Two immediate things are needed in our health system. Medicaid patients need to pay at least portion of healthcare costs. Abuse is rampant in Medicaid.
Secondly, we need to allow a lot more doctors to practice. AMA vehemently protects high wages for doctors by limiting how many doctors get residency. More doctors means cash for all regular visits and Insurance for higher costs. No need for massive bureaucracy where doctors send a $2000 bill to Insurance, Insurance pay $160 and everyone goes home as if nothing happened.
More doctors and stopping Medicaid abuse will go along way.
3
krugman claims that "Approval of the A.C.A., while still not overwhelming, has shown a more or less steady upward trend."
Take a look at the graph from the link Krugman uses to support his claim, and then tell me if that looks anything like a "more or less steady upward trend."
https://www.kff.org/interactive/kaiser-health-tracking-poll-the-publics-...
ACA had a 46% favorability in 2011 and now has 49%. That's about the only way you can claim that the public likes ACA. It's a little better than what we had before, but you still have to deal with one of the most despised sectors of corporate America: the health insurance industry and its high out-of-pocket costs in a declining economy.
https://www.ineteconomics.org/perspectives/blog/america-is-regressing-in...
2
Lots of small business owners feel and think and act like Raymond Zinbran (top reader pick). My business partners and I are among them.
Whenever I hear or read something about the present Republican party supporting small business and vice versa, I wonder where people get that idea. To me, this is just another bit of Republican false propaganda.
As a small business owner, I'm strongly in favor of single-payer healthcare, both for moral and for financial reasons.
I'm tired of the complicated and bloated bureaucracy of our present healthcare system (let alone how poorly it functions, leaving us 13th in longevity among the world's nations).
In our business, we need at least one staff person to deal with our healthcare issues; we need insurance agents to help us work our way through the many complex choices and regulations that are out there. (Yes, we know that the agent could have conflicting interests to ours, but that's they system, isn't it?) All of us at work struggle through the complexities of making claims, finding medications and procedures that fit the rules of our health insurance companies, and on and on.
Healthcare for profit produces profit, not health. And it also produces a bloated bureaucracy. Small business owners aren't healthcare experts. Why are we involved at all in choosing health insurance for anybody else? Why is health insurance tied to one's job at all?
3
Trump and the GOP thinks Americans should be worried about MS-13 killing us?
The greatest threat to American lives is the GOP vicariously "murdering" millions of Americans by taking away access to affordable health care. Like they really care.
Which begs the question, "who are the 'animals' that walk amongst us?"
5
We pay for SS every paycheck
We pay for Medicare every paycheck.
That's called Capitalism.
Unfortunately we have to pay 10 times more for insurance we don't want under Obamacare. That's almost communism
1
Every civilized country has a national health plan of some sort that everyone pays for.
It's called "society."
Single payer would be far better than the ACA.
Claiming that you don't want health insurance implies that you expect other people to pay for your healthcare.
3
One of the reasons, maybe the primary reason, that the approval of ACA is not overwhelming yet is Fox News. I was staying recently in a hotel where at the breakfast room Fox News was on and they continued to say that "Obama Care" is dead, your rates are going to go sky high, and "it actually is killing people". Given that most Republican voters, as well as the nitwit President get their putative news from Fox, it's not surprising that there isn't a higher percentage of Americans that finally get it.
4
I’m a liberal who thinks the U.S. should have single-payer health insurance and get for-profit companies out of the health insurance business, except for optional plans to cover tummy tucks or whatever. But in the spirit of trying to understand the other side, I wish this piece had explained why Republicans should want to deprive anyone of health coverage. Are they just mean? Is there some other reason? Why hurt the people you are supposed to be serving, many of whom actually voted for you?
1
The GOP never explains any of their positions.
They just make excuses for them.
1
I have never - and will never - called it "Obamacare" simply because of the racial animus directed at it as well as the Republican hatred of anything that helps the little people and not just their corporate and plutocratic masters.
It's the Affordable Care Act - ACA for short. If you care about controls on for-profit insurance companies and helping people obtain reasonable health insurance, stop calling it anything but the ACA.
4
I respectfully disagree with Mr. Krugman's prediction that the Republicans will be able to repeal Obamacare if they retain control of the House after the Nov. election. They couldn't pass repeal when they had a handy majority last summer, so why will they be able to do so after an election in which they CERTAINLY will have a far smaller majority if not a total loss of control?
2
Just after the 16 election, a series of focus groups were held in PA, WI and MI of Trump voters on Medicaid or had ACA coverage. What those with ACA coverage didn't like about it were the high deductibles and narrow networks. They pointed to those on Medicaid with low to no copay's and broader network access and said we would like something as good as that, please. So the problem with Obamacare was that it wasn't enough. Trump/ACA voters were looking for more coverage not less or back to nothing at all.
3
Of course.
That's why as a candidate, Trump campaigned on replacing Obamacare with something "better", and when asked what that would me, said that it would cover even more Americans, at even lower costs.
Unfortunately, as soon as he entered the White House, he flip-flopped 100% and started to fully support Ryancare and its different version, which destroys the healthcare of a whopping 30 million Americans (= 10 million MORE than what just going back to the pre-Obamacare system would have done) all while increasing costs.
Thanks to the Democrats, that never got through Congress.
So then Trump signed the tax reform bill into law, which already destroys the healthcare of 13 million Americans all while being responsible for an additional 30% increase in premiums.
And the exact same thing goes when it comes to taxes: as a candidate he said that he believed that the wealthiest could pay a little more taxes, something a majority of GOP voters agrees with.
As president, he signed a gigantic tax cutting bill for the wealthiest into law.
GOP voters also want a lower deficit, and Trump promised to do exactly that. Instead, he passed a bill that increases it by $1.5 billion, and then a budget that puts another trillion on top of that...
8
Mr. Krugman is unaware that part of passing the ACA is that for Social Security recipients, Our premiums went up, our deductible went up. Our co-pay went from ten percent to twenty percent.
Today, Ordinary working class people can not afford to pay for ACA insurance premiums, which if they do purchase ACA Insurance, still have Deductibles so large it is like all we have done is given a cut to insurance companies for doing paperwork.
And many people have been limited to McJobs of less than thirty hours, no health insurance available.
I support the idea of keeping those who work, able to work by providing Pro Active health care, but it looks more like what we need to do is negotiate prices, set pricing structures. Exclude Private Insurance companies who are only taking their slice, and providing little.
3
America needs to come to its senses about how to handle the two things all civilized Western countries have already made a part of their cultures: health care and guns.
8
The first stab to the heart of the A.C.A. was a clause slipped into the Budget Reconciliation Act of 2014 limiting funding of the Risk Corridor program to the internal mechanism of the program itself and excluding any funding from general revenue. The original purpose of the Risk corridor program was to protect small start up insurers from financial ruin by bailing out insurers that fell short of profitability in establishing premium rates in the untested market of the A.C.A. The internal funding was to be accomplished by collecting excess revenues from overly profitable companies and shifting it to companies suffering losses. Needless to say the excess profits fell far short of the excess losses and only about 14% of the losses could be reimbursed to companies suffering a shortfall. This meant that most of those small not for profit and co-op insurers were forced out of business leaving only the large established insurers like United Healthcare, Aetna, Cigna, Humana, Anthem etc. in the marketplace. These companies if they suffered losses could wait for eventual loss reimbursement while the start ups that weren't so well funded and needed reimbursement immediately fell by the wayside. Subsequently most of the "big boys" have bailed out of the individual and family marketplace and remain only in the more lucrative group market. The biggest loser is the individual consumer left with higher premiums and fewer choices.
3
Excellent comment. The original ACA envisioned a number of small, community-based insurers springing up to provide competition to the big insurers. Here In Maine, we have such a program called Community Health Programs, which has actually survived and competes with Anthem and Harvard-Pilgrim. Needless to say, a lot of these community insurers did not survive, for the reasons you cite. It takes a long time to build up the necessary financial reserves to survive in the volatile health market.
2
And another thing: If the GOP holds the House, they will be eliminating or trying to eliminate Social Security and Medicare. The silver lining in that very dark cloud is that many Republican voters will finally wake up to the con.
2
One of the many fallacious critiques leveled at the law is that it will be a “job killer” .. frequently stated even before the law was passed in March 2010. House Speaker John Boehner used the phrase “job-killing” an average of once every 2 minutes in a 14-minute press conference. Of course, once again, the data says otherwise (see BLS series CES0500000001).
Since passage, total private sector employment increased by 15,505,000 employees, one of the largest increases on a total and/or per month basis in the post-war period … larger than under every GOP tenure except Reagan. So much for “job-killing” …
3
Social Security and Medicare no longer seem untouchable. Paul Ryan and the GOP intend to "reform" those programs this year to help pay for tax cuts for the wealthy. I will vote DEM at all levels to try and prevent this from happening.
The late Fred Koch, industrialist and founder of the John Birch Society, had bitter hatred for any government program. Fred's billionaire sons, Charles and David Koch, aka the Koch Brothers, carry on Fred intent to stop and/or destroy all such programs.
I expect the Koch-funded "Freedom Caucus" in the House of Reps to chip away at these programs, a tiny bite at a time. A piecemeal approach will inure the public to the damage being done over the long term.
