Saturday, November 9, 2013

The Trouble with Obamacare, Ad Nauseum

Thinking of the myriad troubles and disappointments of both the substance and rollout of the Afordable Care Act, I'm reminded of a joke I discovered recently:
Jean-Paul Sartre walks into a Paris cafe, sits down and says to the waitress, "I'd like a coffee with no cream."
The waitress replies, "We have no cream. Would you like one with no milk?"
The joke, a very inside one it seems, depends on understanding Sartre's basic tenets. I suppose that one of his major works is titled Being and Nothingness might be a reasonable tell.

In any event, it suggested to me where the ultimate failure, or flaw, lies with Obamacare: It either lacks cream (a public option) or milk (a stronger individual mandate).

One could argue that it's not being a single-payer, Medicare-for-all program is its most egregious failing, but what's germane is what would have been possible in 2009 given the political realities. Progressives could have held out for a public option -- if blue-dog senators could have been swayed -- or in the face of stiffer red-state Democrat resistance at least a stronger individual mandate, such as requiring more forceful, more immediate penalties for opting out of insurance.

From a business/market perspective, removing the private-insurance model from health care altogether would be the no-cream version while much more strictly regulating insurance coverages might be the no-milk variant.

Yes, this is just an exercise in examining the limitations of American politics in an age of ultimate ideological stalemate. But it also demonstrates the limits of bipartisan compromise: Proposing a bill that guarantees automobile safety by lowering the speed limit to zero won't get us anywhere. And "throwing the red states a bone" by eliminating the seat-belt requirement wouldn't sweeten the deal enough for passage.

Progressives need to learn that compromise -- something only progressives seem to do these days -- usually lands them not in the middle but instead in some dismal no-man's land.

Sweetening the Affordable Care Act by eliminating the public option amounted to giving us the Obamacare we deserve. And for someone who likes cream in his coffee, the outcome may be pretty black indeed.

Footnote. I'm not saying that Obamacare won't or can't improve the health-care system in the U.S. The point obviously is that it could have been so much better were it not for "political realities." And what we're left with has enough challenges to drag us down for years before we reap what benefits are actually in store. In the meantime, can we count on overcoming the obstacles the right is throwing in front of us on the way to a successful, long-term rollout? We won't know that for a while, either, hence the dark outlook.

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