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Paul Krugman's liberal conscience has been eaten by giant vampire squid

That's the kindest explanation I can think of.

Bloggeth the formerly-liberal perfesser a few days ago:

What this suggests is that the really important thing, for reformers, is to get the principle of universality established. Once that happens, there’s no going back.

Yeah, well, I guess it helps if you define universe.

So, we're not going to help out illegal aliens when they get sick, that's in all the bills. And Massachusetts, when the money began running out, decided not to help out legal immigrants either. Guess that whole Give me your tired, your poor, your huddled masses yearning to breathe free thing is just some sappy poem engraved on some tarnished plaque on some statue standing on some godforsaken island somewhere.

God alone knows why some people want to make the baby Jesus cry, and he/she/it/they ain't tellin.

But aside from that, people like their new health insurance law, right?

Like good used car salesperson everywhere, Krugman pooh-poohs the doomsayers and points out the bright sunshine:

Liberals have held up Massachusetts as a cautionary tale: pass a reform that isn’t really good, and the public will turn sour on the whole thing.

But what the poll actually finds is that public support for the plan is holding up pretty well, given the political environment. And what’s really telling is this finding:

The poll found that 79 percent of those surveyed wanted the law to continue, though a majority said there should be some changes, with cost reductions cited as the single most important change that needs to be made.

Only 11 percent of state residents favored repealing the law, similar to last year’s finding.

What Krugman doesn't mention is that in that same poll [2008] there's this question:

Given what you know about it, in general, do you support or oppose the Massachusetts Universal Health Insurance Law?

And what smart used car buyers everywhere know is check out the customer reviews:

How about that, support is at an all-time low and opposition is at an all-time high. Not to mention that the uninsured aren't super-keen on this law. Gee, I wonder why.

Support is also higher among those whose income more than 300% of FPL, though not by as great a difference as between the insured and uninsured, indicating that maybe those subsidies aren't generous enough.

But wait! In his column on Monday Krugman not only repeats the 79% support it claim, he adds this:

Like the bill that will probably emerge from Congress, the Massachusetts reform mainly relies on a combination of regulation and subsidies to chivy a mostly private system into providing near-universal coverage. It is, to be frank, a bit of a Rube Goldberg device — a complicated way of achieving something that could have been done much more simply with a Medicare-type program. Yet it has gone a long way toward achieving the goal of health insurance for all, although it’s not quite there: according to state estimates, only 2.6 percent of residents remain uninsured.

This expansion of coverage has tremendous significance in human terms. The Kaiser Commission on Medicaid and the Uninsured recently did a focus-group study of Massachusetts residents and reported that “Health reform enabled many of these individuals to take care of their medical needs, to start seeing a doctor, and in some cases to regain their health and control over their lives.” Even those who probably would have been insured without reform felt “peace of mind knowing they could obtain health coverage if they lost access to their employer-sponsored coverage.”

Yeah it's kludgy, but people were helped! Lives were saved! Yay!

And just who did that focus group study? Lake Research Partners, founded by Celinda Lake, she of uniquely American fame.

Credit where credit is due, the focus group report does go into some detail on both the good and the bad -- people with cancer, heart disease, diabetes get care without which they quite possibly could have died, but most of these people were low-to-moderate-income and in many cases they have been left with significant medical debt.

Now I can tell you from personal experience that even with job prospects doomed by a credit rating that lies on the floor of the Marianas Trench, constant harassment from collection agencies, and every last penny of my savings gone into the maws of the medical industrial complex, alive and in debt beats dead any day of the week.

Krugman, however, doesn't mention that last part, about the debt, when he talks about the tremendous significance in human terms. Others do, though, noting that medical debt and bankruptcy in Massachusetts has not abated.

Okay, we've covered the people who weren't born here [we're not going to] and the lower-income working folks [only if we can put them into debt peonage], what about the really poor?

They used to get care absolutely free, but now often have to pay copays. This would be bad enough, but the whole design behind this 'reform' effort was to shift taxpayer dollars away from directly caring for poor people and funnel them through insurance companies first:

Preservation of the Safety Net
The existing Uncompensated Care Pool, which reimburses providers for uncompensated care, will be converted into a new Health Safety Net Trust Fund that will combine these funds with other Medicaid funds, including Medicaid Disproportionate Share Hospital funds. A new fee schedule will be developed to standardize provider reimbursement. As more uninsured gain coverage and uncompensated care drops, funds will be shifted into the health insurance subsidy program.

Yeah, we're gonna preserve the safety net by killing it.

