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Obama's moderate health-care law

By Ezra Klein

Over on the Twitter machine, I linked to this Matt Yglesias post noting that President Obama appointed a fairly conservative (which is not the same as partisan) Republican and a fairly conservative Democrat to co-chair the deficit commission. It's almost as if Obama is a moderate technocrat in the Clinton mold and not a Kenyan socialist, I said.

In reply, Sean Paul Patrick tweeted, "Obama a moderate? Good one. That 2300 page, 2.5 trillion dollar health care bill was so moderate." But it was! People tend to form their impressions of how liberal or conservative something is by looking at how much partisan activity there is around it. And there was, of course, a lot of partisan activity around Obama's signature legislative effort. But if you believe "liberal" and "conservative" refer to coherent schools of ideological thought, the health-care bill was the most moderate universal health-care proposal offered by any president, of any party, in the last century.

It was far more modest than what Harry Truman, Richard Nixon, or Bill Clinton proposed, relying more on the private sector and tampering less with existing insurance arrangements than any of those plans. It was even more moderate than what George H.W. Bush proposed. As I rarely tire of pointing out, it was a dead-ringer for the bill Republicans rallied around as a conservative alternative to the big-goverment overreach of ClintonCare, not to mention the bill Mitt Romney passed in Massachusetts. The individual mandate, now the most controversial element of the law, began life as a Republican idea.

There was a lot of controversy around Obama's health-care effort, so it became extremely polarized. But judged as a piece of policy, it was much more modest than any of its forebears. Even Clinton, who's now being held up as the moderate yin to Obama's liberal yang, offered something more ambitious, with a far greater role for the federal government. Obama didn't get much credit for this, but that doesn't make it any less true. And it doesn't mean Obama is less liberal than his predecessors: It just means that he, like other presidents, spoke to veterans of past defeats and went with what they thought could pass. The bill that ultimately made it through Congress was very similar to what Max Baucus proposed in his white paper, and what Hillary Clinton and John Edwards proposed during the campaign. Having fallen short seven or eight times before, the Democratic Party as a whole had become extremely pragmatic on health-care reform, and Obama did not take issue with the consensus approach.

By Ezra Klein  | November 12, 2010; 6:08 PM ET
 
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Comments

The health care "debate" really opened my eyes, in a way that quickly made want to gouge them out.

A lot of people apparently think killing poor people is a central part of the American way of life.

Sure, Republicans opposed Obamacare mostly as a cynical political ploy, but the vast majority of them voted against (and filibustered) SCHIP as well, and there was no way in hell they were going to successfully demonize children's health care as a death panel/Medicare cut/government takeover/Kunta Kinte's postcolonial revenge.

They just genuinely, philosophically believe that you deserve to die if you have a preexisting condition and can't afford to pay out of pocket.

You can't insure a car that's already been totaled, after all.

Posted by: dstr | November 12, 2010 7:56 PM | Report abuse

Ezra: You've made precisely the point why it was such a mistake. 18 months of effort and a ton of political capital expended for THIS?


Remember if you're not gaining power, you're losing it. There is no in between. By struggling for something that was not really important to the people, you lost steam over the things that are.

Posted by: 54465446 | November 12, 2010 9:11 PM | Report abuse

In short, the GOP got the plan its been promoting for nearly two decades, and if it fails, the Democrats will get all the blame, preventing any of the truly liberal alternatives from being tried.

Who is play 11 dimensional chess again?

Posted by: Nylund154 | November 12, 2010 10:15 PM | Report abuse

So let me get this straight: Ezra is trying to give us a pep talk that Obama was only doing what Dems have done for decades, which is preemptively capitulate and try and give the Pepublicans what they want, but strangely it didn't work. Is this supposed to make me feel better? Yeah, I get it, the health-care bill wasn't liberal, and the GOP still hated it. If they're going to hate anything the Dems propose to cover everyone, why not actually go with something liberal that covers everyone AND reduces costs by riding herd on the insurers and providers? The GOP will scream bloody murder, but people could actually get health care they could afford, which (silly me!) they might actually like (you know, like Medicare). But nooooooo, Ezra won't talk about that, he'll just wank about whether or not the inadequate crap health care bill we passed could be called liberal or not. Well, I'm glad he's focused on the important matters!

Posted by: redscott1904 | November 12, 2010 10:51 PM | Report abuse

The ACA is infinitely better than the status quo, and the best thing that could have been passed given the political realities. Lieberman and Nelson are actual senators with actual votes. Liberals who refuse to acknowledge reality are no better than the factually challenged, ideological purists who have turned the Republican party into a crackpots only club.

Once people realize that the law doesn't kill grandma, they'll like it, just like every other progressive triumph of the last century. And just like those reforms, it will be improved upon. The real pity is that it could have happened decades earlier.

