pelosi and the deems in congress were. Jobs were on the line.

But I repeat the inherent question. ACA gets bashed here about once or twice a week, and I just don't think I am clear on what the position is.

Should ACA be repealed or not. To read some of the comments it's as if the legislation was an evil creation of Rove and others with a few purposes: helping insurance companies and hurting the poor and also frightening cute animals.

So if it is that bad, go the repeal route 100 percent. Convince deems and the public that a tragic mistake was made, fewer people would be covered under the plan and it is far less preferrable than the status quo.

No?

Then maybe a better focus would be determining fixes that will strengthen the exchanges and their benefits. Or standing more firmly behind ACA so that we have the moral standing to delineate between it and what Ryan proposes.

We are in a situation where the likely GOP nominee proposed a similar plan and that plan remains popular in the state years after it's implementation. We have the ability to absolutely slam home the idea that the incremental change of ACA was not only a GOP accepted compromise, but one that is only the first step.

Instead we have a chorus of woe (oh if Obama had just fought harder, talked louder and farted magic fairy dust out of his butt we'd have a single payer system or a public option). Instead of rallying around the incremental change, as conservatives do, we instead blast our own legislation because it is not perfect.

If we are that stupid we deserve to relinquish control to the extremists on the right. At least they have the common sense to understand the bigger picture and our long term objectives. You didn't get your dream reform people. I get it. I also get that it's a year later and there are targets more fitting than Obama, Pelosi and others that busted their rumps to make the progress that they did.

Or again, maybe you should join the republicans and demand repeal. That would actually make more sense.


: Someone (5.00 / 1) (#26)
by Ga6thDem on Mon Jun 06, 2011 at 08:03:55 PM EST

who throws blows usually don't give away the store in the end or do back room deals with the pharmaceutical companies or the insurance companies.
The fact of the matter is that we probably would have been better off not passing it. Obama would have been better off working on the economy or maybe not since he hasn't put forth the best policies regarding that either. He could have just passed a few things like preexisting conditions and been better off and he may not be in office when the ACA goes into effect if it even lasts that long.
The ACA doesn't even have to be "repealed"/. As it is, Obama has been handing out a ton of waivers to people so they don't have to comply pretty much undercutting the legislation himself and then you have the GOP which is probably going to defund it so what do you have in the end?
At the end of all this, it's really hard to argue against Ryancare when Obamacare is essentially the same thing.

The Republicans would oppose (none / 0) (#18)
by observed on Mon Jun 06, 2011 at 06:04:49 PM EST

school prayer, if the Democrats supported it.


: Thank (none / 0) (#20)
by Ga6thDem on Mon Jun 06, 2011 at 06:12:07 PM EST

you. I keep telling people that the GOP is just a bunch of knee jerkers but you put it very succinctly.

Hmm.. (none / 0) (#31)
by Left of the Left on Mon Jun 06, 2011 at 09:32:39 PM EST

maybe they just know how to negotiate better.

its entirely possible, crazy as it may sound, that politicians may act a certain way because it was in their best interest.

But lets say they were 100% honest, is Republican outrage a guaranteed sign of a good bill? Republican displeasure is evidence of nothing.


: Fair Points (none / 0) (#34)
by AngryBlackGuy on Tue Jun 07, 2011 at 09:23:55 AM EST

I concede that that wasn't my strongest argument. But I do think that GOP opposition to a democratic healthcare proposal is a pretty good indication that it isn't the preferred GOP outcome.

Democrats 2012 campaign slogan (none / 0) (#2)
by jbindc on Mon Jun 06, 2011 at 02:40:35 PM EST

h/t Avis Rent a Car

"We Try Harder"

"Try harder" (none / 0) (#7)
by Zorba on Mon Jun 06, 2011 at 02:58:50 PM EST

at what, though? I was thinking their slogan would be "Vote for us- we suck less than the other guys." ;-)


: Your slogan might be (5.00 / 1) (#8)
by MO Blue on Mon Jun 06, 2011 at 03:01:24 PM EST

more accurate.
Of course, more accurate still is "Vote for us-we can pass conservative legislation better than the Republicans."

: True (none / 0) (#9)
by jbindc on Mon Jun 06, 2011 at 03:03:13 PM EST

But ya gotta think positive spin!

