Monday, 20 October 2014 / TRUTH-OUT.ORG

US Health Reform Keeps Insurance Companies in the Mix, No Matter the Cost

Tuesday, 03 December 2013 13:08 By Paul Krugman, Krugman & Co. | Op-Ed

(Image: GABLE; Canada / CartoonArts International / The New York Times Syndicate)(Image: GABLE; Canada / CartoonArts International / The New York Times Syndicate)

In a recent online post for the Roosevelt Institute, the economics commentator Mike Konczal said most of what needs to be said about the underlying sources of the Affordable Care Act's complexity, which in turn set the stage for the current tech problems. Basically, Obamacare is not complicated because government social insurance programs have to be complicated: Neither Social Security nor Medicare is complex in structure. As Mr. Konczal wrote, it's complicated because political constraints made a straightforward single-payer system unachievable.

It's been clear all along that the Affordable Care Act sets up a sort of Rube Goldberg device: a complicated system that in the end is supposed to more or less simulate the results of single-payer, but keeping private insurance companies in the mix and holding down the headline amount of government outlays through means-testing. This doesn't make it unworkable: State exchanges are working, and healthcare.gov will probably get fixed before the whole thing kicks in. But it did make a botched rollout much more likely.

So Mr. Konczal is right to say that the implementation problems aren't revealing problems with the idea of social insurance; they're revealing the price we pay for insisting on keeping insurance companies in the mix, when they serve little useful purpose.

Does this mean that liberals should have insisted on single-payer or nothing? No. Single-payer wasn't going to happen — partly because of the insurance lobby's power, partly because voters wouldn't have gone for a system that took away their existing coverage and replaced it with the unknown. Yes, Obamacare is a somewhat awkward kludge, but if that's what it took to cover the uninsured, so be it.

And although the botched rollout is infuriating — count me among those who believe that liberals best serve their own cause by admitting that, and not trying to cover for the botch — the odds remain high that this will work, and make America a much better place.

Borscht Belt Republicans

Has anyone else noticed how much the G.O.P. position on Obamacare resembles the classic borscht belt joke about the two ladies at a Catskills resort?

Lady No. 1: "The food here is so terrible, it's inedible!"
Lady No. 2: "And the portions are so small!"

Republican No. 1: "Obamacare is slavery!"
Republican No. 2: "And it's so hard to sign up!"

© 2014 The New York Times Company
Truthout has licensed this content. It may not be reproduced by any other source and is not covered by our Creative Commons license.
Paul Krugman joined The New York Times in 1999 as a columnist on the Op-Ed page and continues as a professor of economics and international affairs at Princeton University. He was awarded the Nobel in economic science in 2008. Mr Krugman is the author or editor of 20 books and more than 200 papers in professional journals and edited volumes, including "The Return of Depression Economics" (2008) and "The Conscience of a Liberal" (2007).
Copyright 2014 The New York Times.

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US Health Reform Keeps Insurance Companies in the Mix, No Matter the Cost

Tuesday, 03 December 2013 13:08 By Paul Krugman, Krugman & Co. | Op-Ed

(Image: GABLE; Canada / CartoonArts International / The New York Times Syndicate)(Image: GABLE; Canada / CartoonArts International / The New York Times Syndicate)

In a recent online post for the Roosevelt Institute, the economics commentator Mike Konczal said most of what needs to be said about the underlying sources of the Affordable Care Act's complexity, which in turn set the stage for the current tech problems. Basically, Obamacare is not complicated because government social insurance programs have to be complicated: Neither Social Security nor Medicare is complex in structure. As Mr. Konczal wrote, it's complicated because political constraints made a straightforward single-payer system unachievable.

It's been clear all along that the Affordable Care Act sets up a sort of Rube Goldberg device: a complicated system that in the end is supposed to more or less simulate the results of single-payer, but keeping private insurance companies in the mix and holding down the headline amount of government outlays through means-testing. This doesn't make it unworkable: State exchanges are working, and healthcare.gov will probably get fixed before the whole thing kicks in. But it did make a botched rollout much more likely.

So Mr. Konczal is right to say that the implementation problems aren't revealing problems with the idea of social insurance; they're revealing the price we pay for insisting on keeping insurance companies in the mix, when they serve little useful purpose.

Does this mean that liberals should have insisted on single-payer or nothing? No. Single-payer wasn't going to happen — partly because of the insurance lobby's power, partly because voters wouldn't have gone for a system that took away their existing coverage and replaced it with the unknown. Yes, Obamacare is a somewhat awkward kludge, but if that's what it took to cover the uninsured, so be it.

And although the botched rollout is infuriating — count me among those who believe that liberals best serve their own cause by admitting that, and not trying to cover for the botch — the odds remain high that this will work, and make America a much better place.

Borscht Belt Republicans

Has anyone else noticed how much the G.O.P. position on Obamacare resembles the classic borscht belt joke about the two ladies at a Catskills resort?

Lady No. 1: "The food here is so terrible, it's inedible!"
Lady No. 2: "And the portions are so small!"

Republican No. 1: "Obamacare is slavery!"
Republican No. 2: "And it's so hard to sign up!"

© 2014 The New York Times Company
Truthout has licensed this content. It may not be reproduced by any other source and is not covered by our Creative Commons license.
Paul Krugman joined The New York Times in 1999 as a columnist on the Op-Ed page and continues as a professor of economics and international affairs at Princeton University. He was awarded the Nobel in economic science in 2008. Mr Krugman is the author or editor of 20 books and more than 200 papers in professional journals and edited volumes, including "The Return of Depression Economics" (2008) and "The Conscience of a Liberal" (2007).
Copyright 2014 The New York Times.

Hide Comments

blog comments powered by Disqus