Wednesday, November 20, 2013

Reality- based commentaries on the ACA/Obamacare

I've seen a couple of non-hysterical pieces today about the state of Obamacare, one from Gene Lyons (Fix The Website, And The Political Problem Solves Itself National Memo 11/20/2013), the other from Paul Krugman at his blog (11/20/2013).

Both of them are agreed on a basic point: get the Obamacare website functioning reasonably well, and lots of people will be able to sign up for a better health insurance policy than they had before, often at lower cost. Gene Lyons, referring to comparison's to Katrina or other epic disasters on the Presidential watch of Georege W. Bush:

Possibly feeling sorry for the ex-rancher-turned-dog-portrait-painter [Bush], Fox News even went so far as to dub this president's [Obama's] mealy-mouthed apology "Obama’s Watergate." Meanwhile, a bunch of ostensibly liberal Washington courtiers/pundits proved their independence by joining the excited throng declaring Obama's presidency finished.

Except wait a minute. Didn’t many of the same savants declare the GOP defunct after the government shutdown a few weeks back? Well, that was melodramatic nonsense too. While much of their intended audience dozes, headline-hungry, ratings-driven, click-soliciting news organizations act increasingly like a litter of kittens in a room full of balloons — excitedly chasing the next big political scandal or a glimpse of Miley Cyrus’s nipple.

Whichever comes first.

That's life at CLNN, "Where the Sky Is Always Falling."

Comparing a health insurance fib to a botched natural disaster or a catastrophic war is morally grotesque to begin with. Goodness, nobody died. If this the worst falsehood President Obama emits, he’ll go down as one of the least mendacious pols in living memory. [my emphasis]
He uses CLNN to stand for CNN, which he has re-dubbed "the Chicken Little News Network."

Democrats have legitimate reason to criticize Obama for a clumsy rollout of the ACA. Krugman puts it this way:

What's going on isn’t a policy question: we know from the states with working exchanges (including California) that the underlying structure of the law is workable. Instead, it’s about an implementation botch, which is an incredible mess, and reflects very badly on Obama. But the future of the reform depends not on policy per se but on whether the IT issues can be fixed well enough soon enough, a subject on which I have zero expertise.

Of course, that hasn’t stopped other people from breathlessly commenting on every twist and turn in the polls, every meaningless vote in the House, and so on. Hey, it's a living.

But at this point there’s enough information coming in to make semi-educated guesses — and it looks to me as if this thing is probably going to stumble through to the finish line. State-run enrollments are mostly going pretty well; Medicaid expansion is going very well (and it’s expanding even in states that have rejected the expansion, because more people are learning they're eligible.) And, while still pretty bad, is starting to look as if it will be good enough in a few weeks for large numbers of people to sign up, either through the exchanges or directly with insurers.
I've written here before about what I thought was an excessively apologetic and defensive response on the White House's part to criticism of the website problems. These two videos from The Young Turks spell out the risks he unnecessarily took on by responding that way, especially by agreed to postpone the implementation of the minimum standards for new health care insurance.

Obamacare Repeal Motive Behind 'Keep Your Plan' Bill 11/15/2013:

Obamacare Unraveling? 11/15/2013:

An actual conservative who doesn't sound insane in his public statements is Norm Ornstein of AEI (aka, Neocon Central) in Republicans Have No Interest in Fixing — or Even Understanding — Obamacare The Atlantic Online 11/14/2013 accurately emphasizes the essentially conservative nature of the ACA:

There is no excuse, period, for the president’s false comments about Americans remaining free to keep their coverage. And there is plenty wrong with Obamacare, partly because it was jerry-built to get around the early and implacable opposition of all Republicans in both houses to passing any health care bill, or to offer a single vote for the plan in return for adding constructive amendments. But the structure, built around expanding the risk pools, creating a fair marketplace of private insurers to enable competition to work, and premium support for those who can't afford coverage, is precisely the one Republicans advocated in the 1990s and right up until 2009. In the supreme irony, it is the same structure Rep. Paul Ryan offers in his proposal for Medicare — call it Obamacare for seniors.

If you think about it, it would be in the interest of conservatives who believe in the magic of markets to make this system work. If it can be demonstrated that real competition in a real marketplace offers good services at lower overall costs, that adds powerful ammunition to the case for free markets. Let’s face it: The unrelenting opposition to all parts of the law, as reflected not just in critiques like Krauthammer’s but also in the more vapid and confused attacks by Sarah Palin and others, is far more about Barack Obama than it is about the structure and nature of the Affordable Care Act. [my emphasis]
Obama's reaction seems politically counterproductive in the situation. He should have responded by more aggressively sticking up for the program, explaining it, and going on the offensive against Republicans and against insurance companies trying to rip off customers with junk policies.

On that point, I disagree with Orstein's comment about "the president’s false comments about Americans remaining free to keep their coverage." As I said in an earlier post, Obama's basic statement on the topic was fair. Even junk insurance plans that were in effect at the time the ACA was passed in 2010 were grandfathered in. But Obama never promised your insurance company would never raise rates. On the contrary, it was a selling point for the ACA that it was based on private insurance. He didn't claim the federal government would dictate rates. The exchanges were designed to make the health insurance market function more efficiently and in a way that benefited more people. And, if Obama doesn't keep conceding to the Republicans on key parts of the plan, the ACA looks capable of going far toward achieving that goal.

Antoher conservative, David Weigel, also thinks the story about political disaster for Democrats over Obamacare is way overblown (Democratic Panic: Still All About Slate 11/18/2013):

You can find anonymous Democrats to panic about anything, and you can find plenty of Democrats willing to trash implementation so far, on the record. But recently, when I was talking to one of the Democrats assigned to win House seats in 2014, I got the impression that the panic is tied largely to the crisis of If the website sucked wind through Thanksgiving, said the Democrat, it was dreadful but, for Democrats, survivable. If it failed into 2014? That would blow open doors for Republican-led delay bills, and the party's vulnerable members would start to endorse those bills, because what choice would they have?

Day to day, it's very easy to write a "collapse of liberalism" story. Talk to Democrats, though, and you learn that to a staggering degree they think a fixed website would end the general crisis. One month of increased signups—that's all they want. Ask them how they feel in mid-December.
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