Soon Oceania will have always been in favor of merely tinkering at the edges of Eastasia

by John Holbo on March 24, 2010

Ramesh Ponnuru:

Understandably, Cornyn doesn’t want to touch the most popular element of Obamacare, the ban on discrimination based on pre-existing conditions. But unless it’s modified substantially, the individual mandate has to stay too — and therefore so do the subsidies and the minimum-benefits regs. Without perhaps realizing it, Cornyn has come out for tinkering at the edges of Obamacare.

This is the problem the Dems faced (well, one of them), just in reverse: namely, what you want is uncontroversial and small-seeming. But in order to ask for that one thing, you have to ask for all this other heavy-duty stuff. Now, in reverse, the Reps can’t object to the heavy-duty stuff without getting pinned to the charge that they want to do really gratuitously, pettily awful stuff.

I predict that Cornyn is ahead of the curve. Soon it will have been the common wisdom all along. Basically for the reasons Ponnuru outlines. There will never be a moment when any large number of Republicans announce they’ve changed their minds, of course. (In 1994 and even until 2006 the individual mandate was moderate – then in 2009 and especially in early 2010 it was radical from the get-go – then in late 2010 it continued on, moderate as ever.)

I hereby lay my bet as to when the flip will take place: immediately after 2010 primary season. During the primaries, Republicans will be strongly and vocally in favor of total repeal, a unified front against being primaried from the right. Then, after the primaries, all that will fade, like a dream upon waking. Blogs and the conservative commentariat will be slightly slower but will catch up before the 2010 general. By 2012 the apocalyptic rhetoric will have faded so far from memory that Mitt Romney will be able to run as a Republican, without having to run from himself. Of course someone will point this out, but it won’t matter that much. Heat of the moment stuff. Ancient history.

Of course I could be wrong. What do you think?



Martin Bento 03.24.10 at 9:01 am

The ban on pre-existing conditions requires the mandate only if we want to save the insurance companies rather than placing a gun to their heads. We should have done the pre-existing ban standalone first. That would have made the status quo a death sentence for private insurance and forced the insurance companies to back a more comprehensive bill, including a public option or whatever we wanted, just to get a mandate and have a hope for survival. Then they could have pressured the conservative Dems and Repubs on our behalf. The mandate’s not due to kick in until 2014 anyway, so there is time to adjust; Blue Shield need not go bankrupt tomorrow (though its stock would tank).

The Court might toss out the mandate. Only some on the far right seem to think the argument against it has legs, and not all of them do. But that would also be true of the arguments for Citizens United, if anything even more so, and the Court went for that. (liberals were foolish ever to cheer on judicial activism, but that’s another subject).

Does this thing have a severability clause, or can it be so construed? Let the Court toss the mandate and leave the rest intact, and the only recourse is single-payer: the government’s right to compel payment to a for-profit private entity may be dubious (I oppose it, and did for auto insurance too) , but its right to tax is not going to be challenged. This is what the Dems should aim for, and, if amendments are going to be allowed on the Senate floor, this should be one of them: if the mandate is ruled unconstitutional, and the insurance companies are not viable, the government takes on the responsibility of providing insurance. Attacking the mandate puts the ball where progressives really want it if Obama and the conservative Dems are willing to kick that ball.


Steve LaBonne 03.24.10 at 10:55 am

Their problem is that their slavering, cretinous base wants them to nuke Eastasia and then sow the ground with radioactive salts. They’re going to have to go so far over the top to stave off teabagger primary challengers that pivoting to a more reasonable-sounding general election position, especially in this age of YouTube, will be quite a trick. I’m not so convinced they can pull it off.


Barry 03.24.10 at 11:37 am

I agree that the GOP primaries will be howling madness, and the general election will be rough. But by 2012, I also agree that the tone will be that the Democrats enacted pretty much what the GOP had spent oh-so-many years advocating, and had pretty much shamelessly ripped of Romney-Care.

And also that the Democrats had behaved like the usual spoiled-brat liberals in 2009-10, screaming and protesting and accusing Republicans of so many bad and obviously untrue things.