Posted by: cce1976 | November 12, 2010 11:29 PM | Report abuse

Also, there's no need to link to a news article explaining the plan's conservative roots. You can link directly to the Heritage website.

OCR Version:
http://www.heritage.org/Research/Reports/1990/07/Using-Tax-Credits-to-Create-an-Affordable-Health-System

Scanned PDF:
http://s3.amazonaws.com/thf_media/1990/pdf/bg777.pdf

Posted by: cce1976 | November 12, 2010 11:34 PM | Report abuse

While all the wasted years of achieving some kind of Universal Health Care System has been cataloged here, by several of those commenting, once again I have noticed no effort whatsoever to discuss the same wasted period of trying to arrest in any way, the spiraling run-away Costs, which none of the other Industrialized Countries experienced when they introduced their various versions of Universal Health Care.

The 'Ambulance Chasing' advocacy lawyers, have had the most profound & Cost significant effect on the Practice of Medicine. The Hospital Methodologies, & staff, all trying to serve in the practice Medicine, have had to be looking over their shoulder, & going overboard to be seen 'Practicing Due-Diligence' as if they were also trained Legal people as well Health Care Professionals, has been responsible in very large part to production of a 2,300 page document in trying to address the scope of the mess that has resulted from all those things I've mentioned here.

It was never gonna happen, & only a 'Soothsayer' would be further setting-up the non-implementable 'The Health Care reform legislation', as a straw man for the Republicans, is as sinsister as it can get.

I don't care who may be called as 'Review Board', if one was ever called, to examine the 2,300 page Bill, as it stands,by the the time they had reviewed the first 300 pages, there would-be, & or maybe, a UNANIMOUS VOTE to scrap the entire 2,300 page, of convoluted, back-door, gerry-mandered, piece of Legislation, sunset it right quick, & start again, & this time starting with Fundamentals, like, tackling the Run-away Costs.

I purposely ended with 'Costs', because jump high & or do double flips with half-gainers, until Health Care costs are not only examined, but dealt with in a way to Arrest the run-away costs,& reduce the costs, which average about a factor of 8 times higher than all the other Industrialized Countries, the whole exercise is a waste of time, or simply an exercise in Futility.

I dare any reader to dispute, with evidence, ANY of what I've written here, please feel free to so do.

Posted by: buntyp | November 13, 2010 12:37 AM

Posted by: buntyp | November 13, 2010 1:12 AM | Report abuse

Ezra, you are missing the point. The thing that is making health care so unaffordable is the rising costs. When the others proposed these expansions, it didn't cost so much.

I demand a limit on demand. If we force plans which allow unlimited consumption, and that is a requirement of the law, it's going be an acceleration of the increasing cost cycle that is just license for providers to increase costs, while insurers whine but see profits rise as 10% of an increasing cost is still an increasing profit (even though there are fewer that can afford the premiums). You can't simply put a law in place that allows for an infinite straw to be attached to future taxpayer liabilities and say the plan doesn't suck.

Concept- insure a lot people, great, fantastic, love it. Prove you can reduce costs first, and it sails right on through. The Massachusetts plan has caused costs to rise faster than similar places. It's not a cost containment strategy. Prove you can cut costs, and then we can afford the plan we need.

Posted by: staticvars | November 13, 2010 1:23 AM | Report abuse

I have posted this already here before You guys should stop complaining because, one the health care we have now isnt as good as it was supposed to be. also the law has just been signed so give it some time. so if u want to say u have the right to choose tell that to ur congress men or state official. If you do not have insurance and need one You can find full medical coverage at the lowest price check http://bit.ly/bandYw .If you have health insurance and do not care about cost just be happy about it and believe me you are not going to loose anything!

Posted by: patriciajeff13 | November 13, 2010 2:22 AM | Report abuse

"I dare any reader to dispute, with evidence, ANY of what I've written here, please feel free to so do."

O.K. here goes.


Here is the data from the CBO. On page 150 ff of http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf, and http://www.cbo.gov/ftpdocs/71xx/doc7174/04-28-MedicalMalpractice.pdf, the CBO found no significant saving in those states such as Texas that have instituted "tort reform. In addition there was no reduction in the frequency of tests and treatments. Their costs and frequencies were also similar to those in states with tort reform.

In a recent letter to Senator Hatch, the CBO said that an ideal system of torts would not save more than 0.5%, 60% (0.3%) of which would be in reduction of overutilization, i.e. "defensive medicine." They admit that this figure may be too high as examples have shown that in some cases, "tort reform" has increased some aspects of overutilization, and they ignored that in their computation. In fact, here is the pertinent paragraph from that letter:

""CBO now estimates, on the basis of an analysis incorporating the results of recent research, that if a package of proposals such as those described above was enacted, it would reduce total national health care spending by about 0.5 percent (about $11 billion in 2009). That figure is the sum of the direct reduction in spending of 0.2 percent from lower medical liability premiums, as discussed earlier, and an additional indirect reduction of 0.3 percent from slightly less utilization of health care services. (That reduction is the estimated net effect of the entire package listed earlier, although some components of that package might increase the utilization of physicians’ services, as has already been noted.) CBO’s estimate takes into account the fact that because many states have already implemented some of the changes in the package, a significant fraction of the potential cost savings has already been realized."

