Krugman’s blog, 1/20/16

There was one post yesterday, “Lessons From Vermont:”

Sarah Kliff has a very helpful account of Vermont’s attempt to create a state-level single-payer health care system, and why it failed. It’s a bit like the old joke about the farmer, asked for directions, who says “Well, I wouldn’t start from here.”

The point is not that single-payer is a bad idea. It is that given where the U.S. is now, achieving the kind of low costs we see in other countries would involve imposing large losses on many stakeholders, including people with generous policies, health care providers, and more — which is the point I’ve been making. The gains would almost surely be bigger than the losses, but that’s not going to make the very hard politics go away.

And just assuming, as Bernie Sanders does, that you can achieve dramatic cost savings without considering how you’re going to deal with the stakeholders — and therefore lowballing the actual cost of the plan — isn’t helpful, and amounts to not really leveling with your supporters.

I’m getting a fair bit of criticism along the lines of “Hey, you try a bronze plan and see how you like it.” Not much, I’m sure — but it’s a whole lot better than no insurance at all, which was how things were for millions of people who now have some kind of coverage (often Medicaid, by the way, which is single-payer) just three years ago. Being realistic about political possibilities doesn’t make you a bad guy.

Remember, Social Security originally only covered half the work force, and more or less systematically avoided covering types of employment — agriculture, services — that employed African-Americans. So should we condemn FDR for his cynicism, or say that idealism with no possibility of results isn’t helpful?



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