Jared Bernstein wrote a very insightful article over at the Economix Blog, The Path to Complexity on the Health Care Act. As a member of the administration during the development of Obamacare, he accepts a lot of the blame for it being complicated. Well, perhaps “blame” is not the right word, because he thinks he was right. Basically, he claims that being able to say that people could stay with their current plans was essential to the law’s success. And I get that. But I think there is something deeper going on that he doesn’t realize.
Think back to 2010. Although it was true that those with employer provided health insurance could (and still can) keep the coverage, people didn’t think that at the time. All we heard at the time (except those of us who trolled the wonkosphere) was that this was a government takeover of healthcare. There were going to be “death panels” to kill off granny. The American Revolution ended in defeat on 23 March 2010! (A date which will live in infamy!) I think it is fair to say that the American public knows very little about Obamacare, but most of what they do know is conservative propaganda.
To me, it is clear: Obamacare is so complicated because the Democrats tried to get the Republicans to sign onto it. And not one of them voted for it! So while I do think that the Democrats (in particular our current president) were hopelessly naive in how they handled healthcare reform, the true villains are the Republicans. The Democrats started with a Republican bill—written especially to appeal to them because this was the bill that for two decades they’d been trumpeting as the “conservative approach” to healthcare reform. That bill was already very conservative and complicated. But in the name of making the bill more to their liking, the Republicans got the Democrats to change it—making it even more conservative and complicated. That’s why we have this complicated bill!
This highlights the fact that the Republican Party could not care any less about the poor and middle classes in this country. I reported this morning on their approach to lead poisoning: they don’t care. When it comes to 11 million people living in a shadowy no man’s land: they don’t care. And when it comes to healthcare: they don’t care. Sure, they’ll propose conservative alternatives to liberal legislation; but the moment the conservative alternative becomes the legislation, they abandon it. This tactic is fully explored in Winner-Take-All Politics: they would love to help that poor, it is just that this particular bit of legislation (whatever it might be) just isn’t quite right.
Still, I can understand that having “keep your current healthcare” was a good selling point. At least, it would sound good in a television interview. But the truth is that everyone I know hates their health insurance. So what Bernstein is really saying in his apologia for the complexity of Obamacare is really kind of what I’m saying: the Democrats were always playing the game using the Republicans’ ground rules. Clearly, the positive, liberal approach would have been to say, “Everyone hates their insurance and we are going to get rid of your insurance company and replace it with an institution that doesn’t have an incentive to deny you care.” I think most Americans would have been very open to that message. And the rest would have said the same thing: they’re going to kill granny!
There were various ways that the government could have dealt with the insurance companies. My favorite would have been for the government to simply buy them out of business. That would have worked out fine. For one thing, they really aren’t that valuable. But they could have pocked the cash and stayed in business. All countries with single payer health insurance have a private insurance industry. The rich aren’t going to accept “Medicare for all.” They will want their own very expensive and private healthcare. So there would still be money to be made. There are other issues, of course. The government would have had to do something for the people who were put out of work by the suddenly much smaller insurance industry. But that wouldn’t have been that costly either. I just don’t see the problem with this. As it is, we are all paying in a very big way for the government not taking the insurance companies out the primary healthcare system. Instead, we directly funded them with tens of millions of extra customers who are federally mandated to buy their horrible products.