MattF 03.24.10 at 11:50 am

‘Frightened, obscure right-wing politicians trying to appear rational’ is not the same thing as ‘rational.’ The tactics and repertoire of people like Cornyn aren’t flexible enough to make a visible change. I think it’s just too little and too late, the dishonesty is just too obvious.


Tom T. 03.24.10 at 11:51 am

It seems to me that the question is where will voters identify. Most voters don’t have pre-existing conditions, so the equation for them will be presented as whether it’s worth it to pay more in premiums and subsidies now for other people (poor people!), on the chance that they might themselves benefit later. Thus far, American voters have always resisted that trade-off (except for the elderly), and they weren’t thrilled about it this time around either. But inertia is now in the law’s favor, I suppose.

The mandate will be seen as a tax on the working class. It’s not an issue for the middle class or the rich, and it obviously won’t be enforced against the poor.

Basically, I think it comes down to whether this is seen as a universal program, or as welfare.


tps12 03.24.10 at 12:01 pm

The slavering, cretinous base is generally clueless on questions of actual policy. As long as Republicans play to the “Obama the Marxist Muslim is stealing our country” paranoia, they can do whatever they want, position-wise.


SamChevre 03.24.10 at 12:29 pm

I actually think it’s portions of the middle class that is likely to really hate this bill; the working class have subsidies to offset the mandate. But the ban on cat coverage and underwriting means that people like my father-in-law are looking at a six-fold increase in health insurance premiums. (Assuming the cost ranges on Ezra’s site are correct.)

And yes, there’s an offsetting benefit; if you get sick, your costs won’t rise. But if you’re not sick, just middle-aged and middle-class and self-employed, this bill makes you much much worse off.


bob mcmanus 03.24.10 at 1:22 pm

1: the government takes on the responsibility of providing insurance. Attacking the mandate puts the ball where progressives really want it

But this (single-payer or public-option, gov’t provided healthcare, healthcare as a right) was exactly what Obama, Rahm and Ezekiel and the neo-liberals did not and do not want.

7:This is what (one of the things) they want, to shift the costs of social welfare from the rich to the upper-middle and middle-class. There are again, multiple purposes here: entrenching the oligarchy, preventing capital flight, preserving the surplus and accumulation.



rea 03.24.10 at 2:14 pm

Most voters don’t have pre-existing conditions

Everybody has pre-existing conditions.


Russell Arben Fox 03.24.10 at 2:26 pm

But if you’re not sick, just middle-aged and middle-class and self-employed, this bill makes you much much worse off.

I support the law entirely, despite disagreeing with its foundational premises, because of the egalitarian goods it offers immediately or in the near future, and the larger egalitarian window it opens. But I’ve never been able to really hate the Tea Partiers (mock them, sure, but not hate them), because a significant portion of their membership–not the loud and crazy ones, but the foot soldiers who show up and sign their petitions–are more often than not stuck-in-the-middle types like SamChevre’s father-in-law. Just yesterday I was talking with a good friend of mine, who owns and runs a small restaurant. 55 employees, half full-time, half part-time. As best as he can interpret the final form of the plan likely to emerge from the Senate, his business is too large for any subsidies, but their bottom-line is still much too small to afford the employee insurance plans available to him. He’s an honest, hard-working guy, and wants to do right by his employees, but he also wants to stay solvent and pay down their debt from their opening, and so is looking right now looking at how to handle the fines for not providing insurance. (He and his partners may split the restaurant into two different businesses, thus getting small enough to avoid fines and/or qualify for subsidies.)


moe 03.24.10 at 2:59 pm

I think you are right and I think I want someone to explain why this forgetting of history happens constantly. History is not just forgotten here, it is overwritten.

Is this an American phenomenon? Is it hardwired into us? (I know our memories are faulty.) It seems to me that it doesn’t happen in daily life. If someone screwed me over in 2004, I remember it now. Perhaps I’m fooling myself though.