Very true (none / 0) (#3)
by Ga6thDem on Mon Jun 06, 2011 at 02:48:35 PM EST

and it was the inherent flaw in the ACA that it relied on subsidies and not having some sort of public option for people to choose from.

If we just went with Medicare for All i'm wondering how much money it would save? We could get rid of Medicaid, SCHIP and probably lots of other programs that the states run.

The next best plan that was out there was the one that allowed a Medicare buy in along with subsidies for health insurance.

if you look at the federal law (none / 0) (#4)
by CST on Mon Jun 06, 2011 at 02:53:20 PM EST

in a vacuum, I'd say this is a reasonable assumption:

"What's more realistic? That Medicare will be made to resemble the exchange/subsidy reform or that the exchange/subsidy reform will be made to look more like Medicare? I think the former. "

But, one thing that you are not taking into account is the continuous shift on this issue. Right now we have VT implementing single payer for their state, CT is considering it, MA is looking hard at their existing plan to see how to cut costs (I don't see a shift to single payer, but I don't see inaction happening here either).

These states are taking the lead, and in a few years there will be more data and more headway on this issue to coalesce around nationally.

Hmmm (none / 0) (#5)
by Big Tent Democrat on Mon Jun 06, 2011 at 02:56:23 PM EST

ACA enabled this in what way? Made Medicaid and subsidies available for it?

And what happens if those funds are cut?


ACA is not an enabler so much as a baseline (none / 0) (#10)
by CST on Mon Jun 06, 2011 at 03:10:35 PM EST

it forces every state to deal with the issue on some level. Either they go with the federal plan, or they attempt something else. But it will become the baseline to compare all the other plans that are in place. And I think VT, etc... will come out looking better.

"what happens if those funds are cut?"

Than you are right, and I am wrong about which direction we are headed on this.


: It's the same sad story, and I don't know (5.00 / 2) (#12)
by Anne on Mon Jun 06, 2011 at 03:50:18 PM EST

why it's still acceptable, that where one lives is more of a determinant of what kind of care one is likely to be covered for.
That's not going to change under ACA; sure, there will be some sort of minimum guidelines, but we don't even know what they are - and you can be sure that at every step of the way, there will be fighting and attempts to undermine those requirements, to get waivers out of those guidelines. And on the front lines of those attempts to undermine coverage will be - guess who? - the insurance companies. Do you think that after four years of hosing those of us who do have insurance, and even with the possibility of millions more victims to suck the lifeblood out of, they're not going to be working to get the minimum coverage requirements lowered - and without a corresponding lowering of cost?
I just don't understand why people don't see this, and I'm really tired of the essential and entrenched unfairness in a balkanized coverage system that the insurance companies have gamed so well.
It just makes me want to scream.

If we passed (none / 0) (#25)
by AngryBlackGuy on Mon Jun 06, 2011 at 07:39:42 PM EST

Medicare for all, funds could be cut and that program destroyed too. There is mo magic anti repeal juice that would have been sprinkled on Medicare for all to prevent a GOP led government from gutting everything.

If your argument is that the GOP might repeal ACA, you can't argue that they couldn't repeal your plan either.

You argue from the position of what the structure is right now. Arguing that a law is bad because it might be repealed isn't fair.


: Cut Medicare??? (none / 0) (#37)
by Big Tent Democrat on Tue Jun 07, 2011 at 10:48:23 AM EST

Not so easy as the GOP is learning.
That is called thinking politically.

: Bellow you posted that (none / 0) (#38)
by Warren Terrer on Tue Jun 07, 2011 at 10:59:00 AM EST

you see ACA as a slippery slope toward single payer and better cost savings. Now you say that expanding Medicare for all, which is a single payer system, would lead to the destruction of the program.
These arguments are contradictory. All you are really saying is you support ACA (because it's what Obama wants) and you will defend it by whatever argument seems to work at any particular time, even if those arguments contradict each other in the very same diary.

