In which Democrats seem to have learned the wrong lesson from Obamacare politics

Last updated on: December 17, 2018 at 9:55 pm by Jane the Actuary

In which Democrats seem to have learned the wrong lesson from Obamacare politics 2018-12-17T21:55:03-06:00 Jane the Actuary

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The “right” lesson is, of course, that in order to ensure one’s signature reform is successful you need to work with the other party — not just a few members of that party whose beliefs are so centrist as to approach your own, but comprehensively, so that it becomes a part of the fabric of the country rather than setting the stage for a pitched battle in which the other party, when regaining power, does everything possible to demolish the system. This is true for Obamacare, and this is true for the GOP’s tax cuts which the Democrats have pledged to reverse as soon as they are able.

(And, yes, I know that the standard response is that Republicans flat-out refused to cooperate. Republicans, of course, respond that the Democrats insisted that every core element of the system’s design had to be as they dictated it, and all the Democrats really offered them was the opportunity to put their names behind legislation they had no input into.)

The lesson that the Democrats have taken away, instead, seems to be that they didn’t fight dirty enough. Here’s a recent Vox article: “The 3 decisions that will shape Medicare-for-all,” by Ezra Klein, which asks three questions which the overall tone of the article implies an answer to. Democrats should have rejected filibuster rules rather than catering to those conservative Democrats who stood in the way of more expansive plans like the “public option” or a reduction in the Medicare eligibility age. Democrats shouldn’t have been so worried about upsetting people that they were unwilling to “go big” by eliminating private insurance. And Democrats shouldn’t have cared about ensuring that the ACA was fully “paid for” with taxes (note: it wasn’t, even so, with various gimmicks, but they claimed it was, anyway).

It is already the case that Democrats have, collectively, decided to call their new proposal Medicare for All because it polls better than “single payer” or other more truly descriptive terms. Do people understand what “Medicare for All” means? Do they have a vague sense that Medicare seems to work for their parents or grandparents? Do they assume that the proposal includes the same sort of supplemental policies as are available to Medicare recipients? Do they imagine that the funding will be as small and nearly-unnoticed as that small bit of FICA that supports Medicare rather than Social Security? In some cases, it seems, based on a prior Vox article, that people interpret “Medicare for All” as giving under-65s the option to buy into Medicare at rates which are simultaneously affordable to the people involved and yet don’t require any special taxes to pay for it.

Yes, Democrats are banking on the generally positive feeling Americans have toward Medicare providing them the ability to pass a law that they will label “Medicare for All.” And, in fact, again per that Vox article, polling shows that 62% of Americans respond positively to “Medicare for All” but only 48% do so when asked about a “single payer health insurance system.”

Now, that same Vox article, again, points out that “Medicare for All” is becoming an umbrella term for multiple proposals, some of which involve the so-called “public option.” But near as I can tell, “Medicare for All” has by and large been adopted as a euphemism for single-payer. And this suggests an intention to pass a law the public support of which is conditioned on that public being ill-informed about it, rather than being honest and open about the costs and benefits of such a law.

And I get that among some Democrats, the question of “will this law have sufficient bipartisan support to continue to be accepted even when political control shifts to the other party?” is considered irrelevant, either because they think the public is stupid enough that any objections are solely because of ignorance, or because they are convinced that, from here on out, they will never, ever, lose control, or because they can implement a system that will so thoroughly destroy what preceded it that there is no going back, in a burn-the-ships sort of way.

But nonetheless — look, I know it’s a lost cause, but we as a country can’t continue with this business of each party trying its best to impose its will rather than working together.

End of rant. Comments welcomed, etc.

Image: https://commons.wikimedia.org/wiki/File%3ADoctor_examines_patient_(1).jpg; By Unknown photographer [Public domain], via Wikimedia Commons

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