An explanation might not lessen my frustration but I’ve wanted one for so long. That America is schizophrenic is not satisfying to me, as an explanation.


roac 03.24.10 at 4:02 pm

I am currently working my way through Russell F. Weigley’s blow-by-blow account (in Eisenhower’s Lieutenants) of the Ardennes Counteroffensive of 1944, popularly known as the Battle of the Bulge. I am tempted to construct an analogy to the Republican counterattack on HCR, popularly known as the Tea Party Movement. But I am concerned about the potential Godwin’s Law violation, given whose idea the German attack was. Can I get a ruling?


Barry 03.24.10 at 4:04 pm

Moe, Brad DeLong had a post on this (in the particular case of finding good readings on the history of right-wing thought). In short: righw-wingers have spent a lot of time arguing and working strenuously against good things, good things which became normal. This looks bad in retrospect (IMHO, it should).

An example which is he has repeatedly used is William F. Buckley’s writings in the National Review, from the 50’s and 60’s. It’s clear that one of the things that he was standing athwart history and yelling ‘halt!’ about was civil rights. He was quite scummy about that, and was clearly a supporter of the KKK (with, of course, lots of deniability and feigned regret).

Just as people b*tching about Social Security and/or Medicare look pretty bad in retrospect, so will the Teabaggers and Megans. The elites, of course, will work hard on whitewashing this.


someguy 03.24.10 at 5:03 pm

In general yes.

But this looks to be a very poorly written and expensive bill. It looks to be an expensive entitlement catering to a narrow section of the middle class. It isn’t old people. It isn’t kids. It isn’t the poor.

It is quite possible that the reaction of the rest of middle class is WTF it costs how much to insure my midddle class neighbor? Fing Deomcrats lied to me.

Really makes it much more attractive for some folks to be self employeed. The new subsidy plus the large tax break you get by being self employeed. I wonder if that will have any unintended consequences in regards to tax revenue?


Maurice Meilleur 03.24.10 at 5:05 pm

roac, as I understand Godwin’s law–a description of the probabilistically inevitable, not a prescription against its happening–by comparing the tea-baggers to Hitler’s forces you would be demonstrating that it holds. Quickly, to be sure, but still. And whether the comparison is apt or not is another matter entirely.


roac 03.24.10 at 5:38 pm

Fair enough. I won’t then, because if my action were to fulfill a natural law, that would support the hypothesis that we live in a deterministic universe. Anyway we don’t know enough to say whether Rahm Emanuel or Nancy Pelosi is Patton.


lemuel pitkin 03.24.10 at 5:45 pm

The idea that the guaranteed issue/community rating requires an individual mandate is simply false. It’s a myth that originated in places like the Manhattan Institute, where the individual mandate began as part of the Right’s approach to health care, and was uncritically adopted by folks like Ezra Klein and (surprisingly) Krugman. But there is zero empirical evidence that it is actually true, and plenty of evidence that it is not.

For instance, New York State has community rating that is even stronger than that proposed in the national bill, e.g. on discrimination by age. But of course New York does not have an individual mandate. According to Krugman, this should have led the New York individual and small group insurance market to collapse in a death spiral. But nothing of the sort happened — if you compare rates and coverage in New York to nearby states before and after community rating was introduced, there is no divergence. See Did Community Rating Induce an Adverse Selection Death
Spiral? Evidence from New York, Pennsylvania and
by Thomas Buchmueller and John DiNardo in the 2002 American Economic Review (the link is to an earlier working-paper version since the AER version is behind a paywall.)

Crooked Timber could do a real service to public discourse if a poster here wanted to challenge the groupthink on this issue.


SamChevre 03.24.10 at 5:58 pm

Really makes it much more attractive for some folks to be self employeed. The new subsidy plus the large tax break you get by being self employed

What tax break? Currently, being self employed makes taxes much HIGHER (both halves of SS, no tax deduction for health insurance, very limited options for deductible retirement savings). And while it makes it more attractive to be self-employed if you are currently considered high-risk, unless you are below median income it’s much LESS attractive to be self-employed if you are healthy.


someguy 03.24.10 at 6:49 pm


The income tax breaks are large. [Itemized deductions.]

