Krugman’s assessment of Affordable Care!

MONDAY, APRIL 7, 2014

We agree, and we disagree: We agree, and we disagree, with Paul Krugman’s recent column about Obamacare.

Headline: “Rube Goldberg Survives.”

We agree with the bulk of this passage, in which Krugman explains the unfortunate complexity involved in the health care law:
KRUGMAN (4/4/14): The crucial thing to understand about the Affordable Care Act is that it’s a Rube Goldberg device, a complicated way to do something inherently simple. The biggest risk to reform has always been that the scheme would founder on its complexity. And now we know that this won’t happen.

Remember, giving everyone health insurance doesn’t have to be hard; you can just do it with a government-run program. Not only do many other advanced countries have “single-payer,” government-provided health insurance, but we ourselves have such a program—Medicare—for older Americans. If it had been politically possible, extending Medicare to everyone would have been technically easy.

But it wasn’t politically possible, for a couple of reasons. One was the power of the insurance industry, which couldn’t be cut out of the loop if you wanted health reform this decade. Another was the fact that the 170 million Americans receiving health insurance through employers are generally satisfied with their coverage, and any plan replacing that coverage with something new and unknown was a nonstarter.

So health reform had to be run largely through private insurers, and be an add-on to the existing system rather than a complete replacement. And, as a result, it had to be somewhat complex.
Our health care “system” is crazily, maddeningly complex. (Medicare is fairly complex on its own, for whatever that may be worth.)

That said, we agree with Krugman on the need for the unfortunate Rube Goldberg aspects of the ACA. No major Democratic candidate has ever proposed “single-payer.” As far as we know, Krugman is giving an unfortunate but sane assessment of some of the reasons why.

We tend to agree with Krugman on the need for Obamacare’s unfortunate Rube Goldberg features. On balance, we don’t agree with this:
KRUGMAN: But the nightmare is over. It has long been clear, to anyone willing to study the issue, that the overall structure of Obamacare made sense given the political constraints. Now we know that the technical details can be managed, too. This thing is going to work.

And, yes, it’s also a big political victory for Democrats. They can point to a system that is already providing vital aid to millions of Americans, and Republicans—who were planning to run against a debacle—have nothing to offer in response. And I mean nothing. So far, not one of the supposed Obamacare horror stories featured in attack ads has stood up to scrutiny.
Is it true that “this thing is going to work?” On balance, we don’t agree with that, mainly because of something we first learned from Krugman.

When Obama ran for the White House in 2008, he told people that insurance premiums would go down $2500 under his health plan. That isn’t going to happen.

If you watch Fox News, you’re constantly told about that “broken promise.” If you watch MSNBC, this topic is never mentioned at all.

Here’s a related problem which is also never mentioned. As long as data like these obtain, we won’t be inclined to say anything like “this thing is going to work:”
Health care spending, per person, 2011:
United States: $8508
Canada: $4522
Germany: $4495
France: $4118
Australia: $3800
United Kingdom: $3405
Japan: $3213
Spain: $3072
Italy: $3012
The plan is working in the sense that more people are getting insured. The plan is not “working” to the extent that data like these will persist.

Something is crazily wrong with those numbers. They represent an ongoing “health care horror story” in and of themselves.

Perhaps for that reason, those numbers are virtually never mentioned in our public discourse.

We became aware of this problem from a series of columns by Krugman almost ten years ago. We think he should continue to talk about this astonishing problem.

This problem is almost never mentioned at liberal news orgs, including MSNBC. A conspiracy theorist would say this silence is a gift to the corporate and professional guilds which are looting average Americans through our super-expensive health care.

Obamacare is getting more people insured. Has it addressed the looting?

65 comments:

  1. This pathetic post is just another example of blogger's jealously of Josh Marshall's site's success.

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    1. We need more of your valuable insight. And Bob's.

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  2. Is calling someone a looter the same as accusing them of a crime?

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    1. Corporations are careful to make sure they include language in our laws that prevent their looting from being technically "illegal" and therefore a crime. We are basically being looted by fraud.

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    2. Thanks. I really wasn't looking at it from a criminal law standpoint though. More from a definition on a journalistic basis.

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  3. We agree, and we disagree with Somerby here. Is Somerby's post designed as an explanation of Krugman's column for general readers?
    He offers a string of standard presentations straight from the playbook of the socialized medicine guild.

    On the other hand this seems like an Obamapolgist explanation of why POTUS caved to the corporatists who own his party and abandoned his pledge to support single payer. IMHO.