So, I see 5 or 6 universes here: foreigners [no care], poor people and non-creative-class folks [good care, but in a your money or your life kinda way], old people [less care], rich people, and the rest of us.

This isn't an inefficient Rube Goldberg apparatus for helping people that we can fix later as we go along, it's a fairly efficient machine for transferring yet more wealth from the have-nots to the have-a-lots that will accidentally help some people along the way.

Any liberal worth their salt would have called bullshit on this long ago, and would still be calling bullshit on it even today.

But hey, Basement Cat beckons!

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Submitted by hipparchia on

*i* almost quoted ceci connolly in this post. she was trumpeting the fact last week that obama was travelling to massachusetts on friday but couldn't be bothered to speak up about massachusetts' health care reform, even though that's basically what obamacare is modeled on. i was going to say something to the effect that obama doesn't have to when he can get a tame economist to do it for him, but ultimately i decided not to.

to be scrupulously fair to celinda lake, it was one of her partners who conducted this particular study. but yeah....

CMike's picture
Submitted by CMike on

Instead of making an argument that may be useful in the immediate term, maybe we should bite the bullet and start making an argument that defends the interests of working class people against those of the dollar worshiping (i.e. godless) plutocrats klepto-crats.

Submitted by lambert on

Nevertheless, that aliens might get it is one of the key arguments against what the wingers call ObamaCare, it does need to be stomped, and this point does that.

I agree, it's tactical.

Valhalla's picture
Submitted by Valhalla on

I'm not so good at meme building, but I was thinking the other day about the approach to Medicare for all in which first we'd lower the entry age to 55, then lower, etc. (and perhaps raise at the other end, too).

Does anyone remember the slogan that went with reducing speed limits? Wasn't it something like "55 Saves Lives"? That would have some resonance (with us bitter oldsters, anyway).

Of course, as a meme it suffers a bit since the Republican Congress repealed the law in the 90s (?). And it only covers one aspect of the Medicare for All debate. But it would be (I think) fairly popular among the early- to mid-boomers, who are in just about that age range now.

Just a thought.

Submitted by hipparchia on

that's the one i remember, although i think there might have been others.

i'm terrible at coming up with slogans, so have no idea how to translate it to expanding medicare.

Submitted by hipparchia on

all the more reason to work faster on building that wall!

you and i and a lot of other sane people know that providing free care to those who don't 'deserve' it is just plain good sense [as well as good morals] but i think this one is more likely to shift rightwingers from fearing scary brown people to fearing scary brown people bearing killer germs.

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Submitted by stavner on

If the MA plan has problems, then it's up to the people of Massachusetts to fix it.

I think Krugman said that if we can start on universal health care, we can expand it. If we tried to pass single-payer now, the insurance companies and their lackeys would be even more against it. This way, we could gradually expand the program.

Submitted by lambert on

And one problem with incrementalism is incrementalists; for whatever reason, a lot of incrementalists have no claim to intellectual honesty on policy, so when they say, as they must say, "Trust us, it's going to get better," there seems little reason for trust. That's why it's especially distressing to see Krugman relying on Lake, the very personification of sleazy fauxgressive insiderism.

Submitted by hipparchia on

If the MA plan has problems, then it's up to the people of Massachusetts to fix it.

the massachusetts model has been tried multiple times in several states over the past couple of decades and appears to be unfixable.

I think Krugman said that if we can start on universal health care, we can expand it.

yep, i agree that's what he's saying. i'm saying the model that he's selling us is neither universal nor expandable to universality.

If we tried to pass single-payer now, the insurance companies and their lackeys would be even more against it. This way, we could gradually expand the program.

this is the conventional wisdom, and it sure sounds plausible.

the problem i have with that interpretation is that if the democrats had wanted to gradually expand to single payer, they would have written a bill that would have gradually expanded medicare to everyone. period. end of sentence. end of paragraph. end of story. they chose not to do that, which suggests that what they really want is to solidly entrench the insurance industry as a linchpin in the healthcare industry for a good long time to come.

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Submitted by BDBlue on

I see, for example, the popularity among the uninsured has rebounded a bit (maybe it's the high unemployment rate, creating a different pool of uninsured?). That 60% still support it is actually pretty good. It's hard to get 60% support for anything (and we tout it in other contexts like single payer).

The biggest failures in Massachusetts, it seems to me, is that it hasn't done anything to help medical debt and bankruptcies and the related point about destroying the social safety net. And I wonder if these things even affect its popularity. It should, but I think many in this country are so used to the idea that, of course, seeking medical help means bankrupting you that it doesn't occur to them that it shouldn't or doesn't have to. Or maybe this is a long-term effect and we haven't seen the full effect on the popularity of the law yet.