I think they outweigh having to pay the second half of SS Taxes. But maybe I am wrong. I didn’t consider the tax break on IRA contributions so I was already off on that.


SamChevre 03.24.10 at 7:12 pm

You can take a tax break on IRA contributions, but those are much much smaller than the amounts you can defer with a pension plan.

And I don’t think itemized deductions do much specific for the self-employed; what is it I’m missing?


someguy 03.24.10 at 7:40 pm

SamChevre ,

You use the basement for work. The basement is 35% of the house sq feet. [Basements might be not allowed this is just an example.]

So 35% of your mortgage is a deductible expense. [Or something like that. I think that is right.] And it goes on and on and on.

I definitely could be wrong.


Ceri B. 03.24.10 at 7:52 pm

Someguy: I have done freelance self-employed work in the past, and will again when health allows, and associate with a lot of self-employed people in various fields. Every single one of us, without exception pays more in taxes when we’re self-employed than in years when we’re employees. Yes, sure, there are a lot of deductions, but there are also a lot of restrictions on them and the IRS is much more enthusiastic chasing our violations than ones by corporate executive officers – we all end up paying fairly substantial penalties for unintended violations, on top of overall tax bills higher than when we’re employed by someone else.

To take your office example: There are hard, hard limits on what you can do with anything you’re deducting as a business expense. Do you ever do anything personal in the basement? Store anything personal there? If so, it’s probably not deductible. A computer on which you ever play a game or browse a website for fun is generally not deductible. And so on. There are people who get away with such things…and they tend to be managers and officers in large businesses, not the self-employed.


james 03.24.10 at 7:52 pm

The tea leaves I have been reading point to multiple reasons for the Tea Party protests:

1. You’re not the boss of me. The idea that the government can issue a fine and criminality because someone did not buy a particular product is pretty heinous. It really should be implemented as a tax increase on everyone that equals the average cost of health insurance with a corresponding tax deduction for purchasing said health insurance.
2. Give the drunk some more cash. Governments tend to view all new revenue as a source of new must have spending. Here is a whole new source of spending for the congress to mismanage
3. There is no such thing as a free kick. The rich alone do not have enough money to cover the increase in costs. That leaves either increases in taxes and/or cutting other spending. Cut in spending does not seem likely. Therefore, if you are not in the primary benefit group, you are paying. This only drivers your healthcare costs up.

Ideally it should have been single payer – (Dutch version), no lawsuits unless criminal negligence, and price controls on prescription drug prices.


Marc 03.24.10 at 9:36 pm

People here really seem to be engaging in a bizarre exercise – discounting all benefits and considering only costs, as well as projecting some sort of worst-case imaginary future on what will happen. Re the mandate: we have to have car insurance, yet somehow people live with the rank injustice.

For example: people without insurance do get health care – in emergency rooms. This is extremely expensive and leads to much poorer outcomes. People are stuck in their jobs because they need health care; with community ratings we’ll get a lot more people starting up things like small businesses. Insurance companies engage in all sorts of cruel practices to avoid spending money, and that sociopathic behavior has a cost.

Now maybe the forces of evil will ensure that none of this works properly, but it seems more than a little bizarre to assert as fact that things will turn out so terribly and that costs will be so high. I simply don’t buy that this will end up as some sort of oppression; abuses are much more likely to spur retaliatory regulation than not. Political pressure against unreasonable costs is usually very effective, after all. The real fear is that the parasitic rich might end up paying more in taxes.


Marc 03.24.10 at 9:41 pm

I’d add that, as a moral matter, I really do believe that health care should be universal. If the means of providing it is through insurance, then an insurance mandate is completely defensible – that is, if you prefer to live in the sort of society where we don’t let people die when they require expensive medical care but gambled by not taking insurance. I’d be just as happy to pay for it through taxes, but the free rider problem is a real one given how we actually choose to do things.


