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Hullabaloo


Monday, June 20, 2011

 
She Is?

by digby

Wow, I have to say that this actually stuns me a bit. Discussing Bachman's rather clever new meme about Obama wanting to destroy Medicare, Ezra Klein explains that she's right:

If Republicans can make their peace with the Affordable Care Act and help figure out how to make the Affordable Care Act's exchanges work to control costs and improve quality, it'd be natural to eventually migrate Medicaid and Medicare into the system. Liberals would like that because it'd mean better care for Medicaid beneficiaries and less fragmentation in the health-care system. Conservatives would like it because it'd break the two largest single-payer health-care systems in America and turn their beneficiaries into consumers. But the implementation and success of the Affordable Care Act is a necessary precondition to any compromise of this sort. You can't transform Medicaid and Medicare until you've proven that what you're transforming them into is better. Only the Affordable Care Act has the potential to do that.

So Bachmann is perhaps right to say that the president is moving us towards a day when ObamaCare -- or, to put it more neutrally, "premium support" -- might come to Medicare. He's seeing whether it works in the private health-care market first and, if it does, there's little doubt that the political pressure to extend it to other groups will be intense. The question is why Bachmann and her party are doing so much to stand in his way? The corollary to Bachmann's accusation that the president has a realistic plan to privatize Medicare is that the Republicans, for all their sound and fury over the Ryan budget, don't.


Golly, it sounds like just everybody's on the same page, it's only a matter of working out some of the minor details. But put me down as one liberal who would not be happy about this because it would mean "better care for Medicaid recipients" (always the big gun to our empathetic little hearts) or that it would lead to less "fragmentation." (You know what really would lead to less fragmentation? Medicare for all.)

Indeed, I was hoping (probably vainly) that the Affordable Care Act was the opening act in reforms that would lead eventually to some form of universal, nationalized health care plan that wasn't based on for-profit insurance companies taking a piece of the action at all. After all, that was what we liberals were assured would happen eventually by policy wonks who were exceedingly annoyed whenever anyone raised the possibility that this might not be the best way to go about it.

Truthfully, this would be the opposite of what I'd hoped for and that most liberals hoped for. I certainly do not want elderly people thrust into a health care system where they have to navigate profit making insurance companies, no matter how well "it works" on a macro level or how much "support" they get for their premiums.(And there is ample reason to doubt that it will work for such a sick population anyway.) It honestly never occurred to me that the administration and the promoters of this health care reform were actually designing it with that in mind.

One thing's for sure. Bachman's on to something. I knew her comments had a perverse sort of logic, but it never occurred to me that she was right on the merits. Live and learn.

Update: I should not fail to note something that Ezra and everyone else knows: when it comes to controlling costs, the Medicare program does a much better job of it already. Now, it's true that the ACA is supposed to bring those costs in line. But when I see things like this --- that the dreamers will want to eventually put Medicare into the marketplace as if that's a laudable goal--- I have to wonder once again why in the hell we had to reinvent the wheel. Medicare exists already and it's better at controlling costs than any other program we have. We should have built on that.

True, it was politically difficult and most of us ended up accepting the outcome. Ben Nelson and Joe Lieberman had to have their egos appeased. But the reason liberals were so wedded to the public option was because it, at least, created an obvious path and useful alternative to actual humans once the insurance companies started their inevitable gouging and manipulations. Regulating is hard, and the resistance from our monied class will always be huge so it is going to take decades longer to implement and get the results from this plan than if they'd simply expanded the existing national plan to everyone. There was a better way.

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