The popularity polling itself certainly has some trendlines that could worsen, but right now, it's not that bad. It's what's going on underneath the polling - the continued bankruptcies and destroyed safety net - that's bad.

And, while I will wait to see the details of the new Senate bill, I think what is most likely to undermine the incrementalist argument there is that all of the unpopular things are likely to take effect immediately (e.g., mandates, taxes) and the public option, to the extent it's the nose under the tent, won't take place until 2013. So people are likely to be angry without even having a public option in place and still won't know anything about it or have any experience with it to demand it be expanded. And, of course, there's the issue of whether it's really going to be publicly run or another one of those inefficient public-private partnerships. Because the nose under the tent only works if it's something people want.

Submitted by hipparchia on

medicare is actually contracted out too. iirc this was a sop to the insurance industry for taking customers away from them. never mind that the whole reason for medicare was the fact that the insurance industry didn't want old people as customers in the first place, but they were smart enough to insert themselves into the process of insuring old people once all their risk was removed.

Submitted by hipparchia on

agreed.

but given only two options, debt or death, people are going to be reasonably supportive of the non-death option, even with a high price tag. i originally likened this to tossing a few scraps to starving feral dogs -- of course they're happy to get the scraps, but if you could poll them, they'd likely prefer full bellies every single day.

given that our politicians and pundits -- including conscience-ridden liberal krugman -- are all doing what they can to keep americans in the dark about other options, it's very possible there will continue to be 'favorable' 'support' for 'reform' efforts for some time to come. insured/uninsured is all americans have ever known for all practical purposes.

sure, krugman has mentioned single payer a few times in an even-handed and wonkish way, but he can be numbered among the ones who are not howling about it and should be.

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Submitted by Valhalla on

a focus group study is basic bullsh*t, and Krugman ought to damn well know better. I am hard-pressed to believe he doesn't.

Evidence of 'approval' of Romneycare is evidence of nothing much at all. It would not surprise me at all if there were similar numbers of people in Mass. who thought the health care insurance system was just fine prior to the new system. Most had health insurance through employers, and almost none had anything better to compare it to experientially. Conversely, had MA implemented single-payer (or even, forfend, a 'robust' public option-like system), I'd expect the popularity numbers to be similar or better, but no one polls on that.

Health care is a basic right. The whole thing about rights and social welfare is it has nothing to do with popularity. What if in the 50s and 60s we determined the fate of the Voting Rights cases wrt poll taxes and literacy tests based on polling? Esp. on polling the people for whom neither was any kind of barrier?

I'm no economist, much less a prize-winning one, but it seems to me one of the basic questions that need answering is whether a change to a system actually accomplished what it was supposed to do. (that is, putting aside any messy, unmeasurable considerations of whether a change is morally the right thing to do). But here's the real money quote from the study Krugman uses:

for participants without medical needs, a number of study participants with insurance through their employers were struggling to afford their health care coverage.

I'm so relieved to know that I'm completely covered by my employer-provided coverage as long as I don't need it. Whew.

But where are the numbers? Again putting aside the fact that rights and basic social welfare policy should hardly rest of focus groups (for cryin' out loud!), who cares about the coverage numbers? There must be numbers by now on increased hospital visits, increased numbers of medical procedures etc etc. That is, if people who were not getting care prior to the new law are now getting care in any numbers.

Submitted by lambert on

Krugman misses the basic, indeed undergraduate, understanding in Health 101:

Health insurance is not the same as health care.

I can't believe I missed this!

Submitted by hipparchia on

I am hard-pressed to believe he doesn't.

i'm with you 100% on that. my take is that he's cheerleading for the democratic party, whatever the costs to the rest of us.

Health care is a basic right. The whole thing about rights and social welfare is it has nothing to do with popularity. What if in the 50s and 60s we determined the fate of the Voting Rights cases wrt poll taxes and literacy tests based on polling? Esp. on polling the people for whom neither was any kind of barrier?

this, for me, is what liberalism is all about -- doing the right thing, even if polls say it's unpopular, and even if it really IS unpopular. there was once a time, in krugman's lifetime no less, when people who identified as liberals [or as christians, or as just plain americans] believed in protecting the weakest and the poorest among us from the strongest, or from the majority if that majority was bent on trampling others underfoot.