Barry 03.24.10 at 9:44 pm

james 03.24.10 at 7:52 pm

“The tea leaves I have been reading point to multiple reasons for the Tea Party protests:

The idea that the government can issue a fine and criminality because someone did not buy a particular product is pretty heinous. It really should be implemented as a tax increase on everyone that equals the average cost of health insurance with a corresponding tax deduction for purchasing said health insurance.”

It *was* implemented as a tax increase, with various subsidies.
I think that this first point makes the case, actually, that the Tea Partiers range from fools to liars.

The rest of the points can be filed under ‘Where the F*ck were these A-holes under Bush?’.


james 03.24.10 at 9:44 pm

Marc – The norm is for US government spending on healthcare to vastly exceeded budget projections (see medicare). After all politcal points are scored for lowballing the costs. It is reasonable to assume that this trend will hold true. Other than costs, its entirely possible that the program will be wildly successful.


agorabum 03.24.10 at 10:05 pm

#12, roac (and #15): I think that an analogy regarding battle tactics and strategy does not invoke Goodwin’s law. The Hitler analogy does not concern conventional military battles. It either relates to appeasment (“Hitler has shown that people like X cannot be appeased or negotiated with and are not rational actors and must be destroyed”), and, far more commonly, to fascist oppression and the Holocaust (i.e “Hitler passed a big stimuls bill to build the autobahns, and then he used this infrastructure to transport his political and racial enemies to death camps, so that means Obama is setting up FEMA internment camps as we speak!”). At its essence, it is used to declare that your message board opponent/target is just like the person responsible for the greatest moral crimes of the 20th Century.

I’d have to say that a conventional war analysis relating to counter-offensives and their resulting political anaolgies do not make the same sort of moral judgments (or really any moral judgment, rather just a tactical / strategic effectiveness judgment). You may proceed without violitiong Goodwin.

Oh, and on topic, I agree; the Republican rank and file were all able to immediately forget and take 180 degree positions on criticisms of the President, conduct during wartime, congressional procedural maneuvers, “up or down votes”, the rights of the legislative majority to pass laws, etc. the moment they lost power. They should easily be able to make such pivots after a primary. Actually doing so depends on who lives in their district; high rates of teabaggers mean they’ll continue to talk about death panels and repeal; normals will lead them to pivot.


Marc 03.24.10 at 10:09 pm

James – It is true that medical costs are rising rapidly, but this is independent of the bill which just passed. This is happening everywhere to some degree, and it is broader than whether the health care system is public or private. We’ve developed sophisticated, and expensive, ways of delaying death by a little bit in terminal illnesses. It is a tough ethical bind that we will need to face, but I hardly see the outcome as better if it is made by private corporations as opposed to people for whom we can vote.


lemuel pitkin 03.24.10 at 10:19 pm

Re the mandate: we have to have car insurance, yet somehow people live with the rank injustice.

My objection to the mandate is not simply that it is unjust, but that the economic arguments being made to support it are false. It is perfectly possible to have guaranteed issue, community rating and the rest of the bill’s provisions without the individual mandate. of course in that case the revenue that the mandate raises — both in premiums and the penalties that the uninsured pay — would have to be raised in some other way. I believe there were politically practical alternatives that would be preferable on both equity and efficiency grounds.

Similarly, without the mandate, some people would choose not to buy insurance, and receive less health care as a result, altho they would not be denied life-saving treatments. Maybe closing off this option is a case of justified paternalism, but maybe not (personally I have no problem with it on substantive grounds but suspect it will make the law much more unpopular than it needed to be). Both questions are debatable, but the point is the debate didn’t happen because people on the left accepted the fraudulent economic argument that the mandate was unavoidable.

people without insurance do get health care – in emergency rooms. This is extremely expensive and leads to much poorer outcomes.

Yes, it leads to bad outcomes, but no, it is not expensive. The higher cost of any particular treatment is more than offset by the much lower amount of treatment provided. The idea that universal health coverage could reduce spending through this channel is another myth. Everyone should have equal access to health care regardless of income, absolutely, but let’s not delude ourselves that denying this right doesn’t make economic sense.