Anyone paying into these programs and who votes GOP is voting squarely against their own best interests. Retirees who've paid into SS and Medicare all their working lives are truly voting against themselves if they vote GOP this fall.
The execrable Larry Kudlow will support this as well as more insane tax cuts next year; it's the only thing he knows how to do.
8
Obamacare will be safe if the Democrats can seize the support of these young millennials, like the president is with the grummpy middle aged white voters.
Can they do it ? given the unpredictable and fluid voting record of the Millennials ? and would they be willing to pay the premium of the insurance consistently, even if the Democrats win the House ?
2
If the MAGA-heads can open their eyes long enough to understand that if Republicans retain Congress, their health care will be severely impacted, that would be a very good thing. It might even make them look at the D on their ballot in November.
However, these Trump supporters have apparently turned into zombies. They believe every one of Trump's lies and chant any slogan they hear on Fox News like automatons.
The Democrats in Virginia are a model for the Democrats everywhere in this election year. The dangers to health care are serious and palpable. Somehow they have to penetrate the MAGA-head skulls to make it clear that they are in danger if they keep THESE Republicans in power--the current GOP Congress who has now lost its spine, and has rolled over for Trump, the oligarchs and the alt-Right.
The MAGA-heads can vote Republican in the future if they like, but they have to be persuaded to clean house in 2018 and 2020. We might even get responsible Republicans back in office again.
4
For the life of me I cannot understand why anyone who isn't wealthy would vote for a Republican. They gleefully take bread out of the mouths of those less well off and give it to the wealthy. They turn deaf ears to the need for gun regulation no matter how many have died from massacres. They have tried to destroy the ACA from its inception, spouting the same old mantra of it costing too much, and then cut taxes for the wealthy to add to the deficit, so there will be less money to pay for it and for the social safety nets. The only thing Republicans will spend money on is war, and that is because it is a money maker for their corporate sponsors. Vote as if your life depended on it in 2018, because it will may.
8
My premiums and deductibles tripled. I could actually be out-of-pocket $25,000 before my insurance company pays me a dime. And this happened before Trump was president. Oh, and my whopping income? $125,000.
And this was predicted when the ACA went into effect. But you have such an intense partisan bias, you refuse to discuss this issue.
1
Erik, I would be interested to hear what the backstory is on your health care premiums/deductibles. You “could “ be out $25,000 before your insurance plan pays a dime? Either you really, really chose a bad plan, or there’s more to this than you are telling us. Please help me to understand.
When exactly did they triple?
As to "intense partisan bias": all studies analyzing what happened objectively, have shown that OVERALL, Obamacare curbed cost increases, compared to the previous system.
"Overall" means that for many people, it didn't, but for the majority it did.
I was self employed in New York City when The ACA came in and my premiums went from over $20,000 a year to about $9,500 a year in one fell swoop. They did rise after that, but never achieved their former levels. For some reason, one rarely hears stories like mine.
I am now on Medicare which should be universal.
Why in the world should your health coverage have anything whatsoever to do with who you work for?
2
Nice Op-Ed Mr. Krugman. Thanks.
As I ask you every time, we need to formulate a working policy/platform/system/plan, to set into place as soon as Liberals re-take the reins. We need to have it figured out before we enter the combat zone. Dotted I's and crossed T's.
We all understand that the ACA is not the end in itself. Whether we call it Single-Payer, Universal Health Care, Medicare 4 All, what have you. Debate it, hash it and make the needed negotiations NOW! That is the future. It has to be. Cost wise and outcomes it just is the only way.
So...as I always ask you Mr. Krugman, The Democratic Party et al, what are the answers?! What are our best minds doing to make America a better place for all?! Not just the 1%. Not just the donors and lobbyists. Not just the connected and lucky. EVERYONE~!
It is possible. It is happening in every other civil society. HELP US!
I look forward to your up coming pieces on how and what will work. Thanks for you smarts and intellect.
4
I'm an expat since 2001. The major difference culturally for those of us in other countries that have a strong social safety net and universal healthcare vs. the USA is that a significant percentage of Americans don't adhere to the moral and financial imperatives of a social democracy...the "I got mine, tough luck for you" meme. This will never change int the USA. It was a major factor for my emigration.
10
If the Republicans launch another attack on the ACA this summer, it would be analogous to the Charge of the Light Brigade by British troops in 1854 (https://en.wikipedia.org/wiki/Charge_of_the_Light_Brigade). It won't end up very well for them.
3
The greatest effect that real healthcare reform would have would be to stop its use as a tool for underhanded control of employees.
Nobody reading this doesn't know of someone who keeps a desperate grip on an absolutely awful work situation "for the benefits".
It's much easier to make it a clickbait issue of race, or entitlement, or "giving those people handouts" than it is to face up to the de facto servitude that our health care system creates for the benefit of corporate America, and the destructive costs it inflicts on everyone through an obfuscatory and opaque "health care" economic system.
It's a pity that nobody talks about this - an economist, perhaps.
6
FYI: Democrats talked a LOT about this in 2007.
That's why they passed Obamacare, which allows any employee who wants to quit his job and go working for a new company, all while keeping his insurance.
And that, of course, is good for the economy too, as it allows the best companies to hire the best talents.
3
I have observed that the people who like Obamacare are overwhelming not on an Exchange plan. Yes, there are anecdotes of lives saved but the brutal reality is that it is an economic disaster. People like Krugman constantly conflate health care with health insurance. Yes, everyone wants universal health care but not everyone wants Obamacare for their health insurance
1
ALL studies analyzing Obamacare have shown that:
1. it saves an additional 40,000 American lives a year.
2. it seriously curbs cost increases.
3. it creates jobs, rather than being an "economic disaster".
Apart from that, polls also show that NOT "everyone wants universal healthcare", only a majority of the American people want this, and as many of them stayed home during the last election, now it's the minority that governs - minority that strongly rejects the notion of universal HC.
Polls also show that a clear majority wants to KEEP the advantages that Obamacare installed, and wants us to go further than that.
That means that you and I now have to fight hard in order to study HOW to obtain the next step towards universal HC, and that starts by informing ourselves, rather than believing the myths you're repeating here ...
10
As a self-employed and small employer, I have enjoyed some of the benefits of being on an exchange plan. Notably, the requirements of those plans not to exclude pre-existing conditions and allowing coverage of offspring til 26.
That said, All health insurance is an actuarial rip-off. That is literally what the business model is, ACA or not. I am a strong advocate of single payer. It is NOT free. I and the next 98 out of 100 people get that. But is is necessarily less expensive than the colossal waste of administrative time and valueless profit wasted in private health insurance expenses.
I have paid for premium health insurance all my life. Yet I was denied coverage because of a"pre-existing condition" years ago when I had a serious event requiring a trip to the emergency room and an overnight stay. Turns out my unrelated condition should not have been considered pre-existing. After I worked for years to pay off the 50k I was billed. I'm out to eliminate the scam of private health insurance.
The ACA is a government welfare program for the health insurance industry. That is it's essence. I hate that. But the good thing it did was create rules preventing the most egregious abuses of citizens by the industry. Those rules are what Trump is trying to eliminate.
The ACA should be repealed and replaced with medicare for all funded by highly progressive payroll taxes for employers and employees. Basically like it is now but reflecting all current healthcare costs.
5
"Ralph Northam won the governorship by a landslide after a campaign largely focused on health care." And Virginia is likely to expand Medicaid with 400K getting healthcare with it. Idaho & Utah also may expand Medicaid. Hopefully universal healthcare as in other rich countries will be a reality. And Medicare/Medicaid for All could happen in not too distant future.
A huge stumbling block to this sort of progress is the tax-cutting drive, which is so pervasive. Unfortunately, the public seems to believe that cutting taxes is a relief to them. When progressive taxes are cut the rich benefit & the poor lose.
We pay taxes for public services and other necessary spending like for defense, so to speak. A NATURAL consequence of cutting taxes is cutting public services, which are indispensable.
During the past 35 years incomes of the rich have been getting evermore higher while the middle class-income stagnated & the size of the middle class shrank. Inch-by-inch the safety-net programs have been shrinking. This trend must be reversed.
If not us, our children or grandchildren, down the line will go from affluent to destitute. Then they will need safety-net programs to SURVIVE. As a well-functioning police, military & fire fighting service, safety-net programs are necessary. We pay taxes to maintain all these things.
The rich have been paying shrinking share of their rising incomes in taxes. Top 1% got over 80% of the benefits from recent tax-law. They ought to pay a bit more.
7
Someone paying 15% on a $1,000,000 income still pays an obscene 17 times as much in taxes as someone paying 28% on the liberals $15 minimum minimum wage ($150,000 vs $8,736).
From...Sit, The idea that everyone as a rule gets paid according to what they are worth is to me an indefensible argument.
For example a McDonald's cook with no benefits gets paid around $10 an hour. Whereas a unionized auto assembly-line worker with benefits & job security with comparable skill and knowledge/education as well as effort is paid close to 4 times more. The autoworker happened to be luckier than the cook.
The top 25 hedge-fund managers made an average of $550 million/year between 2009 & 2016, for their socially not that useful job while teachers, nurses & firefighters are paid (only) around $65,000.
Do you think those hedge-fund managers deserve what they made? Don't you think the hedge-fund managers ought to pay at a higher rate in taxes for their easy money?
