Saturday, June 18, 2011

Catch of the Day

Jonathan Chait had a quick item that wasn't bad, and Steve Benen goes into more detail today, but the Catch goes to Mark Kleiman for being the first I saw to point out that Michele Bachmann's accusation that Barack Obama has a secret plan to replace Medicare with "Obamacare" is really an accusation that Obama secretly supports Paul Ryan's plan. Bingo!

You do have to wonder about the thought process that gets her to that one, though. I can think of several possibilities, with the first one probably the most likely:

1. She doesn't care what Medicare is or what ACA is: she just knows a good applause line when she thinks of it.

2. She knows exactly what Medicare, ACA, and Ryan's plan are. She's already expressed some skepticism about Ryan; here, she's doubling down. Because she thinks Ryan is going to get into the presidential race, and she intends to use the similarities between Ryan's plan and ACA against him.

3. She believes that ACA sets up a British-style government health care system, and supports Medicare as the less socialist option.

4. She really believes "keep government's hands off of my Medicare" -- Medicare is some sort of natural thing, sort of like property rights, and government should never interfere with it.

5. She doesn't actually believe either #3 or #4, but thinks it's good politics for her to pretend to believe one or both of those things.

6. It's a Paul Revere strategy; what she's really trying to do is to get outraged reactions from liberals.

OK, that's all I can think of.

I should note one thing about all of this..."Obamacare." ACA isn't a single program; it's a whole bunch of health care reforms, stitched together in one bill but in many cases essentially unrelated. What Kleiman and the others (and me, too) are interpreting Bachmann as saying is that Obama would turn Medicare into an exchanges-plus-subsidies scheme, which is both what ACA does for the individual insurance market for those outside of Medicare who don't get insurance through employment, and what Paul Ryan would do for Medicare. But ACA for Medicare eligibles is something else entirely; it consists, for them, of removing some subsidies for Medicare Advantage plans and finding new savings (or at least trying to!) within regular Medicare. And for those who have insurance through their jobs, ACA is yet another thing. The idea that there's a single program that ACA is imposing on everyone just isn't right.

Oh, and by the way: Michele Bachmann is now a presidential candidate who some people think has a real shot of winning the nomination. Hey, reporters: you might want to actually follow up on this one.

And also: nice catch!


  1. I think #3 comes closest. To MB and her audience, the word "Obamacare" means "institution of socialized medicine in stages," NOT "diverse measures within PPACA umbrella legislation." I think that to them "Medicare" means something like "privileges for seniors within context of market-organized health care." MB and those like her may envision an evolutionary market-based reform of Medicare rather than Ryan's more wholesale approach, or they may not really have gamed it out thoroughly - either practically or politically. On some level they may hope-believe that, freed of liberal-progressive-socialistic anti-American constraints, fully re-privatized medicine would produce a quasi-miraculous creative superabundance of decreasingly expensive life-saving, -extending, and -improving care options. Either that or we're in the End Times anyway.

  2. I think it's basically #4, but I would add this: What we're dealing with is cultural panic. People who think and vote (and look) differently from Michelle Bachmann have won some elections, gained power and are imposing their will. That is by definition a change for the worse; it's a radical upending of the old and familiar order. Medicare is part of the old and familiar order, so it must be one aspect of the real America that is now under radical attack. The ACA is an imposition of the new regime, so it must be anti-real-American, and one of the code words for that is "socialist." Since Obama is a socialist, he must be intent on changing Medicare into the ACA. If you know what the terms mean to these people, it all makes perfect sense.

  3. 7. The term "Obamacare", to Bachmann, means "Single-payer, European-style socialist health care". The fact that Obamacare means something different to Chait or other Bachmann critics is irrelevant to understanding her intent.

    There's much hand-wringing among the commentariat regarding the ACA as a Maginot Line for the Traditional Right. Why so much anxiety? Well, if Obamacare is, as the Bachmanites assume, the first step to single payer, then that single payer system will undoubtedly be run by the same types of folks who have a track record of using government as a tool for creating a more equal society.

    Lord knows American healthcare outcomes are hideously unequal. Race plays a big role in this, but poverty probably more so. Will the overlords of (the expected, single-payer future version of) Obamacare use their control over US health care to create more just and equitable health outcomes in the US? An admirable goal, and one that can surely be progressed toward through government action.