Martin Bento 03.25.10 at 1:16 am

Marc, I said in the first comment that I opposed the mandate for auto insurance too. If the government is going to require insurance, it should provide it at cost. There is no need for a for-profit rentier. It is true that I “live with” it in the sense that it has not killed me, nor would I take up arms over it, but I did write my legislator in opposition back in the day. I lost; that doesn’t meet I do or should be deemed to support the outcome.

The fact that most liberals never opposed the mandate for auto insurance makes it harder for them to oppose the mandate “on principle” now, which is the potential I saw in the insurance requirement at the time. Slippery slope arguments may not be strictly logical, but they are often accurate accounts of how things work, precisely because people make arguments like you just did: “If you accept A, you must accept B, because it is just a furtherance of the same principle of A”.


SamChevre 03.25.10 at 1:56 am

And it’s worth noting that the auto insurance mandate is activity-based, not existence-based. If you want to do X, you must do Y first is a really common regulatory/legal structure; you must do Y is much less common.


m.carey 03.25.10 at 2:52 am

,roac (#12 & #15): We dont know who corresponds to Patton, but we sure DO know who corresponds to Ike. An he, also lived in Iowa.


Marc 03.25.10 at 3:25 am

There are two distinct objections to a mandate: you can claim that whether you pay for health care or not is a free choice, or you can believe that it should be provided by some different model than insurance. I have no sympathy for the former, at all, because I don’t want to live in a society which lets people die of preventable causes because they were short-sighted. Within that framework the freedom being defended is the freedom to be a freeloader. If you get breast cancer when you’re 30, or have a crippling accident, or a stroke – well you’ll get covered anyhow – so why not save a few bucks? If it gets really bad, someone else will pay the bill.

The reason why is that if enough people don’t pay – but rely on the ones who do pay to cover emergency bills – then the system collapses. I can see why certain ideologies would prefer that this be ignored, but that doesn’t make it ignorable.

Now I’m perfectly OK with an alternate arrangement where everyone pays with taxes instead. But that’s very different from an assertion that there is some fundamental freedom to rely on the broader public to provide you with something while asserting that you have no obligation to chip in when you have the resources to do so.


lemuel pitkin 03.25.10 at 4:30 am

The reason why is that if enough people don’t pay – but rely on the ones who do pay to cover emergency bills – then the system collapses.

Yes, everyone says this — except the people who’ve actually studied insurance markets.

Remember, what we are comparing here are these cases. (a) People have the right to buy insurance at a fixed, affordable rate at any time. (b) As before, and they are required to do so.

So no one in either case is denied health care, since the option exists to buy a policy once you become sick. But neither does anyone receive health care without paying for it, since you do need to buy the policy at that point. Of course there are still big benefits to being continuously insured — paying for routine care, avoiding the hassle of enrollment when you’re dealing with an illness or injury, etc.

The notion of the “adverse selection death spiral” is that under such an arrangement the people with the lowest expected health costs would be the most likely to opt out of insurance. This would require charging the rest of the population higher rates, which would lead to the next healthiest group opting out, and so on. Sounds good on paper, but there is no evidence it actually happens. In existing systems that resemble this — and there are plenty of them — the people who opt out (mainly those with lower incomes) tend to have higher, not lower, than average rates of health problems. So even if eliminating the individual mandate does lead to somewhat higher premiums, there is no mechanism that would lead to continued increases and the unraveling of the system; and the shift in costs is probably progressive on net.

But who cares about all that, Ezra Klein says we need a mandate so hey ho off we go!

You (like lots of people, to be fair) also seem a little unclear on how the mandate will actually work. There are tax penalties for people who fail to purchase insurance. There will be quite a lot of those people — 24 million in 2019, per the CBO. And the penalties are substantial — up to $2,000 per household. And here’s the thing: folks who pay the penalty are still uninsured. This is a new, regressive tax that leaves the people who pay it strictly worse off than before reform. It’s easy to get on your high horse and say that this is what they get for failing to meet their social duties. But if your goal is, let’s say, to provide universal health care as opposed to rewarding the righteous and punishing the wicked, it’s hard to see how you justify this provision.