The top 0.01% incomes paid about 60% in federal income taxes in late 1940s, which dropped all the way down to just 22% by 2005, thanks to the Bush tax-cuts of 2003 when capital gain tax fell to 15%! Inequality rose back to 1929 level by 2007.
Most of us don't have an accurate understanding of how income taxes are structured. We feel if federal income taxes are cut we ALL pay less. Only the rich pay less. Close to half doesn't pay any federal income tax, but they pay payroll tax on what they make. Instead of cutting federal income taxes, payroll tax should be cut to 1% on first $10K & to 2% on second $10K. Lift the cap but cut again to $1% beyond $150-200K to be tolerable to the rich.
From Where I Sit,
That sounds like you are advocating that the rich are justified in paying a lower rate.
All I can say, probably hopelessly, is that a 28% tax on a low-income person exerts a significant negative effect on that person's quality of life, whereas a 50% tax on a millionaire hardly exerts a shrug.
Good column, professor. Putting the Republicans' actions in historical perspective is most welcome.
As long as the world changes, there will always be resistance to change and a reason for the existence of the Republican party, or whatever reactionaries are called in the future.
Their Republicans’ fat cat donors, because they have it so good, want not one iota of change, out of fear the slightest disturbance might upset their mountainous apple carts.
But the lower orders also fear change. Looking at our situation historically, the majority of Americans have it pretty good. Even people who live in trailers often have cars, air conditioning and big screen TVs, which makes them ripe targets for scare campaigns that “those people” will take it away from them.
Wait until you hear the Republicans’ screams when we try to institute Medicare for all. History tells us we should get used to irrational backlashes and deal with them rationally, with the certainty that agents of change will always, even if it takes time and a lot of sweat, prevail.
7
Okay, even a lot of people who opposed Obamacare and many Republicans are coming to see the benefits and won't want to go back. Our concern, however, should be that the success and vitality of the program could prevent something better from being created.
The Affordable Care Act based on a massive compromise before it got out of the gate. It was an attempt to keep the insurance companies from throwing their full weight behind stopping it. That worked, unlike when Mrs. Clinton tried to overturn the health care system when her husband was president: the insurance giants would tolerate none of what she was brewing and it was defeated even before being revealed and helped to put the Democrats into minority status in Congress. The same thing then happened to Obama, limiting his options for his last six years in the White House, a long time.
We need something better than Obamacare, something that addresses the full cost of billions of wasted dollars. The costs must be addressed and somehow controlled. We spend twice as much per capita as other highly developed nations and get almost nothing for that extra money. Not good.
More likely than not, it will be another 20 years, perhaps a full generation from now, before the issue will be addressed comprehensively. So, the success of Obama's plan means great things for a lot of individuals, but more trouble for the nation ahead.
3
Lets hope that Republicans fail to hold the house and or they fail to repeal the ACA. If the democratic party loudly was more than anti-Trump but had a specified economic platform like Medicare for All, progressive, they might win in a landslide.
3
I appreciate this very much, Paul....and would broaden the scope to suggest that there's a plot against human resources in this country--a remarkable, self-destructive urge to grind down and subvert the only thing that made us a creative society: The people.
NO manager of ANY company (other than a sole proprietor) would question the importance of the HR resource in his/her organization. Recruiting, training, compensating, and assuring the loyalty and reliability of staff really has to be Job One in any successful business. The fact that the United States of America is, by policy intended and by means enacted, undermining its own and only source of productivity and continuity, is simply flabbergasting and beyond belief.
Is anyone out there listening? Are we here all alone? What is wrong with this supposedly modern, enlightened world?
4
People seem to want to keep and improve upon Obamacare and many support a Medicare buy in for people 55-64, and/or a public option for anyone. I am pleasantly surprised at how fast the country is evolving on this issue, and cautiously optimistic.
8
"Approval of the A.C.A., while still not overwhelming, has shown a more or less steady upward trend."
Take a look at the graph found on the link Krugman provides and tell me if that looks anything like "a more or less steady upward trend"?
ACA favorability is only a few points above where it was in 2011, with a big dip in the middle when people realized it's basically what we had before but with a few patient protections added.
The recent slight uptick in favorability is due to people recognizing that the Repubbies are trying to take it away and, hey, it's better than nothing.
For those able to look at ACA rationally, it was a huge disappointment. Contrary to Krugman's assertion, majorities of the public has supported single payer for decades despite a constant stream of disinformation about it from corporate-media types like Krugman.
The fact that Obama was too timid in the face of insurance industry opposition to the public plan tells you who centrist Democrats are out to please. I will include the following link because many NY Times readers try to re-write history, claiming that the Republicans sunk the public plan. No. Obama caved.
https://www.huffingtonpost.com/miles-mogulescu/the-real-reason-obamas-pl...
2
That's absurd.
1. Obamacare is insuring 20 MILLION more Americans than what we had before, and saving an additional 40,000 lives a year, all while, overall, curbing cost increases.
It also makes it impossible for insurers to reject people with pre-existing conditions (= those who need insurance most), strongly improves the quality of insurance plans, eliminates all caps on reimbursements, allows people to switch jobs all while keeping their insurance, and allows young adults to stay on their parents' plan until they're 26.
If you want to discard all this as being almost the same as what we had before, you're merely being cynical.
2. Obama is the ONLY president in decades to have been able to make a substantial difference, when it comes to HC, so to call him "timid" on this issue means ignoring reality.
And the ONLY reason why there's no public option in the final bill is because after Pelosi passed a bill in the House that contained a public option, in the Senate an Independent and GOP leaning lawmaker (Lieberman) withdrew his support for the public option at the very last minute, and his vote was crucial to break the GOP filibuster.
3. If you do some fact-checking, you'll see that it's precisely during Obama's two terms (and THANKS to his constant campaigning on this issue, all over the country) that we finally managed to get a majority support a public option and single payer.
4. The ACA allows ANY state to install single payer TODAY.
No more excuses. Time to act.
8
Dr. Krugman:
You say: "Don’t we keep hearing that Democrats are running on nothing except opposition to Trump? Hey, influential commentators say it, so it must be true."
But here's the thing: Democrats are running on a defense of the ACA, but the the ACA was merely the best that Obama thought he could squeeze through and it was, in many ways, a gift to the Pharmaceutical and Health Care Industry.
The people have moved beyond that. They now want a single payer system. So, while a few individual Democratic candidates have used health care as an issue, the Party is still well behind the people on this issue -- and they are still emphasizing the trouble with Trump, not a progressive agenda.
Way back when Sanders was running, you had a column on "How Change Happens," in which you said it happened incrementally, as the result of hard work by serious people, not "happy dreams."
I think you're avoiding the real problem with the Democratic Party because it reveals that you are wrong -- that change happens not when apparatchiks from the two parties sit down to slice up the national turkey, but when a leader inspires people to make real, substantive change.
Ghandi said, "There go my people; I must hurry and get in front of them if I am to lead."
The Democrats and you, Dr. Krugman, could take a lesson from him.
7
You too, apparently. Because Ghandi was an outstanding community organizer.
That means working hard to get enough people to support your view in order to have the physical power to get what you want.
Today, a small majority of the American people indeed wants single payer, but gerrymandering and the fact that many progressives still refuse to vote gives the minority the legal power to govern, on ALL levels of government.
In that case, and whether we like it or not, the only way to obtain a Dem majority in Congress strong enough to block the constant GOP attempts to destroy the healthcare of 30 million Americans and increase premiums even more, is INCREMENTAL change.
Hillary ran on increasing HC subsidies and adding a public option. Considering the state of the union today, that was a VERY audacious proposal.
The next fight is to get this signed into law. And then we'll talk about single payer - and I'm saying this as someone who supports single payer for years already (and who knows that Obamacare already allows ANY state to install single payer TODAY ...!).
The only way to obtain real, radical, democratic, lasting change, as Saul Alinsky already explained, is to have the patience and endurance and then to fight hard for step by step change.
Not understanding this means remaining politically "illiterate", as Alinsky called it, and concretely not achieving anything at all, quite on the contrary.
5
Hmmm. When presented with concrete evidence that the people did a revolutionary change on health care you argue for more incrementalism. Curious.
Democrats lost because nearly 45% of the people stayed home, and they stayed home because we ran candidates who represented the status quo -- including Hillary. What you call an audacious proposal was arrived at not out of conviction about what's right, but rather after a political calculation that she needed to move left. It was hardly audacious; in fact, it wasn't enough.
If you meet a Republican, it's clear he/she doesn't care if you live or die.
At least since 1981.
9
Yup, and that's why I'm voting republican down the line
2
Why, more precisely?
As an ER doctor I never have to worry about treating people properly and promptly. The people, on the other hand definitely need help in paying the enormous bills and the follow-up care and for prescriptions. The ACA doesn't end that problem, it doesn't even address it. It simply tosses the problem onto the taxpayer or the fortunate individual who can afford the insurance premiums. Although it included many more people under its umbrella, it was never designed to control costs, and to provide healthcare, just insurance.
As we all know, businesses in other first world countries do not involve themselves in healthcare; it has long been decided that this is not a business issue, it is an affordable right for all citizens and the government sets the rules. Until that goal is met in this country, we will be more of a third world state.
14
I have come to the conclusion that these Republicans must own a lot of stock in private healthcare companies. Why else would they be against the ACA.