There must be numbers by now on increased hospital visits, increased numbers of medical procedures etc etc. That is, if people who were not getting care prior to the new law are now getting care in any numbers.

there are some numbers, scattered here and there throughout the blogosphere, but as far as i can tell, each interest group has gathered only the information that's pertinent to its mission. there are numbers from one source on increased usage of community clinics, gathered by people whose mission encompasses community clinics. there are numbers on increases ore reductions in uncompensated care in hospitals, gathered by people whose mission encompasses hospitals and free care. etc. i haven't yet found one place where it's all pulled together, but that could also be because i haven't looked diligently enough.

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Submitted by S Brennan on

This is a re-configured comment on the subject from Ian's blog:

If I ask a question that is implicitly: "is this better than that" then it pays to know what "this" is and "that" is.

In this case, "that" is the worst health system on earth measured through the economic paradigm of "bang for buck".

So when "this" beats out "that" it's not telling us whether "this" is good, it's saying, it's better than the worst the world has to offer. I offer up a mental analogue for consideration.

Most people would think rotting away in prison for the rest of your life is a pretty terrible fate...however...there is a group of men on death row where polls show that life imprisonment has well over 60% support "even after implementation". So you will always find a group who say shitty is better than shittiest...and that's what Krugman proved, nothing more. It's pretty sloppy thinking, but I don't have to knock out 750 words day in and day out.

Just because I generally agree with Krugman, doesn't mean I'm married to the guy, nor do I go in for the "Jim Jones" approach to living. Everybody has a bad day writing...although Krugmans writing has suffered since having direct contact with the current administration.. Corrupt leaders have that effect on people.

Submitted by hipparchia on

It's pretty sloppy thinking, but I don't have to knock out 750 words day in and day out.

heh. krugman really is a smart dude and has no excuse for sloppy thinking, and the nyt pays him [probably rather well] so he has no excuse for sloppy writing either.

i otoh left in a fair amount of sloppy writing in my post, but the first [and better-written] post was eaten by the cybersquid somewhere along the line.

as for your thought experiment, i get what you're saying, and what krugman is too, but there's a point where less bad is not good enough.

krugman was a pretty reliable truth-teller during the bush years, and while i sympathize with any liberal's desire to not shoot down a democratic president, it does mean we've lost an otherwise liberal voice who has an otherwise big megaphone that we sorely need.

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Submitted by gqmartinez on

"Bipartisanship" is now seen as more important than the ideas themselves. "Winning" a political "battle" is also seen as more important than the ideas themselves. As with the primary and general election, winning is more important than facts and justice. The rot from the primary is lingering and rotting liberalism.

Obama ran his campaign on "post-partisanship" which, to me is saying that we don't need good policy per se. If there is popular shitty policy that will do. The primary behavior of Dem leaders and A-listers, or C-minusers as I now refer to them (when it comes to good policy), was a tacit acceptance of style over substance.

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Submitted by BDBlue on

He's the symptom, not the cause. Liberalism has been on life support for a long time now. We haven't had a liberal president since LBJ. Bipartisanship has been fetishized for at least the last 20 years.

Obama simply represents the next step in the Democratic Party's long march rightward, just as the GOP has also moved rightward. The conservative movement has succeeded in moving the entire country - Democrat and Republican - to the right. Liberals have succeeded at very little beyond capitulating to the rightward movement or. at least, being unable to stop it.

Don't make Obama more important or special than he is. The big difference with him, IMO, is that he's center-right, whereas I would say Bill Clinton was center and Jimmy Carter was center-left. But the trend has been evident for some time.

BDBlue's picture
Submitted by BDBlue on

I knew someone would realize I had skipped out on writing that Zinn post. But I need time and RL keeps interfering. It is something I need and want to do and now is as good a time as any to get back to it. I think it will tie in nicely with the post I could never quite write.

And this brings me to a technical question, lambert. How come when I go to an individual Corrente blog to bring up a post to get the link, I get page not found if I click on the title? I can only get to the full post if I click on "read more".

Submitted by lambert on

because that's a bug I've got to get around to fixing.

gqmartinez's picture
Submitted by gqmartinez on

During the Bush years there was at least some liberal opposition. Now so many are invested in his political success that they are even further abandoning their leftishness (e.g. Meeks). Further, if you see young Obama supporters, who were trending liberal for years, they are repeating his libertarian/bipartisan BS.

I became increasingly liberal during the Clinton years, as did my cohort generally (18-30 these days)--look at the polls. I interact with this cohort daily and they are anti-GOP but less and less liberal.

For the record, Clinton's first year as president was rather liberal (assault weapons ban, higher top marginal rate taxes, trying to integrate the military). He was backstabbed and betrayed by his own party and Dems lost their majority. But at least he tried to be liberal.