I am sick of this back and forth argument (none / 0) (#11)
by loveed on Mon Jun 06, 2011 at 03:21:38 PM EST

it's all political.
The argument you will never hear.
Separate soc.security.& medicare totally from the budget. These two programs are funded by the citizens, why are we paying twice.
Allow those over 50yrs. to use medicare as there insurance carrier if they choose(all other insurance programs are available). It would probably be cheaper,also a huge influx of revenue(instead of the employee paying the insurance company, the money will go to medicare).It also would give the insurance companies some competition.
The funds from soc.security.& medicare should be totally separate from the budget. Soc. secur. is solvent at this time.The extra money would shore up both programs. I would love to have medicare as my insurer(there probably million who feel the sameway). My employer pays about 11,000 a year for my health benefit).
Not many jobs offer health care when you retire anymore. Medicare is now the official health care carrier for a large amount of retiring seniors. We might as well pay into now and strength it,instead of letting it just collapsed.
Also the government owes soc.secur. 3trill.dollars. No one every talks about a repayment plan.
Why can't they try and make it better,instead of trying to destroy it?

Krugman v. BTD (none / 0) (#13)
by AngryBlackGuy on Mon Jun 06, 2011 at 05:36:23 PM EST

Let's not sugar coat what Krugman says and what BTD's response is. Fundamentally, Krugman believes that ACA will do what it purports to do and is a path towards cost reduction and greater coverage.
BTD assumes the exact opposite. Where I see ACA a a slippery slope towards single payer and better saings measures (and I think Krugman sees that as well), BTD sees a conservative scheme designed only to help the insurance companies. We often talk here about the credibility to pundits and others and when convenient, Krugman is given a lot of credit. But on this point, because ACA isn't popular here, he is ignored.

BTDs point in (1) is speculation. I would argue that the slipper slope moves in the opposite direction. When exchanges do no prove adequate to solve all of the issues, a public option will become more appealing. No one is in a real position to predict how that will turn out IMHO. It's all just speculation.

So (2) is the only real debatable point: BTD uses "when all is said and done" and other speculation about changes to existing law. But the law today is clear and the difference between Vouchers and ACA are clear as day. Krugman puts it best in another post:

"Well, the answer is that the ACA is specifically designed to ensure that insurance is affordable, whereas Ryancare just hands out vouchers and washes its hands. Specifically, the ACA subsidy system sets a maximum percentage of income that families are expected to pay for insurance, on a sliding scale that rises with income. To the extent that the actual cost of a minimum acceptable policy exceeds that percentage of income, subsidies make up the difference."

People can speculate about what might happen or what will happen, but Krugman is talking about what did happen and what the law is. Today. Right now. The only way the structure changes is that Obama refuses to veto amendments to his own plan. Highly unlikely.

Speculating is all we can do (5.00 / 1) (#23)
by Big Tent Democrat on Mon Jun 06, 2011 at 07:33:33 PM EST

unless of course your middle name is Nostradamus.

Mine is Cassandra.


: Fair Point (none / 0) (#29)
by AngryBlackGuy on Mon Jun 06, 2011 at 09:23:45 PM EST

Interestingly, my middle name is "win one to silence the haters lebron".
My mom had skills.

If you'd bothered to do the math (5.00 / 1) (#27)
by Anne on Mon Jun 06, 2011 at 08:12:29 PM EST

on what constitutes "affordable" under the ACA, you'd know that Krugman's statement doesn't hold water; he's right about RyanCare, but he's wrong about ACA being all about affordability. It's named "Affordable" Care Act in much the same way that Bush gave us the "Clean Air" Act and the "Healthy Forests" Initiative.

And just so you know, given that the bulk of the Act has yet to be implemented, that the exchanges have not been set up, that we haven't seen what the baseline coverages will be, and we don't know how the insurance companies are planning - and you know they have people whose sole mission is to plan - to get around and weaken whatever is required of them, Krugman absolutely IS speculating about the ACA.

As I said, he's right about RyanCare, but that RyanCare sucks doesn't mean Obamacare doesn't also suck, in a different way.


I didn't realize (none / 0) (#28)
by AngryBlackGuy on Mon Jun 06, 2011 at 09:20:34 PM EST

That "the nobel prize winning economist didn't do the math" was an acceptable answer.

Between Krugman and Obama's nominee that didn't make the GOP cut, Nobel prizes in economics are apparently being handed out in Happy Meals.


: You do the math, ABG; (none / 0) (#32)
by Anne on Mon Jun 06, 2011 at 09:40:39