8
The GOP was unable to repeal Obamacare with their current majority. If they do hold the House, their majority will certainly be smaller, so how would they then be able to repeal? That doesn't make sense.
1
Not clear on why Republicans will succeed in repealing the ACA if they maintain control of the House. Previous attempts have failed with larger majorities than will have after the midterms. What will be the difference?
The GOP will, sigh, successfully point to rising insurance prices as "evidence" that ACA doesn't work. Too many people will get suckered in by the rhetoric - not understanding that this has happened because of GOP sabotage. Sad.
The fundamental problem is nuanced arguments and logic are simply lost in the noise.
2
Under GOP rule, don't get sick, old or poor. Then you will be out of luck, help and sympathy.
7
I say, welcome to a universal health care system!.
I don't want to boast that our system in Sweden is perfect, we have our problems, mainly with a larger share of elderly people, we need mor youngsters :-).
But one thing that we do have is that we pay a maxiumum ~130$ per year, regardless we need to see the doctor 10 times or 1000 times. If you need to stat overnight for instance for childbirth or a majosr surgery, the cost is a maximum $12/day.
Medication cost me a maximum $250/year.
Yes, it is on the tax bill and we really pay taxes here. But at least I don't need to worry too much if I can affort to pay the hospital bills if I get sick.
13
There are two things Republicans up with which they will not put:
1) The idea that being poor is not necessarily a crime or a moral failing, or that it is something society/civilization should address as a matter of human decency.
2) The idea that government could and should be part of the solution to the first.
7
Personally, I favored the Medicaid expansion, but the preference for the status quo, out of fear of risk or loss, was as strong in 2010.
I am appalled by the behavior of GOP politicians, all enjoying tax payer provided and paid health insurance coverage , continuously trying to deny Americans an accessible , affordable and comprehensive healthcare system .
Average Americans are too busy trying to make ends meet , to understand all the machinations behind the GOP maneuvering , and are totally unaware that healthcare USA lags quite behind most of the other industrialized countries.
A healthy and educated citizen is at the basis of a civilized society.
Do republicans care about achieving this goal ?
8
politically, 'saving Obamacare' is a dead horse...it is past time (remember Bernie Sanders Mr.Krugman?) for Democratic politicians and know-it-all's to get the message: single-payer.
8
Dr. Krugman, please stop lying about George W. Bush. He never tried to privatize Social Security. He attempted to allow people to invest a very small percentage of their contribution in the market so that they could a better return. There is a reason why people cannot live off of Social Security after paying into it for decades. It is because the government-managed return on their money is too low to create any real wealth. Calling what Bush proposed "privatization" is the analogous to calling the public option "socialized medicine," which I am confident you would call a lie. Of course, your lies about Bush's proposal is part of what scared people and prevented its passage.
3
Why would you think, Charles, that the average American would know how to invest money without losing it all? Most Americans understand nothing about economics, finances, and investing. Not the faintest notion about how to invest. The thought of investing on their own, I think, would literally PARALYZE some people. And this is why many people reach retirement and they are poor. Before you force Americans to manage their own Social Security, (which should NEVER be done anyway) there must be a generation that learns, starting in grade school, about economics and finance. This learning should be started VERY EARLY. In kindergarten, if not BEFORE. There are generations who promulgate to their offspring NO teaching, or wisdom regarding investing, because the generations before them did not impart anything to them. Instead what they impart is terrible money habits, and terrible money management. So that has to change. Some people are smart on their own, and lucky, too, and they do fine; they have been taught, or they find out on their own by reading and seeking knowledge. Millions don't understand a thing about how to budget, how to save, how to invest. I don't know why this crucially important part of life has never been taught to children in school!
8
Elin, we can debate whether allowing Americans to invest two or three percent of their Social Security contributions in the market is wise policy or not, but that does not change the fact that calling such a policy "privatization" is a lie. But while we are on the subject, allowing Americans to invest a very small amount and perhaps providing limits or guidelines on those investments is a process that might contribute to people learning that you say Americans need.
Charles,
Nothing has ever stopped people from privately investing in whatever they want.
Bush's plan was characterized by everyone as "partial privatization."
It was feared that the removal of a portion of the investment in Social Security would increase the chance of everyone's benefits being cut.
And SS payers who invested that portion unwisely would not only lose that investment but also see their SS cuts lower because of their smaller contribution to it.
Krugman may have erred in not using the word "partial," but we all know that the GOP's goal was and is to completely privatize it.
The sign "Republicans are Hazardous to Your Health" is excellent, but in reality Republicans are dangerous to the economy. Setting aside the tax scam passed several months ago, if Republicans were seriously interested in growing the economy through job creation, Obamacare is certainly a true economic generator. Any form of new development creates construction jobs, but hospitals are a strong, viable economic source. Jobs are available for low-skilled workers as janitors, house cleaning, cafeteria, mid level positions are found throughout and of course extremely skilled individuals doctors, specialists, nursing staff, administrators. These jobs carryover into the surrounding areas supporting a variety of business. But sadly, this level of reality based, pragmatic thinking cannot be found in today's Republican Party. Wishful thinking no longer works. Now, the only answer is the ballot box.
6
Republicans don’t want social-government operated programs. Hail to the private sector!! Personally, if - big if - the private sector could regulate itself and rein in greed offering health policies to all citizens that actually covered many health expenses it would be a wonderful start. Next, if wages for workers in the insurance/pharmecutical business were fair - yes, if all from custodians to secretaries, etc. earned decent wages and some benefits that would eliminate the need for the government to run the health care insurance business. Of course, all this means the CEO’s would earn less. Multi-million dollar wages are destructive to providing reasonable cost health insurance or fair labor wages. We all need health care; we all don’t need big homes or expensive cell phones or the latest car or ....Big, private business can charge whatever it likes in many areas of the economy, but not health care.
5
The Republicans don't care if average Americans have health insurance or not, they (or, more precisely their wealthy owners) just don't want to pay for it, or anything else for that matter. I really don't think it comes down to hatred - I think it comes down to absolute indifference, and incomprehensible greed. And, to me, that is perhaps even more despicable. With hatred you at least have a chance to identify the source, and potentially defuse it. But not so indifference. I'd sooner be dead than be like that. In fact, in the essential ways, they already are.
7
The money wasted on providing health care for those who need it can be better spent by billionaires and millionaires in the form of tax breaks that, like the one Republicans recently pushed through Congress, will allow those desperate and needy billionaires and millionaires the money they need for additional yachts, penthouses, homes on the Riviera, exotic Italian cars, and most important of all, money to be given to Republicans so that they continue to keep the average citizen's tax money flowing to the wealthy and their corporations. This will all be easier for the Republicans because they have a leader they are in dreadful fear of and who they bow down and worship hoping they are worth of his approval. This is as it should be when the vast majority of the citizens of a country lack the ability to think critically and the intelligence required to know when they're being screwed to the wall. They can't be reached by the media because the only media they pay attention to is the one that tells them that all is well and it's OK to hate blacks and Hispanics and Muslims and Jews and anyone else their president, who really can urinate on their legs and tell them it's raining and they believe him. doesn't like.
6
Dr. Krugman, great column! I think a neglected aspect of the ACA is how it gives us a critical weapon in the war against drugs. This begins with the essential foundation that everyone is to be provided health insurance, although we still have some work to do to extend this concept to drug treatment on demand for all Americans.
And what really, really bugs me is politicians who make war on the ACA yet want to pose for holy pictures on how they claim they’re fighting the opioid crisis. There would be no better example than our Governor Walker here in Wisconsin. He’s running for reelection, and so we now have to watch TV ads about how how hard he supposedly has worked to battle drugs. Yet this is the same guy who has done everything he can to undercut the ACA and decent health care for the poor. His most recent attack is an attempt to subject Medicaid recipients to a work requirement. OK, except among those eligible for Medicaid who would be the most likely to be having trouble keeping their jobs? Those with drug problems, of course. So this requirement would go a long way to pull the rug out from under any kind of comprehensive rehab program. What hypocrisy!
2
Let's hope that as the Republicans fail to kill the ACA, the ACA issue will kill them this coming November.
7
since Paul did not actually come right out and say this, I will.
For Sanity, Freedom and even Health Care, lets VOTE!
9
Yeah, sure. Out here in CA, you get Medical if you are an illegal alien, but NOT if you are a citizen. Get it?
1
No, everyone is entitled to medical care in ERs. It is the law that ERs have to provide care whether someone can afford it or not. And whether they are a citizen or not.
4
A typical right wing false statement. Citizens get health insurance, based on employment, family relation, income or age. Undocumented workers can also qualify for insurance, why not, most of them work and pay taxes and money into social security. However the rate of uninsured among undocumented people actually is higher than in the population of citizens or documented immigrants.
6
That is incorrect.
1
Great choice words for the headline. "Plot against health care"
What other democratic nation can make the claim that an entire political party and its big donors plot, plan, connive, and spend millions of dollars in their hellbent determination to obstruct and destroy affordable health care for millions and millions of struggling American citizens?
Equally staggering, is that by plotting and planning and a very careful use of Pavlovian conditioning and advertising techniques, the Republicans Party and right-wing media spokespersons/pundits have managed to convince a ridiculous number of middle- and working-class people to hate their government and to stand firmly AGAINST affordable health care for all. No, no, we don't want that!