Martin Bento 03.25.10 at 4:41 am

SamChevre, realistically, there is no viable alternative to driving in much of the United States, and this has a lot to do with zoning laws, greater subsidies for the auto than for public transit, and other matters that are imposed by the government. So driving is not entirely a choice. But my objection is not to being required to pay into a pool to cover damage that I may cause by driving; my objection is to the government forcing me to provide profit to a private company through an involuntary purchase. Like I said, if it’s going to be mandatory, which means the demand side is being socialized, the supply side should be socialized too.

Marc, I’m all for universal coverage, and obviously that means some way of compelling people to pay universally rather than per service. My objection is to private insurance being used to do this. It just creates a rentier class whose claim to profit is being enforced by law. What the insurance can do efficiently is price insurance according to risk, as best risk can be estimated. This will and does price many people out of the market. If universal coverage is your goal, then, the insurance market is of no use; the efficiency it creates is counter-productive, relative to your goals. Therefore, if you want universal coverage, insurance companies are purely parasitical: they contribute nothing, and their profit is a pure cost to others. Being compelled by force to give money to others for their profit and my detriment sounds a lot like mugging to me.

I don’t think most liberals would disagree with this in the abstract, but don’t think it as important as I do. I objected to the auto insurance because I saw a slippery slope, and now am being told I should accept this mandate too because I could “live with” that one. The slope is indeed slipping. And people who embraced the auto insurance are in a weaker position to object to the mandate now.


Martin Bento 03.25.10 at 4:52 am

Lemuel, it’s interesting that the death spiral predictions don’t hold water. I had accepted them, because they make sense in the abstract. However, homo economicus is a myth for the most part. Also, with community rating people go to HMO’s. In other words, with guaranteed coverage, people opt for all you can eat, but with a less fussy menu.


Martin Bento 03.25.10 at 4:54 am

I guess I should make clear that I’m glad the bill passed. I don’t like the mandate to buy private insurance, but agree with those who say it will be easier to improve an existing system, than to build a better one from scratch. Now the government is on the hook for health care; that is the biggest hurdle.


lemuel pitkin 03.25.10 at 5:26 am


I agree, it’s better the bill passed than not. And interestingly, Ron Wyden got language included that allows states to opt out of the individual mandate (and various other provisions) if they can convince HHS they can cover the same number of people through some other mechanism without additional cost to the feds. So there’s space now for progressives to be pushing for better approaches at the state level.


lemuel pitkin 03.25.10 at 5:27 am

(Why am I in moderation now?)


maidhc 03.25.10 at 7:48 am

I see this as panning out like the Y2K hysteria. Remember back in Dec. 1999 when people were claiming that all technology was going to stop working as of Jan. 1, 2000? And people were buying canned food and propane stoves and all kinds of things to prepare for the Apocalypse? And all 0f the rightwing media were pushing the concept?

Abruptly, Jan. 1, 2000, you could turn on Fox News or Rush Limbaugh or your favorite rightwing news outlet, and all of the hysteria about Y2K that had been delivered nonstop up until Dec. 31 had suddenly magically disappeared as though it had never existed.

I’m guessing the Republicans will fall back on the issue of illegal immigration in the upcoming midterm elections. Repealing HCR is a loser.


jholbo 03.25.10 at 1:11 pm

sorry lemuel. No idea.


roac 03.25.10 at 2:28 pm

Now that I have permission to make the Ardennes comparison, I find that it doesn’t work. Hitler, who was nuts, forced the counteroffensive down the throats of his professional military leaders, who knew they couldn’t afford it. Whereas the Republicans went crazy voluntarily and unanimously. (Jonestown might be an appropriate analogy, except that “drinking the Kool-Aid” became an unusable cliche quite a while back.)


Doctor Science 03.25.10 at 4:16 pm


a good friend of mine, who owns and runs a small restaurant. 55 employees, half full-time, half part-time. … their bottom-line is still much too small to afford the employee insurance plans available to him. He’s an honest, hard-working guy, and wants to do right by his employees, but he also wants to stay solvent and pay down their debt from their opening, and so is looking right now looking at how to handle the fines for not providing insurance.