BTW, 0.5% is about $32 a year on the average policy.

O.K.?

Posted by: lensch | November 13, 2010 10:08 AM | Report abuse

buntyp wrote:

"I dare any reader to dispute, with evidence, ANY of what I've written here, please feel free to so do."

You didn't use any evidence so why should anyone contradicting you?

Posted by: 54465446 | November 13, 2010 4:20 PM | Report abuse

Perhaps this is real life experience rather than Evidence.

Several years ago, Nevada enacted by referendum a cap on medical malpractice awards, and a mechanism for limiting them before malpractice suits could be filed.

Before the Referendum, malpractice premiums were rising and doctors were closing up practices and leaving the state. After the Referendum, malpractice premiums continued to rise -- and doctors continued to close up their practices and leave the state. Both before and after "Malpractice Reform" it is said that to find good medical care, one must go to the airport.

However, "Malpractice Reform" did do one thing: it essentially conferred amnesty upon medical errors. We have since had some of the most notorious cases of mass infliction of medical injuries.

Posted by: lericgoodman | November 13, 2010 7:05 PM | Report abuse

I disagree with Mr. Klein's assertion that Obama Care is moderate and that the concept of mandates in the health care arena were republican counter offers.

Creating a structure and buracracy that will systematically reduce the quality and access to health care in the United States is not a moderate concept. It is totalitarian and socialistic in it's very concept.
With all the medically untrained bureaucrats going to approve/disapprove Doctors instructions is Radical. As any halfwit, or journalist, could see, this will undermine the ability of the insurance companies to manage their own corporate risks and severly reduce or eliminate the product offerings they formerly offered to the public. The Federal Government has chosen to take on the inherent risk of the insurace business not knowing anything about running a breakeven or profitable enterprise. Their experience lies in Medicare and Social Securiy - both programs are banckrupt, completely mismanaged and draining the vital resouces or the US econpmy.

Citing the proposals of former Prsidents, which were not accepted or made into law, is an irrelevant argument. Those individuals are long dead and the circumstances have changed. The Democratic party has chosen to steal our personal wealth and give it to the people they choose - simply for control of the pie (and the votes). This is bad legislation. Since we can no longer trust our elected represenatives to act in our best interests, if the United States Public, not the Congress, decides that it wants to spend its revenue on universal medical coverage, than a much simpler and more effective plan can be developed. Not a radical take over of 20% of our economic marketplace.

Mr. Klein - your radical skirt is showing.

Paco

Posted by: pacoofamerica | November 15, 2010 9:38 AM | Report abuse

In sum, the wingnut response:

"IS NOT! NYAHHH!!"

Posted by: TomBlue | November 15, 2010 12:08 PM | Report abuse

If the politicians in this country cannot dictate the price of gas and the cost of anything else, just how is it that they are supposed to be able to take over an industry about which they collectively know less than Ezra, who is clueless? This is not a moderate bill, nor will it give the people of this country what they should have. They will ration care while failing to control costs. The rural poor will be no better off than they are today and the same applies to the urban poor. How many doctors want to start or run a practice in Slippery Gut, WV? And yes, it is a real place. Who wants to open a doctor's office in the Huff in Cleveland, the Hill District in Pittsburgh, or Liberty City in Miami? No one.

Instead of helping create a climate that would allow more competition and more rational use of health care our politicians simply want to mandate it and get someone else to pay for it. That is a recipe for rationing that will leave only the truly rich with good health care.

Posted by: buggerianpaisley1 | November 16, 2010 12:57 AM | Report abuse

buggerianpaisley1: "Instead of helping create a climate that would allow more competition and more rational use of health care our politicians simply want to mandate it and get someone else to pay for it. That is a recipe for rationing that will leave only the truly rich with good health care."

Well, that hasn't been the case in all of our peer countries that all have mandates. In fact, they get as good or better health outcomes, cover everyone, and spend far less than we do.

As for cost, there is a good argument that coverage has to come first, because that helps create the political will for cost control.

We're not operating in a factual vacuum here. It's not hard to look at what other countries do and see what has worked. Read T.R. Reid's book "The Healing Of America" and see how we compare to our peer nations. It pretty much explodes the myth that market-based forces are the solution. We simply don't "consume" health care like we do other commodities. (Market theory says if something is less expensive, we'll consume more of it. But if colonoscopies are free, am I going to want to get more of them than I really need? People in France don't see their doctors more than we do. Markets are great things, but that doesn't mean they work well for everything.)

Posted by: dasimon | November 17, 2010 11:59 PM | Report abuse

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