These are the people who could certainly benefit financially and health wise from having government-supported universal health care--as is the case in advanced, civilized, responsible countries.
Of course, this is the same party that supports the NRA mantra that guns don't kill people; the more guns people have, the safer everyone is; and the registration and licensing of guns is a subversive government plot.
Republican politicians need to come with a warning stamped on their foreheads:
THE SURGEON GENERAL HAS DETERMINED THAT THE REPUBLICAN PARTY IS DANGEROUS TO YOUR HEALTH
6
Given the Democrats preternatural ability to snatch defeat from the jaws of victory, I expect the ACA to be repealed come January 2019. When the Dems shoot themselves in the foot, for some reason, the the bullet inevitably hits them in the head.
3
We have Medicare for some (65+) now, so moving ahead to 55+ Medicare shouldn't be that difficult and moves us toward Medicare for all. The Democrats would have to lead the way, but if many Republicans got on board, that would help fracture the GOP wall of resistance.
5
As usual, Paul you're missing the basic logic of the GOP's "repeal & not replace" plan. The plan is to deny healthcare to their own supportersso they will "hate government" even more than they already do, so they will vote for the "government IS the problem" party so that the GOP will stay in power. So now should I demand an "apology" of your shortsightedness.
1
One of your best efforts ever. Plainly spoken, and accurate. The modern republican party is a threat to the nation. They prove time and time again they don't want democracy and a level playing field for all citizens. They support poisoning the land, air, and water for short term profits for a few. They're willing to cheat and abuse our open systems of government with bribery, media manipulation, voter disenfranchisement, and judicial manipulation. We still have the vote, sort of, please utilize it. It's still a great country, but for how much longer?
6
On the matter of destruction, let us observe the current Republican intention to destroy the Civil Service. In the forthcoming Appropriations Bill, the plan is to cut to nil every benefit - pensions, leave, health insurance - and to make all the changes retroactive. Sneaking these provisions into the appropriations bill is SOP - it's meant to turn the United States into a right to work nation. The recent 'executive orders' issued by the president* attempting to strip union representation from federal employees has gone directly into court. Destroying the civil service - that's 2,000,000 workers, 2,000,000 jobs - thru appropriations is much easier and much more difficult to repeal. It's part of the long term objectives dating from the New Deal.
8
As a taxpayer, I applaud that.
1
Jackson, as a taxpayer, you will live to regret it.
1
You won't when you need the services and there is none to provide any for you.
When the land you walk on, the air you breath, the water you drink, the food you eat, etc is poisonous you will be quite unhappy that your life means nothing. And that someone for the sake of profit can make you sick or kill you and pay no penalty because it is now not against the law to poison you.
I would be willing to bet, you would be one of the 1st to yell that they have no right to do that to you, when people like you are willing to let them do it.
1
Everyone in America wakes up daily hoping not to use or lose health insurance. Everyone: citizens, legal residents, visitors, undocumented people, aliens. It is The Number One Issue economically and politically. The Democrats should be pounding it home and forget about the "social issues" that, although worthy, have tanked them in recent elections.
Adequate health insurance is the Great Uniter. Medicare for All is a winner. Bernie was right. (Although the healthcare industry will be a formidable opponent.)
10
Social safety nets are "very hard to reverse?" Seems like it has been happening quite awhile, and with both parties. Remember it was Bill Clinton who proudly said he "ended welfare as we know it." Then the Compassionate Conservative Dubya went to town to ruin the rest of it.
So it seems it has not been so hard.
6
Krugman is being disingenuous regarding the cost of Obamacare. From 2013-2017, premiums are up 133%. In 2018, the average hike is another 37%. Only the very poor are sheltered from these price hikes. To the middle class folks hit with these premium increases (those seeing their premiums triple in 5 years), the program is far from a success. That's real money for no additional benefit.
5
Premiums paid by the insured indeed rose a lot, about 105% from 2013 to 2017, but you don’t provide the reader with the absolute numbers in Dollar: $232 in 2013 to $476 in 2017 in average. Certainly paying 200 Dollars more per month can be a challenge, but most households either get help, can afford it or have the Medicaid option. It is still better than having no insurance or a junk insurance as they were sold before the ACA set standards. Initially health insurers calculated the rates too low. Not enough healthy people signed up. That explains a large portion of the rise, and simply health care is expensive and all premiums have risen, ACA or not. Private employers constantly increase the employer portion of the premiums and/or out of pocket expenses.
6
Family plans are around $1000 per month and climbing fast. Obamacare should have been funded in a more equitable way, instead of sticking the expenses to the self employed, etc. My favorite would have been a surtax on capital gains, which have done quite well.
That is all true, and I am an unsubsidized individual buyer of my health care plan. At 59 years old, I'm paying over $800 a month for a mediocre silver plan. There are only a few million of us, but to be honest, I was getting gouged at about the same rate BEFORE the ACA as I am now. At least with the ACA, I can't be dropped if I USE my plan, and my OOP costs (while rising) are still limited.
3
How about a number or to for readers to make sense of the following?
"But public opinion has shown a steady turnaround since then. The share of voters believing that it’s the government’s responsibility to ensure that all Americans have health coverage has shot up since its 2014 nadir. Approval of the A.C.A., while still not overwhelming, has shown a more or less steady upward trend."
2
Leaving aside the racial factor, which plays some role in this, I think that Paul Ryan and his ilk oppose Obamacare because it can become another Medicare program. Medicare is of course the most financially challenging of all of the entitlement programs at almost $700 Billion per year. Another Medicare type program could mean the end of the Republican goal of a low tax and low service Federal Government.
But I believe that healthcare for all should be added to the pantheon of citizens' rights even if it means higher taxes.
9
While single payer may be in the future at some point, for now, the ACA represents an improvement over the haphazard system that existed before. Republicans repeatedly threaten those improvements without proposing something better in it's place. And why do the people who think the ACA is "so bad" while providing them with a benefit they couldn't otherwise afford, want to get rid of it? Mind boggling.
7
The ACA was passed in the hopes of expanding access to healthcare through government and private insurance expansion. It did very little to those who were already insured through large groups and businesses. The target for expansion were small business and individuals who were unable to buy affordable insurance pre ACA. This included a lot of people who were kicked out of the insurance market by becoming sick.
The Republicans knew that they had to target the parts of the ACA that helped those small businesses, farmers, ranchers, entrepreneurs, etc to prevent them from getting affordable insurance. They have been successful to a point and with the changes in the tax law, now we are dealing with GOP/Trump care. Get ready for skyrocketing premiums across the board, restrictions on pre-existing conditions, max lifetime coverage etc. Voters who voted for the repugnants and Trump will deserve what happens to them and their families, but a lot of good people will die or suffer preventable complications from treatable conditions that they don't deserve.
4
Best bumper sticker I ever saw:
"Liberals oppose war; Conservatives oppose healthcare"
15
The second part is certainly true, but not all liberals have been doing so great on opposing war.
We can do better.
1
In America you better not ever get into an accident, get sick, diseased or old. If you do and are not wealthy, prepare for poverty, bankruptcy, losing your job and home and much worse. Nice country we live in.
13
People opposed to Universal Healthcare are much like a toddler in the terrible twos when a parent reprimands them and takes away their toy. They scream, they cry, and they throw a terrible tantrum which only results in further sanctions and a longer delay until they get their toy back. Soon the child realizes (the smarter the child the sooner they get it) that if they behave properly they will be once more reunited with their toy and be able to commence playing again, hopefully without the offending behavior, lest they lose their toy again. It's a simple lesson taught in childhood at an early age.
The only reason premiums have risen for those who purchase their own healthcare or earn it through employment is because of the childish screaming and tantrums of those opposed to Universal Healthcare, mostly those in the GOP. A simple college Econ 101 class tells us that because of economies of scale, better prices for goods and services like doctor's services, heart valves, and so forth can be achieved by purchasing in bulk. This has been known since man has started to trade with one another before the Paleolithic Era. Such stone age knowledge will be put into effect with healthcare once a bulk purchaser (in this case the Federal Government on behalf of the people) is given the power to negotiate on our behalf. Care should be given to ensure that those who wish to keep private insurance are allowed to. It is the sensible thing to do. Anything short of this is a waste of time.
5
So, all the voters must accomplish in the 2018 midterms is give the House to the Democrats and that will preserve the ACA. That seems simple enough. Ok. This outcome is highly desirable. I do not think the GOP will be able to exorcise Obamacare. As the article states, the voters have seen the value of this healthcare plan and want to preserve the Sxf
4
Everyone must put emphasis and work to get out the vote. Health care is really a human right; it should not be a political gift.
Please listen to the candidates and vote. Vote for health care in November.
12
How is it a right when delivered by private citizens. You do not have a right to someone else's time or education.
2
Driven, I don't like the rhetoric of "rights" when applied in this way, but your objection seems spurious to me, in that we are obligated by law and tradition to offer our time and education in the name of everything we pay taxes for. For example, people who have no trouble being forced to contribute to the construction of roads or weapons suddenly get huffy when it comes to healthcare. If not a right, I think it's a civic obligation, like so many other things.
4
Driven, I don't like the rhetoric of "rights" when applied in this way, but your objection seems spurious to me, in that we are obligated by law and tradition to offer our time and education in the name of everything we pay taxes for. For example, people who have no trouble being forced to contribute to the construction of roads or weapons suddenly get huffy when it comes to healthcare. If not a right, I think it's a civic obligation, like so many other things.