And this is the sort of person who *should* have been pushing for single payer. He wants to do right by his employees — but he’s failing. That’s too many people with full-time jobs and no medical insurance, not even counting the part-time employees, most of whom probably don’t have insurance, either.

Your friend is screwing his employees. In a sense, it’s not his fault, because he’s in a industry where wages and prices are set based on a screw-the-workers standard. He can’t pay his people a living wage (if you include insurance as part of that wage, which you should), because that would raise his prices above the competition. The loans he has to repay were given on the assumption that he would pay industry-standard wages and benefits — which is to say, crap.

Small business owners and entrepreneurs like Russell’s friend *should* have been pushing for single-payer, to detach medical insurance from employment. They should *still* be pushing for it. You tell me why they aren’t.


Oliver 03.26.10 at 6:16 am

36 – you are free to found a non-profit insurer, are you not?

The advantage of having multiple insurers is competition for lowering costs of treatment.


Stuart 03.26.10 at 11:23 am

One thing always surprises me – how the conservative parties kind of give the lie to the idea that the boy who cried “Wolf” would ever get punished for his deceptions. After all, again and again they can cry out about how the newest piece of prospective progressive legislation is going to destroy the country, and then a few years down the line when nothing has happened they can make the same claims about the next piece of legislation and still have nearly half the country listen to them as if they had credibility.


chris 03.26.10 at 3:36 pm

@44: In short, exploitation is a Hayekian optimum. Decent employers can’t survive in the market unless decency is also enforced on their competition through regulation. (Or through meaningful negotiation with the workers — IOW, unions.)


Doctor Science 03.26.10 at 4:50 pm


Decency can probably be an unregulated optimum in economies where movement (of jobs, between jobs) is slow. If workers and employers know that they are likely to be together for 10-20 years, then mutual decency can be self-protection, and might not need either regulation or unions. This is the conservative dream, but it is undermined by both capitalism and modern life.


Ray Davis 03.27.10 at 8:39 pm

Not that this has anything to do with anything except the flow of the comment thread (which is where I am! SCORE!), but I love roac’s taking an empirically inducted law as a legislatively prohibitive law. The move’s not only witty in context but wittily applicable to most attempts to scientize the humanities. (Or am I being reductive? SCORE!)


PQuincy 03.29.10 at 3:23 am

Lemuel Pitkin writes:

“The notion of the ‘adverse selection death spiral’ is that under such an arrangement the people with the lowest expected health costs would be the most likely to opt out of insurance. This would require charging the rest of the population higher rates, which would lead to the next healthiest group opting out, and so on.”

I recall that those 40% annual increases for small-group healthcare insurance just announced in California were explained (by the companies themselves) exactly as a typical adverse selection spiral: the recession had forced healthier members of these groups to drop their coverage, shifting the underwriting risk and leading to dramatic increases in premiums (which, not surprisingly, was going to force more of the relatively healthier members of the groups drop their coverage, etc..)

How is the not an “adverse selection death spiral”, though one exacerbated by an economic downturn? (The point being that small- to moderate-group health insurance can be only in an unstable saddle-point equilibrium, in which every group would eventually experience the kind of disruption likely to trigger a spiral).


Jamey 03.29.10 at 3:34 am

I predict “Repeal Obamacare” will go right into the dustbin with term limits should Republicans win back control of Congress (unless Obama is there to veto it, then they will cynically pass it, safe in the knowledge that it will be vetoed).

As far for Romney and whether he will be punished for exhibiting some semblance of sanity at one time, that will depend on whether he has a serious primary challenger. I think we can count on Ron Paul to be a royal pain once again. But I wouldn’t exactly consider him a serious primary challenger. But if a serious challenger emerges that is acceptable to the corporate interests who fund the Republican Party, count on him (don’t consider Palin a serious challenger either) to bash Mitt mercilessly, and make it an issue whether the forces of amnesia want it to be or not.

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