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    1. I think in 1957, the Civil Rights movement and LBJ managed to get a Voting Rights Act through the Senate that was the first real break in Jim Crow. It was criticized as weak at the time but it opened the door for the 1964 Civil Rights Act.
      I think Obamacare is a similar kind of start along the road towards socialized medicine--like that enjoyed in most other countries, rich and poor. I am wanting to give Obama and Obamacare credit for getting the ball rolling towards something like a single-payer system. Obamacare is far better than nothing.

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    2. Yes, I hope this will be true too.

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  4. Fine argument, Bob.

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  5. "Obamacare is getting more people insured. Has it addressed the looting?"

    I thought there was a rather famous provicion of the ACA that required health insurers to spend X percentage of the money they take in on actual care, or rebate the difference back to consumers.

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  6. "No major Democratic candidate has ever proposed “single-payer.”

    Not true. Bob Kerrey proposed a single-payer system during his 1992 run.

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    1. As did Truman.

      Will Bob correct his mistakes as he demands of Maddow? Readers want to know.

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    2. Let us also not forget that John Edwards as recently as 2008 offered "Medicare for everyone" as a mandated "public option" that employers had to provide their employees in addition to private, group plans.

      Edwards reasoned that as administrative costs for Medicate were 4 percent compared to 20 percent for privately managed health insurance plans, more people would be opting for the "public option" and we would eventually have "single payer."

      Bob might mull those high adminstrative costs as he wonders why health care costs are so high. He might also mull whether the lack of insurance to pay for preventative health care might also be driving up the costs of caring for people whose illnesses or injuries could have been taken care of for far less cost if treated earlier.

      If so, then insuring more people will have an effect in holding down, and perhaps even reducing, future per-capita health care costs in the U.S.



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    3. Come to think of it, Medicare wasn't universal, but it certainly was "single payer."

      I think a "major Democratic candidate" proposed it, if I am not mistaken.

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    4. No major Democratic candidate has ever proposed “single-payer.”

      Bob is part of the guild. The guild gets to define who is major and who is not. That is why us "rubes" don't know who is proposing an end to the looting.

      http://www.ontheissues.org/2004/Dennis_Kucinich_Health_Care.htm

      Admit your guild membership or admit your error.

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    5. Somerby is not part of the guild. He is not a paid journalist. He is a citizen blogger.

      Have you considered that your ideas of what constitutes "single payer" may vary? Some definitions say it is only when the govt pays, others say it is when a govt or quasi-govt entity not only pays but also organizes health care provision, as in some other countries. Medicare reimburses costs, but not all costs, just some, and there are deductibles. Some single-payer definitions say the single payer must pay all the costs for it to be "single payer".

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    6. I am sorry to be the one to break this to you. Somerby talks a good game from time to time. He tries to show solidarity with the common working people. But he is cut from the same Ivy elitist cloth that dismissed real progressives like Dennis Kucinich. Follow my link.The proposal is there in black and white.

      Citizen blogger my behind. Harvard educated toady for the Clinton-Gore Third Way boomer brigade masquerading for
      the "little guy" is more like it.

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    7. Kucinich lost me when he showed up with his child bride.

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    8. Well to each his own 2:54. But what does his marriage to a
      younger person have to do with Somerby and other Third Way types trying to dismiss real progressives as major candidates?

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    9. Yes, note the game that Bob and his fans play.

      Not only do they get to define "major candidate," but they also get to define "single payer."

      Thus, not FDR (his was tied to Social Security, but he dropped it to get SS through), Truman, Johnson, or more recently Kerrey, Edwards or Kucinich and their plans fail to fly through the shifting goal posts of "single payer" or "major candidate."

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    10. @3:53, as I said earlier, I think it hinges less on whether these folks were major candidates than on the definition of single payer. I suggested the various definitions available using Google and I don't think the plans of some of the people mentioned fit those definitions very well.

      But if he did goof up in that one statement, I don't think it affects the rest of his post much. I tend to agree that the job of reforming health care is less than half done. It seems like a pretty obvious complaint to me and I don't understand the noise level in the comments.

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    11. @4:05 Because this is a game to you and not a discussion of an important issue affecting us all, right?

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  7. Does Bob know insurance premiums and health care spending per person are not the same thing? I can't tell from this prose-poetry rant.

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    1. But we can tell loads about your attitude toward Somerby by your use of the phrase "prose-poetry rant" rather than "essay."

      Seems to me he is saying both are too high, not confusing the two.

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    2. Anon 2:19

      Does he "seem" to be saying it or just "suggesting" it?
      Did he mean to "imply" it, or would he rather readers "infer"
      that he did?

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    3. Excuse me, I didn't realize you were a stupid troll filling the air with stupid troll nonsense.