BDBlue's picture
Submitted by BDBlue on

But Obama is President because the Democratic Party leadership picked him, so I view him not so much as individually important (although his cultural markers are what made him so appealing a salesman for neoliberalism) as much as a symptom of what is wrong with the party as a whole. Democrats in Congress could put a repeal of the awful telco immunity on his desk to sign, they could put a timeline on Iraq, they could hold torture investigations, they could pass a regulatory package for the banks, they could hold meaningful hearings and investigations on the banks, they could pass the bill to audit the Fed. There isn't a lack of push back against Obama because he's just so awesome, Democrats will follow him anywhere. It's more, IMO that Obama gives them cover that a lot of them - not all of them (see, e.g., Marcy Kaptur, Alan Grayson, etc.) - are only too happy to have. They use him as an excuse for doing what they wanted to do all along - sell out to the highest bidder.

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Submitted by stavner on

They might just do that. Until a couple of months ago, it looked like we wouldn't have a public option at all.

Submitted by lambert on

Remember when Obama tried to call co-ops a form of public option?

It's not getting the words "public option" in the bill at all. Even the argument that the public option would keep the insurance companies honest has faded away -- since a program with 9 or 10 million enrollees can't do that. Now the argument is that the great victory is establishing the principle of universality, but of course that was also surrendured long ago, when "progressives" allowed universal to be defined as, say, 95%. What a fucking farce.

Submitted by gmanedit on

still controlling the flow of funds? That's motivation to fall in line right there.

Update: Yep! http://washingtontimes.com/news/2009/oct... "High-dollar fundraisers have been promised access to senior White House officials in exchange for pledges to donate $30,400 personally or to bundle $300,000 in contributions ahead of the 2010 midterm elections, according to internal Democratic National Committee documents obtained by The Washington Times."

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Submitted by deniseb on

so disappointed in the primaries is that we thought public opinion was moving leftward this year. I thought we could finally have a candidate that would come right out and sell liberalism, instead of running away from it. We'll never know now, but the support for health care reform indicates to me that the country was ready to admit that Republicanism has been a disaster. It might not have been necessary at all to stay in the tepid center.

Submitted by lambert on

But we'll never know.

Leadership would have helped. And "progressives" nailing the Overton Window firmly in place more or less where it was before didn't help either.

Submitted by hipparchia on

ouch. fits them reasonably well, though, it looks like. i sympathize with their overwhelming desire to win the next several electoral and legislative battles, whatever they may be, but supporting bad policy simply because the republicans are refusing to support it is ultimately stupid.

i think i agree mostly with bdblue. lbj was the last liberal president. i think hillary would have been approximately another jimmy carter.

the democratic party most definitely installed obama as their candidate, by hook or by crook. the thing i haven't figured out though is whether the people [in the party leadership] most responsible thought they were getting a more liberal president than they got, or did they really mean to keep moving to the right and truly wanted the conservative they got? i lean toward believing the latter but politicians and power players have shown themselves to be susceptible to slick marketing and pretty words before, so it could just be that they were taken in too. either way, they haven't done much to take care of the people who need for govt to work for them, and the bloggers with the biggest megaphones haven't helped much.

Submitted by gmanedit on

They told "the people who need for govt to work for them" to go away: too old, too female, too blue-collar, too hillbilly—too needy, not "creative" enough.

Submitted by jawbone on

Party. That national week or month of de-registration for any of us still registered as Dems should come close enough to the crap public option-ed health care system they're going to foist on us, their AHIP bailout we'll have to pay for not only in premiums but taxes to subsidize those premiums, that the Dems realize how people are reacting.

BTW, finally have heard some brief, but not really clear, mention by MCMers (including NPRers) that people will be paying forward on the tax part of the health care deform a couple years before anyone will get any benefit. It's going to be like the Big Banksters finding new ways to charge higher fees and interest, whatever they can, to make as much profit as they can before even a slight reduction in their ability to screw the public.

And folks will be mandated to BOHICA to the BHIP (Big Health Industry Players).

Being out in the cold with no computer, it's hard to know what's really going on, but it does seem we have been well a truly fucked over by the Dems. Damn.

Oh, and some MCMer on public radio actually mentioned that the plans Senate has come up with will essentially be a hit on the middle class, that the study released by AHIP about premiums going up from the Senate plan actually has a basis in the reality of the MA plan--again, no depth of explanation to the comment.

And never, ever does anyone mention single payer. The closest is to say the Dems won't have a strong public option based on Medicare.

Helllllp!

Submitted by lambert on

What will be interesting is if the Kucinich amendment is allowed to come to the floor.