Monday, July 2, 2012

Elsewhere: Economy, ACA

At Greg's place today, I remind everyone that for all the substantive importance of health care and the Supremes, it's the economy that has the potential to really change the November elections.

And at PP, I make the case that ACA is unlikely to get popular if it's fully implemented; instead, it will just disappear. That is, for example, the Medicaid expansion won't be part of "Obamacare" any more; it will just be Medicaid. And a lot of the rest of it will wind up invisible to voters -- or, if visible, not associated with anything having to do with the Obama-era health care reform.


  1. One of the interesting things about the ACA is the manner in which it becomes a Rorschach test for one's ideology, entirely separate from the likely behavior of real human beings. Among conservatives, you get the argument that hc is "not a right", by which brown people and other marginalized folks accept their poor hc fate because well-placed conservatives want them to.

    And on the left you get today's "The ACA will be unnoticeable" argument. Really? Didja read the classicist's link yesterday, about the 60-year old divorcee, making $47 K/year, who will spend $10 K - $16 K annually in the exchange? How in the world is that not going to be noticeable, in particular if folks like her number in the millions (because corporations behave with the malfeasance that liberals have warned us of for years?)

    The reason why it won't be noticeable is because liberals have waited for years for this type of reform, darnit, and the actual needs of real-life people are not going to stand in the way of dreams. Which, come to think of it, is not substantively far from the conservative position about brown people just bowing down and accepting their poor hc fate.

  2. I understand and agree with your point, CSH. However, in fairness that is a point about the short-term. I think at least some on the left (Mr. Bernstein is one) mean that ACA will become invisible in the sense that, like Medicare or Social Security, it will become accepted as a fundamental aspect of society. That is not to say that there will not be issues associated with it, some of them intense. But the ACA in general, or rather it's component parts like guaranteed issue, Medicaid, etc., will fade into the general background. That is, of course, a mid-term to long-term view.

    1. A natural experiment to test that hypothesis, Anastasios, would be the following: does anyone with a HH income of $47 K shell out $16 K for hc under Medicare?

      I've no special expertise on that question; however, considering how furiously Senate candidate Rand Paul walked back his (pre-Senatorial, still-libertarian) call for a $2,000 Medicare deductible, it does seem highly unlikely that many $47 K income HH's are shelling out $16 K for hc under Medicare.

      The other thought this brings up is: perhaps the reason the middle class is dying in the US is because neither political party, really, gives a damn about them. The right gives us policies favoring the rich, the left policies favoring the poor, and always the 60-yo divorcee in the classicist's link is left holding the bag. Eventually, that adds up until you get the America we live in today.

    2. CSH,

      Speaking as one who has bitter experience of being in situations where no one gives a damn about me, I agree with you entirely. As a middle-class person, I compare the current political climate to those situations and say, "Yep, this is another one of those."

      Having said that, I am really out of ideas as to how to change that. When political parties approach me for money and time, I generally respond that they do not speak for me or my concerns. The standard response is that if I gave them time and money, and lots of people like me did as well, then they would stand for my concerns and beliefs. Would they really? I have a hard, hard time believing that. And since I don't believe it, I don't act, and things stay the way they are. It's a kind of prisoner's dilemma -- I would act if I was sure others would as well, and that the party's would respond. But since I am not sure of that, I am afraid any money or effort I expend would be used to the benefit of others.

      In this I also have to say, and I am afraid that I am yanking our friend Mr. Bernstein's chain here, that political scientists are very culpable. As they constantly assure us that none of our efforts and beliefs make the slightest iota of difference, that none of the victories we aspire to matter, and that the American system is set up to defeat us -- well, what's the point? It becomes an exercise in sitting back and waiting until the forces of the economy make a choice as to who will be elected, and then endure or enjoy the consequences. Actual engagement is a fool's errand -- just ask any political scientist (yes, I am quite deliberately chain yanking now).

      Now, on the matter at hand, and being somewhat less fatalistic, I understand what you say, CSH, but we keep circling back to "what realistically is a better option?" Yes, it would have been sensible and correct to simply follow a best-practices approach and copy the French system with appropriate modifications. Then again, it would probably be sensible and correct to simply copy the British political system (currently functioning much better than our own). However, the votes aren't there for options like that. Do nothing? Also not really an option, although the Republicans would like it and may well force it on us yet. Storm the Capitol and the rest of the government and hold guns to people's heads until they see sense? Toss half the states out of the union (either the red half or the blue half depending on your preference) and thus establish a greater consensus? I understand everything you say. I agree with much of what you say. But I just don't see what else there is to actually do.

    3. Anastasios:

      Neither Social Security nor Medicare have disappeared. We talk about them, by name, all the time! We're not going to talk about "Obamacare" or "Affordable Care Act" that way, or at least that's my claim.

      And I think it's a real misreading of what political scientists say to conclude that people can't make a difference. I certainly don't think that.

      Last point: it's pretty clear to me that ACA is targeted towards helping middle-class Americans. That's a separate question from whether it will work as the sponsors intended, or whether it's the best possible plan...but surely the people most hurt by the US dysfunctional health system relative to their overall situation are the middle class.

  3. My goodness. In my mind, where the country is remade however I dream it, policy is guided by a type of Rawlsian consideration; i.e. its okay to help some more than others, but be sure not to harm anyone. I should note that's how it works in the promotional pamphlets produced within each party's tent, but in reality policy is guided by ideology, and where ideology clashes with the needs of real people, ideology always wins that battle of cognitive dissonance. So if our 60-yo divorcee puts on some odd revolutionary garb and protests in the square, she is just a weirdo according to the talking heads on MSNBC and the liberal blogosphere, as opposed to a citizen expressing her unmet needs. Not that the right is any different, mind you.

    I don't mean any disrespect, and its hard not to be glib in this context, but when Jonathan argues that the ACA is targeted toward middle-class Americans...of course it is. Presumably in the case of Kylopod's brother and many others, the ACA will indeed work that way. Others, such as the 60-yo divorcee, will become painfully aware that the ACA is "targeted" at them; indeed, if someone could remove that target - from her back - I expect she would be most grateful.

    And one more, a conspiracy: given the extent to which ideology trumps real peoples' needs, perhaps Roberts' 11th-hour flip is motivated not by some high-minded benevolence but rather the ultimate rope-a-dope maneuver. Perhaps it is the deepest expression of conservative cynicism toward the needs of the 60-yo retiree and the millions like her whose hc will be victimized by corporate opportunism come 2014.

    Because I bet that 60-yo divorcee hasn't quite come to terms how much the ACA is going to suck for her, as she presumably didn't read the classicist's link. Nor is she aware in what millions folks like her will number due to the obvious incentive on the part of her employer to damage her in that way.

    When she finds out, she will be

    a) Completely devastated and
    b) Burning with a white-hot hatred of liberals and the Great Society.

    Depressing. I have no answer other than the sprinkling on the nation of the magic fairy dust of deep distrust for institutional phenomena. Think it will work?


Note: Only a member of this blog may post a comment.

Who links to my website?