Here’s how GOP Obamacare hypocrisy backfires

By Michael Lind
Salon, October 28, 2013

The smartest thing yet written about the botched rollout of the Affordable Care Act’s federal exchange program is a post by Mike Konczal of the Roosevelt Institute at his “Rortybomb” blog at Next New Deal. Konczal makes two points, each of which deserves careful pondering.

The first point is that to some degree the problems with the website have been caused by the overly complicated design of Obamacare itself.

Konczal’s second point is even more important — the worst features of Obamacare are the very features that conservatives want to impose on all federal social policy: means-testing, a major role for the states, and subsidies to private providers instead of direct public provision of health or retirement benefits.

This point is worth dwelling on.  Conservatives want all social insurance to look like Obamacare. The radical right would like to replace Social Security with an Obamacare-like system, in which mandates or incentives pressure Americans to steer money into tax-favored savings accounts like 401(k)s and to purchase annuities at retirement, with means-tested subsidies to help the poor make their private purchases. And most conservative and libertarian plans for healthcare for the elderly involve replacing Medicare with a totally new system designed along the lines of Obamacare, with similar mandates or incentives to compel the elderly to buy private health insurance from for-profit corporations.

Will the flaws of Obamacare really hurt the right and help center-left supporters of universal social insurance? I doubt it.

To begin with, this implies a willingness of the right to acknowledge that Obamacare, in its design, is essentially a conservative program, not a traditional liberal one. But we have just been through a presidential campaign in which Mitt Romney, who as governor of Massachusetts presided over the creation of the most important model for Obamacare, rejected any comparison of Romneycare with Obamacare

Nor are progressives likely to press the point in present or future debates. Unlike conservatives, who are right-wingers first and Republicans second, all too many progressives put loyalty to the Democratic Party — most of whose politicians, including Obama, are not economic progressives — above fidelity to a consistent progressive economic philosophy. These partisan Democratic spinmeisters are now treating Obamacare, not as an essentially conservative program that is better than nothing, but as something it is not — namely, a great victory of progressive public policy on the scale of Social Security and Medicare.

In doing so, progressive defenders of Obamacare may inadvertently be digging the graves of Social Security and Medicare.

If Obamacare — built on means-testing, privatizing and decentralization to the states — is treated by progressives as the greatest liberal public policy success in the last half-century, then how will progressives be able to argue against proposals by conservative Republicans and center-right neoliberal Democrats to means-test, privatize and decentralize Social Security and Medicare in the years ahead?

I’m sure a number of token “centrist” Democrats will be found, in due time, to support the replacement of Medicare by Lifelong Obamacare. And with neoliberal Democratic supporters of the proposal as cover, the overclass centrists of the corporate media will begin pushing for Lifelong Obamacare as the sober, responsible, “adult” policy in one unsigned editorial after another.

Once Medicare has been abolished in favor of Lifelong Obamacare, perhaps by a future neoliberal Democratic president like Clinton and Obama, Social Security won’t last very long.

The conservative Republicans and centrist Democrats will argue that the success of Obamacare, in both its initial version and the new and improved Lifelong Obamacare version, proves that a fee-based, means-tested, privatized and state-based system is superior to the universal, federal, tax-based Social Security program enacted nearly a century ago in the Dark Age known as the New Deal.

The genuine progressives will respond with a defense of Social Security. Whereupon the faux-progressives, the neoliberal heirs of Carter, Clinton and Obama, will reject the option of preserving Social Security — why, that’s crazy left-wing radical talk! — but insist that the subsidies for the poorest of the elderly be slightly increased, as the price for their adoption of the conservative plan to destroy Social Security. Throughout the process, the right-wing Republicans and neoliberal Democrats will ask, “How can progressives object to means-testing, privatization and 50 state programs, when those are the very features of the Obamacare system that our friends on the left celebrate as a great achievement?”

Think about it, progressives. The real “suicide caucus” may consist of those on the center-left who, by passionately defending the Affordable Care Act rather than holding their noses, are unwittingly reinforcing the legitimacy of the right’s long-term strategy of repealing the greatest achievements of American liberalism.

(Michael Lind is co-founder of New America Foundation.)…

The Next Social Contract

By Michael Lind
New America Foundation

The Affordable Care Act, backed by President Barack Obama, focused on the problem of coverage rather than costs. The ACA rejected the New Deal/ Great Society tradition of universal, taxpayer-based social insurance for the conservative alternative of tax expenditures and individual mandates to purchase private health insurance.

While some elements of the law are laudable, as a whole the ACA combines all of the faults of the bad approaches to public policy, while rejecting the sound approach of universal federal social insurance. Means-tested subsidies, tax expenditures, and elaborate federal-state hybrid systems (in this case, health care exchanges) are all united in an overly-complicated system. For working-age, non-poor Americans, the Affordable Care Act (ACA) envisions a transition from system of tax expenditures based on employers to another indirect system based on tax subsidies to individuals purchasing insurance in state-created exchanges.

In the long run, the health insurance system should be integrated into a single, life-long, comprehensive social insurance program. As a step in that direction, Medicaid and SCHIP, two inefficient and unfair federal-state hybrid programs, should be completely federalized and merged with Medicare.

The U.S. health insurance system is likely to move either toward efficient social insurance or toward inefficient and costly voucherization of the social insurance elements like Medicare and Medicaid, combined with rationing of health care of a kind unknown in other advanced industrial democracies. For reasons of solvency and fairness alike, health insurance needs to be absorbed into an expanded, comprehensive American social insurance system.

Report: “The Next Social Contract” (44 pages):…

Mike Konczal’s article covered in yesterday’s Quote of the Day message has received considerable attention in the blogs, since his concept was a real eye opener. While most are distracted by the temporary kludge of the opening of the federal Obamacare exchange website, the real lesson is that the complexity of coordinating all of the entities that are involved in enrolling individuals into the exchange plans confirms the complexity of Obamacare itself. The computers will be fixed, but Obamacare can never be.

Michael Lind of the New America Foundation elaborates on Konczal’s observation that the neoliberal Democrats have adopted the conservatives’ model of reform – “a fee-based, means-tested, privatized and state-based system.” Even though neoliberals and conservatives theoretically are bitter enemies (witness the insults hurled over the shutdown of the government), and battle publicly over Obamacare, they are silent partners in delivering to the nation the Heritage/Romney/Clinton/Obama model of a largely privatized health care financing system.

The New Deal/Great Society approach to our social insurance programs – Medicare and Social Security – was to make them federally administered and federally financed, an approach then supported by centrists and liberals. Now we have a conservative program – Obamacare (that really isn’t social insurance, especially when considering how many are left out) – that is now supported by centrists and silently by conservatives (e.g., Ryan’s Republican voucher plan for Medicare).

Publicly, only the liberals are standing up for expanding an improved version of Medicare to cover everyone. Many of the centrists also support it but are toeing the neoliberal line of Democratic Party loyalty by remaining silent (not to mention the fear of offending their health industry campaign contributors). Most conservatives recognize the superiority of the single payer model in achieving the goals of universality, equity, and affordability, but many are also libertarians and are opposed to those goals simply because of their ideology.

We need to abandon the process of trying to meet on common ground through the Democratic and Republican parties. Virtually all liberals, most moderates, and some conservatives agree that everyone should have health care and that it should be financed equitably through an administratively efficient program. When we vote we should ignore the candidates’ political parties, but instead vote based on their advocacy for health care justice (and other forms of social justice). For those who do not think that is feasible, all we need is more visibility (a cryptic comment if there ever was one, but use your imagination).