• Moderate health reform beats no health reform

    Ezra Klein read my mind. Earlier tonight a tweet went through my brain but never came out because I don’t tweet, and nobody in my household would have appreciated it. It was, “One reason I favor the ACA to just about any other health reform proposal is because it passed.”

    A lot of other health reform ideas are fine, though some are not. And I could have and would have supported many of them last year, if only they could have passed. They couldn’t then and they can’t now. It’s a strong reason to reject repeal (as if it were possible). It is not likely anything could really replace the ACA. The politics just don’t work. Heck, they barely worked for the ACA, but they did work.

    It’s hard to understand how anyone paying the slightest bit of attention to politics during 2009 can imagine another comprehensive health reform bill passing. It’s an exceedingly fine needle to thread and many Presidents and Congresses tried and failed before Obama and the 111th. Why should we believe it could happen again and soon? It can’t and it won’t.

    And that’s why it’s worth making our peace with the ACA. Is it really that bad? Really? Is it worth risking coverage for tens of millions of people over? It is, after all, a moderate bill, which was Klein’s point. That’s both why it passed and why we should accept it and move on.

    People tend to form their impressions of how liberal or conservative something is by looking at how much partisan activity there is around it. And there was, of course, a lot of partisan activity around Obama’s signature legislative effort. But if you believe “liberal” and “conservative” refer to coherent schools of ideological thought, the health-care bill was the most moderate universal health-care proposal offered by any president, of any party, in the last century.

    It was far more modest than what Harry TrumanRichard Nixon, or Bill Clinton proposed, relying more on the private sector and tampering less with existing insurance arrangements than any of those plans. It was even more moderate than what George H.W. Bush proposed. As I rarely tire of pointing out, it was a dead-ringer for the bill Republicans rallied around as a conservative alternative to the big-goverment overreach of ClintonCare, not to mention the bill Mitt Romney passed in Massachusetts. The individual mandate, now the most controversial element of the law, began life as a Republican idea.

    It was a good idea. Republicans won! Yet they’ve assigned themselves the impossible task of repeal. I guess politics ceased being the art of the possible a long time ago.

    See also: Klein’s follow-up. I wish he’d stop reading my mind. It’s getting spooky.

    • Agreed. That is a point I make with friends. There is stuff I do not like in the bill. It is not what I would have preferred, but it does increase access. It does address costs, though not as well as I had hoped. Quality is addressed indirectly. Given that there was no alternative, and will not be if it is repealed, I end up supporting it.


    • “One reason I favor the ACA to just about any other health reform proposal is because it passed.”

      Classic bureaucratic thought. All politicians define their success *not* in terms of outcomes, but……”I got something passed.” Whether it makes the situation worse is irrelevant. It’s not even important. Outcomes couldn’t be further from their minds.

      Something changed…that’s why you support it. Congratulations.

    • Richard missed the point. You`ve said it before: political feasibility matters. What has no chance of passing is largely irrelevant.

    • Moderate health reform beats no health reform

      I have to disagree. You end up with all kinds of pork and special interest stuff in bills that no one understands and no one really wants. It is neither fish nor fowl. Why not hold out for what you really want. Why not hold out for a a meaningful compromise like my plan:


      Further employers were moving in the on this by dropping health insurance and increasing deductible. Such moves are IMO a positive.

      Also if we get move people paying directly they may then demand better legislation. They may demand a reduction of excessive licensing, easier access to meds.

      • @Floccina – It’s been nearly a century. Isn’t it time to begin to solve problems rather than hold out for that which will never occur? (I didn’t read your plan.) What is so wrong with a plan agreed upon by some Republicans in years past and clearly favored by many Democrats more recently?

        Never have I said it is ideal or what I’d prefer. It’s what can pass, and did. It takes major strides toward solving some, but not all, problems in health care. It is not inconsistent to support the ACA and also to suggest where we need to do more.

        By the way, despite what Obama says, the ACA does not support the employer-based system. It appears that way now, but it won’t work out that way once the Cadillac tax has had some time to work.

      • I would hope readers of this blog know that problems in the insurance market lead to hardship and contribute to poor health outcomes. It’s a privilege to be able to take all the time in the world to wait for perfect health reform. Some people don’t have that luxury and they’ve waited long enough.

    • Amen, though I just spent a couple of days with Uwe R. and I worry that too many health policy analysts are looking for “suffering so people can see how wrong others are”, that is the reverse side of Floccina’s art of the non-possible. If the cost of perfect reform is a century of suffering where the benefits don’t kick in until that happens, the discounting completely kills the benefits (especially if you use preference based discounting). That makes it even less sensical. Doing things soon is worth an incredible amount more than waiting.


      • @Jim Burgess – Either way, we’ll get at least a little over three more years of suffering. After that, I predict there will still be suffering in some states. We’ve got an incredibly long way to go. From a purely analytical perspective, the state variation ought to provide a lot of fodder for research, provided there’s some data to work with.