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.Our health care “system” is crazily, maddeningly complex. (Medicare is fairly complex on its own, for whatever that may be worth.)
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.
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.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.
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.
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: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.
United States: $8508
United Kingdom: $3405
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?