Revenge of the Kludgeocrats
So. It’s been awhile, about 3 years now, so it’s understandable that some of us may have already forgotten our bitter disappointment when the Affordable Care Act morphed, before our eyes, from a brave new universal healthcare plan, that would finally bring the US in line with the rest of the industrialized world, to a neoliberal Frankenstein’s monster designed to lead New Deal liberals and Reagan conservatives to a great post-partisan Kumbaya moment.
As we know, ACA barely made it, thanks only to a Democratic super-majority, without a single Republican vote. And the result is a healthcare law that left liberals and conservatives both holding their noses over a law that hardly anyone approves of in its current form.
By the time, conservative-bait and liberal dreams were all present and accounted for, ACA had turned into a Rube Goldberg model of healthcare policy.
One of the interesting bits of ACA history is that it is based, in large part, on a 1989 Heritage Foundation blueprint of the conservative alternative to single-payer healthcare along the lines of Medicare.
At that time, Republicans were not fond, at all, of the 1986 Emergency Medical Treatment and Active Labor Act which requires any hospital participating in Medicare (i.e., most, if not all) to provide emergency care to anyone who needs it, underwritten in large part, by the federal government. Republicans hailed the Heritage Foundation plan, a market-based approach dependent on individual responsibility, much more to their liking.
In 1993, President Bill Clinton tried to stitch this all together into a healthcare reform bill that included an employer mandate to provide health insurance for all employees through a regulated exchange of HMOs. Republicans, at the time, proposed an alternative that included an individual mandate, rather than an employer mandate and means-tested subsidies to be used in state-based insurance exchanges—sound familiar?
Supporters of that earlier Republican reform plan included Orrin Hatch, Chuck Grassley, Bob Bennett and Kit Bond who subsequently fell out of love with it when President Obama proposed it. Whereupon they promptly pronounced their former brainchild unconstitutional and henceforth “dead to them.”
And, of course, we all know only too well the long, sad story of Romneycare which ended tragically when Daddy Warbucks disowned it.
Obamacare, as it turned out is, unfortunately, a cumbersome, clunky, unnecessarily hard to implement program specifically because of all the conservative policy goodies that had to be folded in if it were to succeed on a bipartisan level. Things like individual mandates, means-testing, variable subsidies, state-level exchanges made up of private insurers, (except where the states opt out) all of the needless, counterproductive minutiae that characterize conservative social policy efforts
Meanwhile, ACA succeeded on a strictly partisan level and now we are all stuck with the 19th century gears and gizmos that had to be included to woo conservative votes that never materialized. We could have had Medicare-for-all and, if we did, the 33 million uninsured would probably all be enrolled by now.
Which brings me to the most interesting part of all. Despite all of the gloating, finger-pointing and nay-saying that Republicans are currently indulging in over the glitchy roll-out of Obamacare, this is exactly the unwieldy, non-starting system that Republicans like Paul Ryan would like to transtion your Social Security and Medicare to. What fun!
This is the absolute zenith of hypocrisy, of course, but it’s exactly what the kludgeocrats of the GOP will be pushing whenever and wherever possible. Right now, as we speak, and as Paul Ryan sits down to his budget conference, what Republicans want is for all of the current social insurance programs to migrate to Obamacare-for-all.
And fat chance that their hyper-partisan base will see through the hypocrisy. I suspect that if Ted Cruz took a copy of the ACA, slapped a new cover on it and shopped it around as Cruzcare no Republican primary voter would catch on.
Republicans are determined to kludge up all of our time-tested, tried and true social insurance programs. Take Social Security: they want to replace it with a program of mandates and/or incentives to build retirement funds in 401(k)-type savings accounts and then use those funds to purchase retirement annuities. The poor would receive variably-adjusted, means-tested subsidies to do the same.
Likewise, Medicare would be bogged down with Obamacare-like mandates and coupons to buy their own elder-care health insurance and become much more complex and difficult to navigate for future seniors. Anyone who thinks that isn’t a big deal? see Medicare, Part D roll-out.
As Michael Lind of Salon recently wrote:
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 predict that it is only a matter of time before conservatives and Wall Street-backed “New Democrats” begin to argue that, with Obamacare in place, it makes no sense to have two separate healthcare systems for the middle class — Obamacare for working-age Americans, Medicare for retired Americans. They will suggest, in a great bipartisan chorus: Let’s get rid of Medicare, in favor of Lifelong Obamacare! Let’s require the elderly to keep purchasing private insurance until they die!
Already, though, Democrats and Progressives are taking their victories where they can and losing sight of how unnecessarily screwed-up Obamacare is because of its conservative-tickling features. Right now, Democrats should be making the point to constituents that the problems with implementing Obamacare are those very conservative features that had to be included to bring Republicans along. Future focus should be on using any political gains to reform the reform and try to make the ACA resemble something like the policy that liberals envisioned before bipartisanism took its toll.
So, here’s the deal . . . when Republicans inevitably start making noises about “updating” Social Security and Medicare along the lines of our beloved Obamacare, place fingers in ears and repeat after me “LALALALA!
And remember, Obamacare is not the policy that liberals and progressives dreamed of—it’s only slightly better than nothing. So be careful what you settle for . . . if you decide that Obamacare is anything greater than a small step in the right direction, you’re painting yourself into a corner where you might find yourself signing up for Lifelong Obamacare instead of the far, far superior Medicare that your parents and grandparents enjoy.