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    4. Sorry. Was the question was too tough for you to answer?

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    5. Did he somehow conflate the two? Of course not. But this sounds like a superficially plausible complaint to discredit Somerby written by someone who hates his guts but must be here day in, day out, attacking whatever he writes.

      Get a life and go away.

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    6. You must be the one in the comment thread below insulting everyone who tries to contribute.

      I presume the per person figures TDH posted above includes both insurance and direct care spending. If not, why post it. They are no conflated. They are cojoined.

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    7. You are making that assumption but it is not necessarily true. You would need to go back to the source of the figures, which TDH has cited previously but not today. As I recall, they came out of a previous Krugman article, but I may be wrong about that. That source should explain how they calculated the numbers. The reason why I believe it does not include insurance is that it is used to make cross country comparisons to nations where people do not have insurance costs, as we do. If you truly care about this, send an email to Somerby and ask him where the figures come from (or perhaps take one of the figures as a search term and Google it).

      If you want to be treated more courteously, I suggest trying to sound less like a troll and more like someone interested in discussion rather than playing "gotcha" with Somerby.

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    8. Pardon me 3:17. You seem to be attacking everyone who comments here. Including me. Do you think it is a good idea to call everyone but yourself a troll?

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    9. 3:17's has made up his own unique definition of troll, which seems to be anbody who disagrees with him. He might solve his problem by finding a dictionary of Internet terms.

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    10. I am 3:17 and I am heartily sick of trolls and anyone who gives aid and comfort to them. I define a troll as someone who is more interested in attacking Somerby than in discussing the ideas in his posts. @3:49 came across as another insincere parody of Somerby's style raising inane questions irrelevant to anything in the post. I have yet to revise that impression.

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    11. You are 4:45 and 3:17. Who else are you? Because I am
      3:05 and 3:49 and I am sick of being attacked by you for no good reason.

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    12. Why don't you all just get names?

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    13. When the trolls here stop attacking Somerby for no good reason, I promise to (1) get a name, and (2) stop attacking people who behave like trolls.

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  8. I wish I knew what part of the passage Bob agrees with that he finds fault with. I mean, since he only agrees with the bulk of it, some of it must be bunk. Is it a lot? Or is it a major part, like where Krugman does his part as a good career liberal to cover up the looting?

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    1. Read the essay over a few more times and see if you can figure it out. If Somerby thought a lot of the part he agrees with were bunk, don't you think he wouldn't agree with it, and don't you think he would say which it was, given that he is hardly shy about criticizing others?

      Typical specious troll garbage.

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    2. Words have meaning. If Bob says 'bulk" he meant it. That seems to mean there are parts of it he disagrees with. I often use TDH when discussing issues with my friends and I do not want to mislead them.

      I don't refer friends directly to this blog because of the vitriol in the comments section. Your response, while seemingly well intentioned, just shows how vicious this place has become. You have become just like the nasty trolls you deplore.

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    3. That your troll garbage somewhere else please.

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    4. You are a very nasty name caller. I wish Bob would ban people like you.

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    5. In the words of the immortal PeeWee: "I know I am but what are you?"

      Go away.

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    6. Is that kind of like Bob Dylan's famous phrase?

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  9. Some people are focused on the extent to which ACA will be a positive accomplishment that will help put Democrats in office in the upcoming elections. Others are focused on the need to reform health care. I think that accounts for whether people will ask for more or be happy with what Obama has accomplished with this legislation.

    Those wanting to see glowing essays about the success of Obamacare will not welcome the urgings of those who point out that the job is incomplete -- as Somerby is now doing.

    On a different topic, Cannonfire is talking about how Benghazi may have been targeted because it was the point of CIA coordination of weapons-running into Syria. Seymour Hersch apparently has a new article out about Turkey's involvement in Sarin attacks blamed on Assad. Cannon is asking why this info has been kept secret from the American public. MSNBC has said nothing about it either, never mind healthcare looting.

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    1. Looking at a map of the middle east it is easy to see why the CIA would pick a lawless place like Libya, so close to Damascus, to do their drug running into Syria.

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    2. They were running weapons, not drugs.

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    3. Even more convenient to pick Libya. But pardon me. I must have been thinking of their activities inside the US when I said drug running.

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  10. Hey TDH readers. Guess what fact Bob diappeared from this post?

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  11. 'No major Democratic candidate has ever proposed “single-payer.”'

    If not, why not? But a "public option" - really a foot in the door for universal single-payer - was certainly discussed and approved by about 70% in polls. Krugman is wrong about this - it was insurance companies which killed the public option.