I thought Krugman was hired as a Nobel economist. Why this constant repetition of DNC talking points found in dozens and dozens of other places.
Why not write about the Italian crisis and the Europe?
5
Not even one word from the noble laureate on today's reported job growth, wage growth, level inflation, and unparalleled low Black unemployment rate?
I know Professor Krugman can not publicly laud President Trump, that would be going against the "resistance."
But at least he could have mentioned that all this good economic news is due to President Obama.
Or someone who is a Democrat. How about Hillary?
5
Only universal programs become more popular. Food stamps, AFDC Ana Medicaid have not achieved the status of Medicare and SS.
4
Foodstamps, aka SNAP, has come under siege since Reagan floated stories of Cadillac driving, steak and lobster eating welfare queens...
6
Food stamps are certainly popular with those who benefit the most from them: anybody involved in the growing, production, distribution or retail selling of food and groceries to the public-- including to those among us who must use food stamps for part of their food budget. That's why the aforementioned groups come out in defense of food stamps when the GOP decries them.
1
In 2018, our health insurance system is designed primarily to generate shareholder profits for the companies who supposedly provide health coverage, when in fact those "insurers" more often prevent the delivery of health care. The insurers are generating billions in profits, while far too many citizens are denied basic health care.
The GOP would like to extend this same model to every other service that our government provides, by "privatizing" these functions so that shareholders profit while services are denied.
It is time for voters to stand up and demand that every elected official helps return our government to one which serves our citizens, rather than one that serves the profit needs of a small group of shareholders.
17
A simple definition of democracy is a government that is by the people, for the people, and of the people.
Now, if you go by behavior not words, which political party does try to take policy and legislative action to help people individually and collectivity in society, and which political party openly works against a government that works for the people, a clean environment, justice for all, and a balance between freedom and equality?
And the key question is why would the members of a political party actively ignore and vote against the needs of its people and the well being of society and the planet?
And why is the U.S. the most expensive health care system in the world with only mediocre outcomes compared to nations with universal health insurance where health care is far less costly and the outcomes are better?
Why is the U.S. the only so-called advanced nation that allows the legalized bribery of politicians by the wealthiest and most powerful individuals and corporations who are permitted to contribute lots of money to political campaigns but also have ways of hiding the names of those who do?
Let's name the names of the wealthy Wizards of Sickness, Pollution, and Sleaze behind the curtain, who demand their politicians vote against helping all the people, in favor of cutting their taxes again and again and transferring those taxpayer dollars to helping big corporations and wealthy individuals become bigger and richer to please investors.
8
Here in Maine, after eight years of implacable opposition by our Tea Party governor, Maine citizens took the matter into their own hands and approved the Medicaid expansion by a referendum initiative last November.
Predictably, the governor is dragging his feet in implementing the expansion, claiming that there are no specific funds appropriated for the expansion yet in next year's budget, even though there is enough money in the current budget to begin implementation, clearly a stall tactic on his part.
As this shows, the real fear of the GOP, as Prof K.points out, is that the program will succeed, not that it will fail..
10
"... if the republicans lose the House this November, they probably will, and..."
Don't bet on it! Less than two years ago a large majority of American voters didn't want, nor did they expect, a Trump victory in the '16 presidential election. But many of those also didn't like Hillary and th idea of her being President. But ALL th polls had her far ahead, and that led too many would-be Democratic voters to abstain from voting for her, and many from voting altogether.
So please, again, for the sake of this once great country, don't believe the polls!
5
The polls were pretty darn accurate. The media's interpretation of the polls was just terrible.
2
It was difficult for polls to take Russian intervention into consideration.
3
I agree with Daniel. Nate Silver's final assessment was that Trump had about a 1 in 3 chance of winning. How many people pooh-poohing the polls are buying scratch tickets at much longer odds?
Who said that stupidity, exemplified by the ossified minds of corrupt and cruel republicans, has no impact in the daily lives of ordinary people? Government's role is to ease the lives of it's constituents by satisfying basic needs, potential or current, to guarantee some stability, even happiness, for a more equitable society. Can't we see that the brewing of resentment is real, and based on our ever enlarging inequality...as sensible regulation is trampled upon by loose cannon Trump, and his minions. arrogant- entitled- affluent republicans whose huge social distance makes it impossible to 'feel' for the anguish of the common man? And health care, as much as public education and dignified jobs, ought to be of prime interest to every politician who dares to claim legitimacy. So, not making it widely available and affordable remains a mystery...if not crass incompetence in understanding the issue. However much I hate to extend this brief diatribe, it must be said that all this smacks as 'racism', as Trump's aim is clear, erase Obama's achievements, as Trump's ego cannot stand that a black man is way better, ethically and morally, and with a 'heart', than his petty ignorant mind. And republicans, hopelessly devoid of a mind of their own.
6
Let's make healthcare a right and bearing arms a privilege. But let's also deal with both cost and coverage. To affordably cover all Americans we need the price of individual interventions as well as their volume. Our culture and the incentives in the healthcare system continue to drive overconsumption with little to show for it in terms of better outcomes. The price of hospitalizations, tests. drugs, procedures etc. is certainly an issue but the use of these is a much bigger one. Unlike in any another developed country, a US patient can often be unsure whether a diagnostic or treatment plan is designed purely for their benefit. Until medical considerations are the only ones dictating patient management we have little hope of getting on top of the problem. I am a retired cardiologist. Americans have been taught to believe that more is better and that "leaving no stone unturned" is in their best interest. A more enlightened cultural approach is needed.
6
Hey New York Times... why is this valuable and timely article so buried? I am a major ACA advocate, saw this link on VoxCare, and then came back to the Times to find it. Boy, did I have to search. Healthcare is a major blue wave issue. We need your help!
1
It is on the front page of the digital NYT, if you subscribe. It is $3.50 per week, billed at $15 every four weeks. A bargain, compared to what I pay for my local print newspaper, which is $60 a month.
1
Why do they hate Obamacare so much ??? It's the Name. Surely, something championed and ultimately passed by a Black man could never be good for God fearing, church going, white people. It's giving "those people" unearned benefits, something for nothing. All their pettiness, nastiest thoughts and beliefs encapsulated in one word. Despite the fact that most people benefiting from the program are white, you'll never convince Trump/GOP voters otherwise. It's truthiness, and spite. You know, their Mothers Milk. Just saying.
3
White and WORKING but that doesn't matter because it contradicts the narrative of "takers"..
It fits the racial animus of Republicans. There is an idea that the ACA is a giveaway to lazy people, even though it actually has helped keep rural hospitals (that serve Trump's rural base) in business.
Nothing anyone can do will ever change their mind, short of killing the ACA and letting the Red states close their hospitals and let their poor suffer and die. Even then, it is highly doubtful they would ever change their minds.
Race trumps almost everything in today's Republican party.
2
Paul, I agree with your Op Ed piece on the ACA - but cannot help but wonder if we in America will ever be able to pry our healthcare system away from all the "Carpet Baggers" that feed off of it. After reading Elisabeth Rosenthal's excellent book 'An American Sickness', I now know all about the history of healthcare in this country and I am more convinced than ever that only a complete and overwhelming breakdown will cause us to throw it out and start over with a sane policy like the rest of the advanced countries in the world.
Our healthcare "system" is hanging by a thread and it will probably not take much of a country-wide healthcare crisis to cause it to fully implode. For example, we are long overdue for a serious epidemic crises, or even worse a pandemic, and when this happens our system is almost certain to collapse. I can only imagine that the local and federal government will then have to take over delivery of and access to healthcare to try to stem the panic and staunch the spread of the disease. One can only imagine the chaos of a fully armed populace overrunning local healthcare centers and demanding immediate access - regardless of insurance coverage. Assuming that we even recover sufficiently as a nation, I would be very surprised if the survivors would even consider re-establishing another for-profit healthcare system.
1
The "infrastructure argument" for universal healthcare values our workforce as a fundamental part of our economic health. A healthy workforce is at least as valuable as good roads, safe pipelines, etc. One that is not tied to employer-supplied healthcare, therefore more mobile to pursue better jobs, is a more productive workforce. Even a racist should be able to see that. The "punishing me for success" position is so narrow minded it's balmy.
3
Obamacare is an abomination as is Medicare. So much so that huge #'s of Doctor's are refusing to take on new Medicare patients due to the restrictive reporting requirements as well as their dismal payments for services and Obamacare forcing double digit increases in monthly costs and deductibles. The Medicare mess is forcing Doctors to abandon small practices to join faceless conglomerates where they will make a salary and not have to deal with the paperwork restrictions. Maybe they could start the fix by repealing the HMO act of 1973 which let hospitals and medical facilities become for profit businesses. This quickly changed the system to one of curing disease to treating disease because that is where the money is.
1
To be fair to Republicans in the House who want to repeal the ACA, they do have somewhat of a rationale for why they fear that such programs will succeed, as stated by Paul Ryan: government entitlement programs like the ACA (and expanded Medicaid or Medicare) will make Americans soft and dependent upon government, allowing them to rest complacently in a hammock of dependency, rather than becoming industrious and taking responsibility for their lives. But being fair to Republicans like Ryan in this way isn't going to make them look much better, because, like so much else with the GOP, this rationale is a sham. Just which Americans do Republicans like Ryan think are in danger of becoming soft and complacent? Well, certainly not hardy, virtuous (white)(and Republican) Americans, but Those People of weak, malformed, and inconstant character. Thus is bigotry and contempt masked as heartfelt concern for people's souls.
