Bobo, solo

David Effing Brooks has a question in “The Incredible Shrinking Obamacare:”  Considering how it’s turned out, what was all the fuss about?  His monstrous piece of crap will be followed by a few comments.  Here’s his repellent turd:

During the debate over Obamacare, both supporters and opponents assumed the giant law would transform the American health care system. The supporters argued that the system would help Americans purchase health insurance through carefully regulated state exchanges.President Obama envisioned a day when consumers could shop for health coverage “the same way you’d shop for a plane ticket on Kayak or a TV on Amazon.”

In 2010, the Congressional Budget Office estimated there would be 21 million Americans using the exchanges by now. Many supporters argued that the exchanges would eventually replace the current dominant employer-based system.

The promise of Obamacare was that it would foster competition and offer lower premiums while covering tens of millions of Americans without, as Obama often put it, adding a dime to the deficit.

Unfortunately, most of the exchanges are in serious trouble. As many critics pointed out at the time, the law is poorly designed to induce younger, healthier people to get into the system. The penalties attached to the individual mandate are too weak. The subsidies are too small. The premiums are too costly. The deductibles are too high. Many doctors aren’t participating in the networks.

Only about 12 million people are in exchanges. More important, the exchanges are attracting sicker, poorer people, who drain money, and are not attracting the healthier people who pour money in.

Many insurers are suffering catastrophic losses and pulling out. As James Capretta of the American Enterprise Institute has noted, Aetna has lost $430 million since January 2014 on insurance plans sold through Obamacare and is withdrawing from 11 of its 15 states. United Healthcare has lost $1.3 billion on the exchanges and will cut its participation to three states from 34.

That means less coverage; 24 million Americans still lack health insurance. That means less competition. Before too long, a third of the exchanges will have just one insurer in them. That also means higher premiums. Blue Cross Blue Shield has requested a 62 percent increase for next year in Tennessee and an average 65 percent increase in Arizona. Some experts put the national requested increase at 23 percent.

The exchanges are also producing less coverage. The insurers that are staying offer pared-down restrictive plans that look more like Medicaid.

Does this mean Obamacare is failing? No. The law has produced many positive outcomes across the health care world. More than 20 million more Americanshave coverage because of it, and the evidence suggests their health has improved.

But it does mean Obamacare is not what we thought it would be. It’s a much more modest add-on to the pre-existing system.Sarah Kliff put it well in Vox: “Obamacare’s insurance expansion is on the path to looking like other safety net programs we know, offering limited services to a predominantly low-income population.”

Kliff quotes former administration official Michael Adelberg: “The exchange population — 85 percent of which qualifies for financial assistance — looks a lot like the Medicaid population. And with it, we’re seeing the start of the Medicaid-ization of exchange plans: narrow networks with no frills.”

Again, this is not bad. But we’d have had a very different debate if we knew the law was going to be a discrete government effort to subsidize health care for more poor people. For one thing, Democrats would have probably paid a much smaller political price if their effort wasn’t billed as an extravagant government grab to take over the nation’s health care system. The administration imagined something transformational; it ended up with something significant but incremental.

There are also lessons for people who think about policy making. First designing technocratic systems that will actually work is really hard. Second, designing effective technocratic systems that can pass politically is really, really hard. Third, designing politically plausible technocratic systems in a country divided on fundamental philosophy is hardness on stilts.

Philosophically, Obamacare tried to split the difference between European-style government coercion (the individual mandates) with a traditionally American respect for competition and freedom of choice (the exchanges).

But lawmakers couldn’t stomach a law involving forceful coercion (punishing penalties to make the young take part) and they couldn’t stomach a more purely market-based system. They wound up with a nonfunctioning compromise.

From here on out the health care debate will return, but in polarized form. Democrats are already really pushing for the public option, a heavier state player. Republicans are pointing out that technocrats are bad at designing dynamic systems and the insurance markets should work more like traditional markets. The next president will have to deal with all this, especially if the exchanges go into a death spiral, even though the subject has been basically ignored in the campaign.

It will be hard to govern after a campaign about nothing.

Dear, sweet, baby Jesus on a pogo stick but he’s got a set of brass balls to be able to write crap like that.  Here for a first comment we have “James Landi,” from Salisbury, MD:

“Oh please David–there was no “philosophical disagreement” to the ACA, and you know it. Lest you forget, the Republican party’s united effort to humiliate the president, derisively name the ACA Obamacare and then take the country through a national object lesson on three scores of floor votes over the past six years to demonstrate their abhorrence for the president was certainly not a lesson in country above politics. And then there are all those brilliant Republican governors who are blocking every effort to establish insurance exchanges in their health care bereft states . SO, you conveniently leave out the fact the ACA was a conservative innovation, the prototype run successfully in Massachusetts, and had the Republican standard bearer taken pride and ownership of the ACA concept and run as a Republican moderate “technocrat” who could unite the Republicans and Democrats in an effort to fix the ACA, we’d likely be moving into the second term of a Romney presidency. But no, there was no “philosophical disagreement” and you know it– there was only “table pounding neyt, neyt, neyt” from the knuckleheaded nihilist “refuseniks” who have created the party of no and given rise to the monstrous spectre of Trump.”

And here’s “Alan R. Brock” from Richmond, VA:  “‘They wound up with a non-functioning compromise.’  This is true. It is also true that Republican reactionaries were absolutely determined to render the ACA non-functional while offering nothing of substance as an alternative and not engaging in good-faith debate about how to improve the dysfunctional, incredibly expensive U.S. health care morass.  Such is the mindset of the party that now offers Donald Trump as their representative.”

And “gemli” from Boston also had a few words for Bobo:

“In their every word and deed, Republicans, including David Brooks, demonstrated that they cared more about the health of insurance companies than they cared about the health of uninsured Americans.

In a long tradition of attacks on welfare, food stamps, Social Security and anything that might help the needy, the ACA faced a barrage of assaults from conservatives that was so intense that no effective law could have emerged unscathed. John Boehner nearly swallowed his tongue in purple-faced apoplectic rage when the law passed. And things went downhill from there.

Opposition to Obamacare became a litmus test for Republicans who were determined to deny the president any shred of success. In all the years of Republican stonewalling when Congress did virtually nothing, the House voted 60 times to repeal the ACA in an impotent symbolic display of noncooperation.

Obamacare was a response to an out-of-control free market system that allowed insurers to drop sick policy holders, refuse coverage for preexisting conditions and set unrealistically low lifetime benefits. It might have been hailed as a mirror of the RomneyCare system that was working in Massachusetts, but instead destruction of the ACA became a badge of what passes for Republican honor.

The ACA emerged bruised and battered after the attacks, and so did the millions of Americans that might have benefited from a nonpartisan to help the sick. It’s too late now to pretend otherwise.”

I wonder how Bobo can stand to look at himself in the mirror every morning.

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