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Hullabaloo


Tuesday, March 14, 2017

 
The dog that caught the car

by digby



















In case you haven't been following the ins and outs of  how we got to this place on health care, I thought David Leonhardt at the New York Times had a good take on it:

How did the party’s leaders put themselves in this position? The short answer is that they began believing their own hype and set out to solve a problem that doesn’t exist.

Obamacare obviously has flaws. Most important, some of its insurance markets — created to sell coverage to the uninsured — aren’t functioning well enough. Alas, Paul Ryan, Mitch McConnell and Donald Trump are not trying to fix that problem. They’re trying to fix a fictional one: saving America from a partisan, socialistic big-government takeover of health care.

To understand why that description is wrong, it helps to recall some history. Democratic attempts to cover the uninsured stretch back almost a century. But opposition to universal government-provided insurance was always too strong. Even Lyndon Johnson, with big congressional majorities, could pass programs only for the elderly and the poor — over intense opposition that equated Medicare with the death of capitalism.

So Democrats slowly moved their proposals to the right, relying more on private insurance rather than government programs. As they shifted, though, Republicans shifted even farther right. Bill Clinton’s plan was quite moderate but still couldn’t pass.

When Barack Obama ran for president, he faced a choice. He could continue moving the party to the center or tack back to the left. The second option would have focused on government programs, like expanding Medicare to start at age 55. But Obama and his team thought a plan that mixed government and markets — farther to the right of Clinton’s — could cover millions of people and had a realistic chance of passing.

They embarked on a bipartisan approach. They borrowed from Mitt Romney’s plan in Massachusetts, gave a big role to a bipartisan Senate working group, incorporated conservative ideas and won initial support from some Republicans. The bill also won over groups that had long blocked reform, like the American Medical Association.

But congressional Republicans ultimately decided that opposing any bill, regardless of its substance, was in their political interest. The consultant Frank Luntz wrote an influential memo in 2009 advising Republicans to talk positively about “reform” while also opposing actual solutions. McConnell, the Senate leader, persuaded his colleagues that they could make Obama look bad by denying him bipartisan cover.

At that point, Obama faced a second choice – between forging ahead with a substantively bipartisan bill and forgetting about covering the uninsured. The kumbaya plan for which pundits now wax nostalgic was not an option.

The reason is simple enough: Obamacare is the bipartisan version of health reform. It accomplishes a liberal end through conservative means and is much closer to the plan conservatives favored a few decades ago than the one liberals did. “It was the ultimate troll,” as Michael Anne Kyle of Harvard Business School put it, “for Obama to pass Republican health reform.”

Today’s Republican Party has moved so far to the right that it no longer supports any plan that covers the uninsured. Of course, Republican leaders are not willing to say as much, because they know how unpopular that position is. Having run out of political ground, Ryan, McConnell and Trump have had to invent the notion of a socialistic Obamacare that they will repeal and replace with … something great! This morning they were also left to pretend that the Budget Office report was something less than a disaster.

Their approach to Obamacare has worked quite nicely for them, until now. Lying can be an effective political tactic. Believing your own alternative facts, however, is usually not so smart.

He leaves out the part about the centrist and right wing Democrats who sabotaged efforts to make this plan a lot better and a lot stronger. Joe Lieberman even did it out of sheer pique when he backed off the excellent plan to allow 55-65 year old to buy into Medicare in order to punish the left. There is plenty for the Democrats to answer for in all this too.

But basically, he's right. Obamacare is a bipartisan, hybrid health insurance plan that covers a lot more people than were covered before and had the framework built in to improve it in substantial ways in the future if the Republicans would ever sober up and join the modern world. Other countries have such hybrid plans and are able to cover everyone without bankrupting the country or the individual citizens.

But no, we have an antediluvian, throwback bunch of know-nothings populating one of our two major parties and instead of being chastised by the people they've been rewarded and now some previously unknown weirdo like Steve Bannon is in a position to pretty much destroy the world. In a polarized political world, it only takes a little luck and good timing to shift everything the other way. That's where we are.



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