3
GOP politicians don't respond to ordinary voters. They respond to their billionaire bankrollers, such as the Koch brothers, who don't want a free and equal society in which adequate medical care is a human right. They want a plutocracy in which the wealthiest buy what they want and everyone else suffers. The GOP must be voted out.
4
Your mistake is thinking that the Democratic Party is any less beholden to their bankrollers, billionaires or not. "If voting changed anything, they'd make it illegal." - Emma Goldman, circa 1917.
To DRS below: You are against a redistribution of wealth because of ACA. You must not be getting the tax benefits from the latest redistribution of wealth tax act.
3
The lady's sign says it all. REPUBLICANS ARE HAZARDOUS TO YOUR HEATH (CARE, sic.) Many will die, while health care companies grow richer, and Republicans (and some Democrats,) also growing richer, do as they're told, in legislatures and Congress. Let's put it another way: Voting for Republicans could shorten your life, and the lives of your loved ones. Republicans do not love you. They love money and power. Anyone, who can't see this, is purposely blind to the truth.
2
Republicans in Virginia received a wakeup call last November, when Democrat Ralph Northam not only won by a landslide but Democrats almost took control of the House of Delegates by gaining 15 seats, The vote in the House of Delegates for Medicaid expansion was 67 yeas and 31 nays, which means that at least 18 Republicans supported the expansion.
There were no Virginia senate election last November, but four senate Republicans changed their minds and supported the Medicaid expansion; and that made the vote in the senate 23 in favor and 17 in opposition to the expansion.
Because of the vote, about 400,000 Virginians, mostly working poor folks, will now have access to health care. It took five years of work by advocates and enlightened Virginia legislators, which included some Republicans, but not the majority of them.
As an advocate for the expansion, I had the opportunity to speak with many that opposed the legislation, doing so by using a very dopey economic argument, one that had no basis in reality--the vote actually stops the “ dollar migration” from Virginia, since VA taxpayers have been paying Federal taxes for the ACA . Also, when asked why they did not consider this a pro-life issue (a favorite position for Virginia Republicans), since health care saves and protects lives, it became clear that being pro-life for most only pertained to abortion opposition--those outside the womb were on the own when it came to life-saving and life-protecting health measures.
2
There are peopl are going to die unnecessary deaths in GOP run States because those States did not expand Medicaid. This is a national dIsgrace.
We get the governments we deserve.
1
The two biggest lies in America...Republicans are "conservative"...and Republicans are "Christian" (in the old-fashioned sense of the Christian religion that meant following the teachings of Jesus Christ and not breaking several of the Ten Commandments every day.)
3
Donald Trump, Steve Mnuchin and Wilbur Ross have never worried about providing health care for themselves nor their nine wives and counting.
Life long government benefits and employment welfare dole queens Paul Davis Ryan and Addison Mitchell McConnell, Jr. have never worried about access to health care.
4
What's really pathetic is how little republican politicians would gain monetarily from ACA repeal and how little most need any additional money.
3
Everyone needs to pay their share.
No more freebies for healthcare. Those of us that do pay up are tired of carrying those of you who don't.
4
That's a shame. You will be exhausted long before the rest of us give up on civilization. (If figure if There can presume to speak for millions of Americans I can do the same.)
1
As comments from conservatives here show, Trump's slogan may be "America first", when it comes to healthcare THEIR slogan is clearly "me first".
That's how the GOPe, now strongly supported by Trump, can constantly propose to destroy the healthcare of tens of millions of Americans, all while massively shifting middle class money to their wealthiest donors.
GOP voters today couldn't care less about America as a whole, for them it's "me against all others". So all that the GOPe and Trump have to do to be able to attack and destroy basic pillars of America's greatness on a daily basis, is to make their voters believe that those bills will put them individually first (whether that's true or not doesn't matter, as Fox News' fake news is there to MAKE them believe that it's true), and they'll happily re-elect those same lawmakers - who in turn also adopted the "me first" mentality of their voters, as the only reason why they destroy the greatness of America is simply because that's what their wealthiest donors want, so it's what will boost their own career, and that's it.
4
The Democrat running to unseat a Republican incumbent in the second district of Arkansas has talked about health care in all his ads. He's a cancer survivor, so is a poster child for preexisting conditions. The Republican, who voted to kill the ACA, has mentioned nothing but Nancy Pelosi and vague fears. It will be interesting to watch Republicans run away from their legislative agenda. They likely will get away with it since their base can't comprehend the actual results of government action.
1
The ACA is terrible law, we should have a plan like every other "advanced" nation. Repealing it would be terrible, since it did expand coverage some. But as Prof. Krugman has pointed out many times, it's a 3 legged stool, and it needs all the legs. One leg is the mandate, which is gone. Without healthy people buying in, premiums are guaranteed to skyrocket. so the ACA is dead anyway, and any congress which gets elected in 2018 will have to start over. One might hope (ha ha) with medicare for all.
1
Dr. Krugman, the GOP is trying to kill the ACA because their real constituency - the 1% megadonors - don't want to pay for it. The GOP has made abundantly clear who they represent and it's not us 99%. 90% of Americans favor stronger gun control laws but the GOP Congress refuses to deal with it because they know their NRA contributions and support will dry up. So, kids will continue to be scared to go to school and kids will continue to die, as well as anyone at a concert, mall, movie theater, workplace, college campus, and churches until we vote out every last one of them and get some adults in Congress that know how to compromise and reach across the aisle to enact sensible laws for ALL Americans. #2018Bluewave.
2
What's "breaking" the budget is the persistent and criminal under-taxing of America's corporations (record profits) and filthy rich (never richer). The country's falling apart but all's well down at the country club. It's rampant Banana Republicanism and it's criminal.
5
Thank you, Paul! Which all brings me back to VOTE!
1
David Brooks should read your essays. He has a lot to learn on economics instead of his mumble jumble pseudo theories on sociology. The working class in this country vote against their pocketbooks and accept the Republican culural wars instead. Trump is the ultimate barker who lines his own pockets and those of the rich at the expense of the rest of us.
1
Recently I have been watching re-runs of the "Doc Martin" series on PBS that takes place in Cornwall UK. I noted that patients come to Doc Martin take their place in the waiting room and then walk in for their visit and walk out. Why didn't patients stop at Elaine's desk and whip our their credit cards to pay what they owed? Oh they have a national health care system that's why. So easy, so lacking in stress, no paperwork. NHS maybe in some trouble but it will be saved because it serves and saves people. I remember Republicans falsely proclaiming (what else is new) that Stephen Hawking's ALS was treated privately. No way said Stephen, the NHS has taken care of me right from the beginning. Meanwhile back in North Carolina, another Southern state that refused medicaid expansion, my county, Buncombe, has 17% of its population uninsured. Why to go NC and America. Cruel
1
In talking to folks from Canada visiting my small business through the course of almost 20 years, I never met one badmouthing his or her nation's provincial health care system. I did however meet scores of Fox news watching Republicans claiming that Canadians were crossing the border by the tens of thousands to use our physicians & hospitals. Guess which set I believed?
Once while in the reception room of a dental surgeon, a pork-bellied individual began loudly complaining that he couldn't get an appointment because of all the welfare cases in front of him. At the same time he scanned the room making eye contact with all those present. The receptionist smilingly indulged him, realizing that he represented the attitude of a good many patients.
This is the gratification the deniers reap while feathering the nests of the profiteers & bean counters. For this dude, our sick system so satisfying.
3
In 2010 Canadian Premier Danny Williams (Newfoundland) came to the US for heart surgery.
My cousin waited two months to get an MRI to find out what was wrong with his heart. He had 90% blockage on one side and 80% on the other. Another two months to get a heart bypass.
During Myrtle Beach's Can-Am Days some Canadians arrange to get knee or hip replacements at one of the hospitals on the way down. They stop in on the way back to have it checked and head for home.
It seems not everyone is pleased with Canadian health care. You could be talking to people who have developed low expectations and are now feeling just lucky to get what they get?
2
I have a theory that Republicans want to sabotage health care (aka Obama Care) because they know that the current system, which largely provides health insurance for those employed, discourages employees from leaving their employers and striking out on their own or starting over with a new company. The current system may act to freeze employees in place, regardless of the problems they encounter from their management. The ACA would allow more flexibility in their employment options.
4
One addition to your comprehensive essay: healthcare has been a great job creator. Your column on the jobs created by the healthcare industry in West Virginia alerted me to the economic impact of this new and growing industry. People with good living wage jobs in the industry should be encouraged by the Democrat's efforts to strengthen the social safety net.
2
Here in Oklahoma, we barely have public schools, much less affordable health insurance. But we do have an election coming and the chance to do something about it.
Only one candidate for Governor, the former attorney general Drew Edmonson, is running on a platform which includes reversing existing policies and accepting the Medicaid expansion of the ACA. All other candidates just mouth words about "making healthcare affordable", some by "expanding competition"(which would be interesting except for the fact that we only have one insurance company offering policies in the state and it is unlikely that others will come back given our low population), other by means that they don't spell out, which I suspect means by waving a magic wand.