    But Bob is right - total costs are not going to go down, they are going to increase, and somebody will be paying for the subsidies to the low-income people who weren't covered. Insurance companies won't be paying - their stocks have only gone up through all this (except when it looked like Obamacare might be killed by the Supreme Court).

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    1. Karma is a bitch. Insurance companies are going to get theirs when climate change heats up. Large scale disasters are going to result in bankruptcy of insurance companies. They will also result in health insurance company failures because such disasters have major health impacts. When they have to pay up, the system will collapse. At that point we will either be a third world country or we will have an opportunity (and motivation) to enact health care economically, eliminating the overlay of looters being funded by the current system. It is gloomy and will be difficult to live through, but it is going to happen because no one has the will to do anything different.

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  12. In my world we often talk about the triangle between quality, speed, and cost. Stuff is a tradeoff between the three. How Obamacare was created shows this. Obama promised quality and low cost. You can keep your provider and your premium will be lower. Somehow speed didn't enter into his calculation at the start of the process. Unfortunately as the process went on, speed became a factor. He had a very narrow window of time to get the deal done before his veto proof majority in the senate would disappear. So from going to be a non factor speed became essential which meant the other two factors would have to suffer. While some would argue differently, IMO the tradeoff that occurred was cost. As has happened so many times before, as Krugman has discussed more than once, the president and democrats had to accept a deal with at best very limited cost savings.

    Note how this works out in partisan terms. Republicans attack him on the basis of what he gave up in the trade. "Where are the cost savings?" they cry. "A Republican plan would be cheaper," they proclaim, "if only we had one." But what would have happened if Obama had made a different deal, given up quality, to reduce costs? "Death panels, rationing, interference with the marketplace, he hates freedom" would have been the talking points.Now in fact, it's a bit more complicated than that and the lines aren't quite as sharp as I have drawn them, but that is in broad strokes what happened.

    What so many folks have advised Obama to do in theory is impossible in practice. He will never be able to satisfy his critics, because his critics are in the business of criticizing. It's a waste of time and effort to try.

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    1. Excellent points. Somerby should spend some time in your world. He could have said this much more clearly as you have done.

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    2. Couldn't you have offered praise without knocking Somerby? Praise from a troll is worth exactly nothing.

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    3. "Praise from a troll ... ZZZZZZZZZzzzzzzzzzzzzzz

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    4. Your triangle refers to the cost of the product, quality of the product and speed with which the product can be produced. In the case of health care legislation, the term "cost" refers to the cost to create the program, not the cost to deliver health care services by that program once created. You have confused the two. If health care costs remain high, that means the quality of the legislation was poor and the system was poorly designed (e.g., of poor quality), not that it cost more to produce that legislation. So, I think this is not a particularly good model of what happened.

      I agree that the Republicans will criticize whatever is presented by Obama and that their criticisms will have little merit because they don't care whether make stuff up, as long as it is negative. Obama has never mastered the rapid response technique employed by the Clintons to deal with the Republican noise machine. He lets memes get established and then cannot dislodge them.

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    5. Do not forget that Obama is the first Democratic nominee for president to get over 50 percent of the popular vote since Jimmy Carter -- and Carter got 50.1 percent.

      Obama is also the first Democrat since FDR to do it twice.

      So his skills as a politician are quite formidable.

      That said, I also get the impression that he is far more interested in the judgment of history than in the judgment of the Republican noise machine. Remember, he was pulling the nation's first national health insurance plan through Congress as he was dealing with an economy on the brink of global collapse.

      I think that history will judge him quite kindly.

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  13. It's a bit early to be making all these pronouncements. One of the major effects -- reduced administrative costs when providers almost always know immediately who will pay them and when -- will not be fulfilled until we get close to universal coverage. lots of things are going to shake out, but it will take time.

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  14. "No major Democratic candidate has ever proposed 'single-payer.' "

    Can you imagine the lengthy screed Bob would pen if Matthews or Maddow ever said anything so objectively false? Let's collectively hold our breath for Bob's correction.

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    1. One lengthy screed? It would have multiple parts and several "epilogues."

      In fact, Bob could have used it for the next 16 years.

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  15. Hey TDH readers. Guess what fact Bob diappeared from this post?

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    1. When he ran the chart a while back it had an extra country in it?

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  16. Dean Baker does discuss the high cost of medicine in the US on a pretty regular basis, however he is a fairly lone voice--unfortunately. He has a book that can be read online for free which addresses what he calls loser liberalism and how to correct these so called free markets which aren't free at all, but rigged by policies which abet the looting by big corporations, policies such as patent monopolies to name just one way in which the medical industry redistributes money upward. There are other ways to pay for research and development without the looting.

    GW

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