Thursday, October 24, 2013

Obamacare is not a liberal policy

By Frank Moraes

Mike Konczal has written the most insightful thing I've read this month about the problems with the Obamacare exchanges, What Kind of Problem is the ACA Rollout for Liberalism? He argues that the failure of the exchanges is not the result of liberalism; it is the result of neoliberalism. Or to put it more clearly: New Democratic ideology. We could have had an old fashioned approach to healthcare reform: a single payer health insurance system. That would have been simple. And I have had many frustrating conversations over the last two years with conservatives who complain about Obamacare and ask why we couldn't just have a single payer system. The answer, of course, is that after Fox Newsstarted shouting about "socialized medicine" these same conservatives would be absolutely positively against single payer. But I digress.

Obamacare is so annoyingly complicated because it is designed to be a kind of public-private partnership and that no one thinks will be as good at reducing costs as a single payer system would be. If we had the simple government insurance system, the exchanges would be trivial. You would log on, enter your information, and the program would spit out how much it was going to cost you. Or even better: there would be no exchanges; the correct amount of money would just be taken out of your paycheck. Instead, we have a system that interacts with multiple private insurance systems and then these have to communicate with the government to figure out how muchit will pay. And in the end, you have a totally messed up system that tells you to try back later.

The issue now is as it has been since Obama first became president: why do the Democrats make their laws more conservative when the Republicans block everything? The Democrats in Congress never even considered a single payer system. We were on track to get the conservative Heritage Foundation plan long before Kennedy died and the Democrats lost their super majority in the Senate. But as a result of the Democrats big rush to make the law more conservative ends right here with an over-complicated law that the Republicans can point at and say, "See! Liberalism doesn't work!"

Well, in fact, we haven't tried liberalism. For the last 35 years, Democrats have tried to "get along" with Republicans by moving more and more and more to the right. And the response? The Republicans just move more and more and more to the right. In fact, as the entire political system has moved rightward, the ideological divide between the parties has grown. For each step the Democrats have taken to the right, the Republicans have taken twosteps to the right. Nice going guys!

Konczal pointed out something else that I really like because I've been saying it for a long time. Let me quote myself, because I think I put it better:
The truth is that the Republicans have backed themselves into a corner. It is not that alternative plans are hard, it is that they simply don't exist on the right. When the Republicans decided that their very own Heritage Foundation plan (AKA Obamacare) was something straight from the rotting corpse of Stalin, they effectively gave up on any kind of "free market" approach to healthcare reform.
This is a very big problem for conservatives. The mess that our previous healthcare system was will not go away if Obamacare fails. The remaining conservative healthcare "reform" ideas either nibble around the edges or actually make things worse. The people will not stand for this—not for long anyway. So the only alternative to Obamacare is some kind of single payer system. This is yet another example of conservatives demanding everything and as a result, actually losing ground.

Like most liberals who have been paying attention, I've never liked Obamacare. The idea that the government would require people to buy into a broken health insurance market strikes me as an authoritarian overreach. But such theoretical considerations are not that important to me. What isimportant is getting a system that works. I'm sure the government will make Obamacare work. But it is a conservative policy, and I have always wanted a liberal policy: a single payer system, which would have worked far better.

(Cross-posted at Frankly Curious.)

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