    Its funny, my family was traveling through middle America on our way home from a trip the other day, and we stopped at a rural McDonald's in an area that civilization forgot. Race wasn't a factor there (everyone was white) but class and poverty issues were rampant. If the single-payer outgrowth of Obamacare attempts to improve overall health in America, then greatly increased services would find their way to the area of the aforementioned McDonald's, while my small daughter, who currently benefits from her family's BigInsurance plan, could find herself somewhat worse off.

    If "somewhat worse off" translates into "will have to wait extra long for critical care", then authorities would have her dad to deal with. Progressives could rightly say that I am selfish and unreasonable, but they would have to do so to me, my Tea Party friends...and our pitchforks.

    It grows a bit tiresome to read, constantly, how the Tea Party's concern with Obamacare is simply irrationality. The progressives who will administer single-payer (assuming that is coming) have a track record of using government as a means of creating a more equal society.

    Might there be some reason that health care is, you know, really really different from other areas of progressive social engineering? If you are the beneficiary of big health care, and you have small children, look at said children as you ponder this question. The Tea Partiers may not seem quite so insane.

  4. CSH, what you're saying may be true, but the reason the question arose is that Medicare is ALREADY "single-payer, European-style socialist health care." It just is, regardless of who says this or doesn't. So the question was why Bachmann would think that changing Medicare to regulated private insurance (like the ACA) would be part of a socialistic scheme. Worries about children don't really explain this, since Medicare doesn't cover children and the changes that Bachmann is imagining wouldn't affect them.

    Also, as to you and your own children, I don't think there's any single-payer system anywhere that prevents you from buying additional private insurance for you or your family if you so wish. You don't need pitchforks for this; you just need to send someone a check every month. Even in Europe, if you have the means, you can always buy more stuff, including health stuff, than other people get from the state. Part of the panic on the right seems to be some idea, rooted in nothing that anyone has proposed or even contemplated, that America, uniquely among advanced nations, is going to put an end to private acquisition and make everyone wear the same gray Maoist uniforms all the time, or something.

  5. Jeff, thank you for engaging my argument. You make several good points, not the least of which is that Bachmann's argument is ex facie irrational; Medicare is certainly single payer. To this conversation, of course Medicare is a companion to Social Security, which has done a pretty good job of diminishing elderly poverty, meaning that there isn't really a more perfect society to be had by triaging Medicare medical care toward the poor or disadvantaged elderly.

    You're also right that I could buy private insurance in a single-payer system; I'm not familiar with how that works in European countries, but I am quite familiar with Canada, having many relatives there, some of whom I was visiting recently. Our Canadian relatives all buy some sort of supplemental insurance, though they generally support Canada's health care system.

    In particular, my wife's uncle is a multiple-cancer survivor who has also been very successful, he owns time shares in Latin America, where he has several American friends to whom he defends the Canadian system. For us, he noted that his care has always been provided in a timely manner, but he says this with a shrug, indicating that he's not entirely sure why, he's just happy it worked out that way. Even those of us with private American insurance can relate to that; you need some procedure, and the byzantine machine approves it on some opaque criteria, and as long as it doesn't harm you you just shrug and think of it no further.

    I'm no expert on the data, but it seems that the big difference between a hypothetical single-payer Obamacare and the European-style systems is that the American system starts with a huge rich-poor discrepancy in current care outcomes. (This is why progressives can say American health care is inferior while Tea Partiers say it is world-class; it all depends on whether you count the poor).

    So if an American single-payer system attempted to redress these inequities, it would surely do so in a way that was opaque to us, much as the Canadian system is opaque (but satisfactory) to my wife's uncle. If you are a "have" on the current American health care landscape, such a single-payer transition would be definitionally worse for your interests, possibly much worse.

    Complaining about this makes me an asshole, yes? Who begrudges the poor from having better opportunities? I don't usually, but health care...its different. Its final. Irrevocable. Because health care is so crucial, I suspect the progressive engineers of American single-payer would be cautious about how quickly or transparently they attempted to redress the obvious inequity in American health care.

    Perhaps the Tea Partiers are trying to make sure of that?

