Paul Krugman writes about the reactions of conservatives to the Medicaid expansion today in The New York Times:
So ignore all the talk about too much government spending and too much aid to moochers who don’t deserve it. As long as the spending ends up lining the right pockets, and the undeserving beneficiaries of public largess are politically connected corporations, conservatives with actual power seem to like Big Government just fine.
Krugman uses Florida’s Republican governor Rick Scott to demonstrate his point, but his conclusion correctly targets conservatives. And as Loyal Readers™ of this blog well know, conservatism, especially economic conservatism, is a bi-partisan phenomenon.
He also says this:
You might ask why, in that case, much of Obamacare will run through private insurers. The answer is, raw political power. Letting the medical-industrial complex continue to get away with a lot of overcharging was, in effect, a price President Obama had to pay to get health reform passed. And since the reward was that tens of millions more Americans would gain insurance, it was a price worth paying.
Jeezus. This is a slick snowjob worthy of Fox News, or MSNBC. Krugman spins Obama’s health care reform initiative as a noble, pragmatic compromise, when it was nothing of the sort: “letting the [for-profit] medical-industrial complex continue to get away with a lot of overcharging” is not reform, if the word has any meaning. Further, the unqualified statement that this was the “price President Obama had to pay” to get reform passed is an unevidenced assertion, and one that completely whitewashes the president’s actions and intent. The “reward” of tens of millions more Americans gaining insurance is certainly a reward all right, for insurance companies. And the assertion that this was “a price worth paying” is highly problematic: how exactly is that calculation determined? More importantly, who is paying that price? (Steven Brill can tell you about that.)
The framework of the Affordable Care Act was based on the conservative Heritage Foundation’s blueprint. It rests on the entrenchment of our for-profit healthcare system. An actual noble, pragmatic compromise would look much different than that. That kind of legislation would have contained a public option — essentially a Medicare buy-in opportunity — both as a means to drive competition and ultimately reduce costs in the private insurance market and as a meaningful step toward a single-payer system. But despite the president’s lies to the contrary, he had already made a secret deal with health industry “stakeholders” to shitcan the public option very early in the negotiation process, in July 2009. He never had any intention of pushing for it on behalf of all those other “stakeholders,” the U.S. public.
Perhaps I am reading too much into it, but I also find Krugman’s term “health reform” troubling, too. A few years ago, I wrote about the administration’s shift in verbiage from “health care reform” to “health insurance reform,” which occurred in October 2009. It was then that I learned that the fix was already in. But I won’t repeat all of that here. I continue to be astonished that liberals like Krugman seem incapable of grasping the inescapable conclusion that Obama never wanted a public option and does not support single-payer. Like all Republicans, he is a True Believer in an essentially private, for-profit health care system. The president stood squarely with Blanche Lincoln, Max Baucus and Joe Lieberman — whose wife is a health care industry lobbyist — while pretending that the overwhelmingly popular public option was a casualty of those Big Meanies in the Senate.
Krugman is right, of course, that one reason so much of the ACA runs through private insurance is “raw political power,” but the fact is that the president possessed no small amount of that himself. The other reason for the continuing private insurance gravy train is a political ideology shared by Republicans, the president and many in his party: economic conservatism. When applied to health care, its defining feature is profit before health. (Krugman understands this probably better than anybody.) This is why I cannot take seriously anyone pretending to care about the debt, the deficit or health care who is not an unwavering supporter of single payer. And it is why I will not abide ostensible liberals letting conservative Democrats off the hook.