  6. CSH, the progressive engineers ARE being cautious -- that's why we don't have single-payer (except for people 65+), we have the ACA. As to a single-payer transition being "definitionally" worse, there are very few Americans for whom that could be true other than those who have life tenure at their jobs. All other non-elderly, non-veteran Americans are in continual danger (until the ACA fully kicks in) of losing their access -- and their family's -- to affordable health care, even if what they have at the moment is good.

  7. Jeff - thanks again for engaging my argument, two quick thoughts:

    1) I agree that single-payer (in the abstract) would not be definitionally worse, but the single-payer that attempts to redress health care inequity surely would. Its hard to imagine the version of single-payer that didn't attempt to redress inequity (that's how these things work, yes?), but the devil is obviously in the details.

    2) You're right that the non-elderly/non-veterans could think of ACA as a backstop...does the Tea Party contingent see it this way? I'm not sure, not being one or really even knowing any of them. Thinking about how inertia works in life, particularly when things are going well, it wouldn't surprise me at all if Tea Partiers are animated by a resistance to changing a good thing, and as long as nothing changes, Big Insurance is a relatively good thing for them, and quite plausibly better than a single-payer alternative. Basing opinions on inertia is sort of irrational, but we all do it all the time, so its not clear why the Tea Partiers deserve special scorn for it here.

  8. OK, CSH, but:

    1) Health-care inequity isn't like other inequity. I can pretty much know, as a straight white Protestant male, that attempts to redress racial, religious, gender or sexual-preference inequity will not help me personally (except in the abstract sense that a more just society is better for everyone, etc.). That's because those efforts are aimed at groups to which I "definitionally" don't belong. But the group that has inadequate access to health care is not such a clearly defined group. It can include anyone in the middle or even upper-ermiddle class whose luck happens to run out at some point. Pre-ACA, the only people definitionally excluded from the group that could benefit from current reforms are veterans, the elderly, the poor (who get Medicaid), and the filthy rich, those with enough millions put away that they could pay cash for any futgure procedures or treatments they might need. Even Michele Bachmann is not definitionally excluded from the group that could benefit. (Sarah Palin might be, depending on how well she's managed the millions she's been making -- but for her whole previous life up to 2009 she, too, was vulnerable to a bad turn of the inequities screw.)

    2) I don't think anyone here is saying that Tea Partiers as such deserve special scorn. If they don't understand what ACA is or how it would benefit them, they deserve to have this explained, certainly. The scorn is aimed at Michele Bachmann, who has no excuse for misunderstanding -- she's a member of Congress, she has a taxpayer-provided staff that briefs her, she knows perfectly well that Medicare is single-payer while the ACA works through private insurance -- but she's making ludicrious arguments, apparently out of some combination of intellectual dishonesty and demagoguery.

    Still, having said that, there's probably some degree of muddle and misunderstanding even in her case; see my first comment in the thread above. Ludicrously, the demagogic arguments are now crashing into each other, so we get people like Bachmann "accusing" Obama of being (a) a socialist who (b) wants to end socialism. Would it seem less scornful if we answered this with ROFLMAO?

  9. To #1: you know that ad for AIG where the guy greets his neighbor with his "number" in tow, and his neighbor is trimming his hedge with his own "number", which is "Gazillion", reflecting the fact that he has no clue how to fund his retirement? The guy trimming his hedge is...all of us. Those of us under 45 know full well that corporate pensions will be nonexistent at our retirement, that social security is dubious at best, and that we're more or less on our own. And still, we haven't saved shit.

    Given the choice between "save for retirement" and "buy beer", we're all choosing the beer. Your point that consumers should see the ACA as a backstop is well-taken, but I daresay that most of us don't think that way, as evidenced by our beer consumption while our 401Ks are lagging.

    To #2: again, if I had to guess, I'd say that when Bachmann talks about the ACA, she's not actually talking about the ACA, but rather using the ACA as code for the single-payer progression of the current legislation that her constituents fear. If the ACA were the end of health care reform, there would be very little for anyone to fuss about. However, if the ACA is the opening salvo for single payer, then many of the issues discussed on this thread come into play. Thus when Bachmann talks of the ACA, she potentially really means "ACA as opening salvo for further nationalization of health care to come".

    Interesting discussion though.


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