Until we have Medicare for all, I urge all my fellow Oklahomans to ensure that Drew Edmonson becomes our next Governor.
3
Are Democrats running on healthcare or are they running away from it in Republican held districts? Women that vote Republican; are they aware that Republicans continually attack their right to access to healthcare? What other issues would get them to ignore this? Are they aware they are being tricked, or just don't want to admit it? How many women--and men-- for whom healthcare is an important issue, who did not vote in the last election, are planning to vote in this election? That is the key to the election, as well as sensical gun control, which is also a major public health issue. The "Right" to bear arms does not override the Right to public safety and the Right to have access to healthcare. The democratic party may not be seen as a base for healthcare, but those who seek access to healthcare and at a reasonable cost, should be a political base in and of itself. Will these people vote?
Right, Krugman has plotted against strong nationwide single payer medical, specifically he’s spread the preposterous rumor that most people who get the benefit are happy with their employer supplied medical (not so much health) insurance.
Furthermore he consistently elides over the massive deductibles in many plans under the ACA, and he pretends that Medicaid is decent medical insurance; it’s not. If you’re poor, registered, and living in the right state, of course it will patch you up, or deliver your baby.
And I see, like a lot of people, Krugman confuses having medical insurance with health care, some times they’re the same, often not.
4
Do not vote for Republicans in November. Plain and simple.
The motivation for Republicans is to do what large corporations and the 1% want them to do: tax cuts, reduce regulations for Banks, decrease protections for the environment, reduce budgets for education, healthcare and social programs, increase the budget for defense.
Most Americans will be voting against their own interests if they vote Republican.
Wise up Americans and review your tribal affiliation.
1
In my experience, most of the money spent through Medicaid goes directly through patients into the earnings of nursing homes which, like most capital, are largely owned by Republicans -- patients are passive conduits from the Treasury to Republicans. So why do Republicans want to cut Medicaid, since they ultimately get most of the money ? Do they somehow need people to suffer rather than live in minimal decency ?
1
The ACA is great of your premiums and deductibles are heavily subsidized. Once you make a cent over the government's arbitrary limits you pay in full and have health insurance that is so expensive and complicated it makes accessing care not much easier than having no insurance at all. After paying over $1000 a month for 2 ppl, even a physical results in a bill for routine lab tests. So the 10s of thousands in premiums we have paid over the past 3/4 years don't even get us a free blood test. And if you need to see a specialist you have to see your PCP 1st , triggering another copay just for a referral for a Dr who we have to pay in full for the visit because of a super high deductible.
The American health care system is a joke and the insurance companies are laughing all the way to the bank with our money! The higher their stock prices go and the more they spend on lobbying against patients rights, the more we all have to spend for increasingly low quality healthcare.
How can we have any power in a system in which the prices are a secret until you get a bill in the mail? And the price of meds can double or more without reason? And the insurance company can deny coverage to save a buck, but keeps all the premiums paid?
3
Krugman and the left must also realize how important it is for everyone to have a cell phone. It's important for work, lining up work, or reporting to work, and it's also an important link in the event of a health emergency. So when is the liberal left going to start agitating for us to all get free cell phones from the Govt.? Cell phones are so important! And also, TV's are important too. What if there is a flash flood or a weather advisory? I think the Govt. should also be providing TV's to the public given the public safety issues. Give me a little more time, and I can think of some other essentials the Govt. SHOULD BE providing to ALL AMERICANS.
4
This is a rather embarrassing reductio ad absurdum. There is a real difference between a cell phone and health care. If you cannot see the difference, then there really is no conversation.
5
Another example of the conservative disability when it comes to reasoning with analogies. Almost no one will die of not having a cell phone, whereas the absolute necessity of health care is the basis for regulating it. Food is a necessity, and people will sacrifice on quality and quantity long before they starve - but who deserves the equivalent of a medical McDonald's? - and when worse comes to worst, we have government assistance in the form of SNAP and other emergency services.
Large corporations and hugely wealthy families want a weak Federal government so that the government can't tax them and regulate them to keep them from exploiting ordinary folks and the environment. (Except, of course for the military so they can browbeat weaker foreign nations.)
BUT if citizens like their federal government because of helpful programs, they will want a strong central government.
ALEC and other Republican groups have taken advantage of racism to turn Americans against their own government.
Countries like France, Germany, Denmark etc. have strong central governments and are able to act in the best interests of their citizens. Unlike the U.S., where Republicans con Americans into supporting policies that benefit only the wealthy.
3
Do you really think that there is more choice with government bureaucrats? They are worse than private industry because they are indeed untouchable. At least in the private sector you can have choice. I agree we need a strong central government but we need them to keep the free market playing field level by not giving large corporations unfair legislated advantages over their competition. The free market will work better if the government does not pick the winners and losers.
2
Fundad, spoken like a man who has never been placed on hold. In the private sector I can always choose from a variety of deaf, dumb and blind 'customer service' departments, who keep me busy while management is working on how to charge me more for delivering less. I know that choice is a *talking point* in this debate, but I prefer to consider my experience point.
BLUE ALERT -- The only feature of Obamacare ever touched on is the number of uninsured that become covered. The facts are that since Obamacare the rise in healthcare costs has gone in half. As a result, EVERYONE'S premium increases have benefited. Further, small businesses of less than 50 employees (touted by the right as an engine of the economy) that cannot afford insurance now have a way their employees can get covered. Journalists and politicians need to talk about this to counter the right casting it as a welfare program.
2
This is and will continue to be a major issue for the American people. I hope the ACA will follow the path of Medicare and the enlightened world as far as health care. The Republicans gnash their teeth, yell socialism and other names as usual. But in the end the right thing is adopted. But not with Republicans at the helm. Instead of all the vitriol how about working together to make our health care affordable for the little guy. Which is most of us.
While America bickers over who will pay for healthcare, the prices keep going up and up. Medical price inflation has been rising at twice the rate of inflation for all other services.
What this proves is that our current method of paying for healthcare (which some people call the free market method)
is unable to contain costs. Time to try something new.
1
Once again, PK has written an excellent column. Perhaps it is not politic for a respected NYT columnist to say it bluntly, and in so many words, so I will:
Republicans are enemies of humanity.
In addition to health care, they want to destroy job protections, good public education, freedom of choice, freedom of press, free and fair elections, and they see the function of government as enabling thieve, fraudsters, and religious hucksters to prey on the common person. Government against the people, not of the people, and not by the people.
What's not to dislike?
2
Health care, a job with a living wage, education, social security, a home of one's own - yea, that’ll destroy freedom of all Americans to pursue the dream - the fake lottery dream and promise that it will come in the afterlife if you believe them.
As untouchable as Social Security is, Republicans continue their "plot" to privatize it - after all it's the kleptocrats holiest of holy grails.
F.D.R. never experienced the hatred Hillary got - he might change his mind about welcoming it with today's GOP.
Conservatives conveniently ignore that poverty, poor health, hunger, unemployment - or worse, laboring for subsistence wages - is enslaving and is certainly not freeing except for those at the top with astronomical surplus wealth.
Reasonable socialism is actually liberating to all; clawing back on the distribution of wealth to surplus amounts to those who do not need and back to those who actually have a deficit and need it to survive.
Nordic countries have a good blend of socialism with capitalism that actually works. It's not perfect, but do we really want what is perfect for the wealthiest among us? Besides, socialized medicine has no effect on those with wealth - they will always have better healthcare options than anyone else - so what's their complaint?
A sick population means sick workers, sick military and a sick nation. Is that what Republicans are for?
Imagine how fast the GOP would attack Social Security if it were called Obama-Security.
5
This is really another effort at voter suppression. if you
are dead you can't vote.
2
The health care concerns are part of a larger problem displayed by many current Republicans--they view governmental social contracts as anathema: https://www.foreignaffairs.com/sponsored/social-contracts-and-public-goo... ("Social Contracts and Public Goods Provision," 23 May 2018) . This is part of a decades-long pattern that degrades the overall fabric of our society.
What is rarely stated is the fact that much of the 'opposition' to ACA among voters comes from those of us that favor 'single-payer', or other REAL Universal Healthcare, sans Corporate profits and private 'Insurance' (i.e. 'protection'/extortion, a la Al Capone!)
Too often all opposition to ACA gets conflated with the supply-side/sociopath/aristocrat/feudal/punish-the-poor Republicans.
2
Every person who loses Health Insurance is a greater burden on all of us than Medicare or Medicaid or those on the ACA(as it was before 2016). Why? The uncovered must go to the MOST EXPENSIVE source of care: ER. The uninsured wait to get care that they cannot afford and are more likely to require hospitalization. Bot ER and Hospitalized patients unpaid costs are “passed through” to all payers. That increases costs over all. That drives costs of insurance up. Higher insurance costs drive employers from the healthcare benefits and thousands more are uncovered, Additionally the primary cause for malpractice law suits is bankruptcy of patients. Unable to pay for medical care patients seek legal help. Rather than declaring bankruptcy, lawyers work for their client’s best result and sue the hospital and doctors when possible. That drives the cost of care up by driving malpractice rates up for hospitals and doctors, which costs are passed on to consumers and inflating the cost of healthcare.
It’s hard to explain and easy to confuse the state of healthcare costs, so we should stop! Instead, explain democracy. If the majority wants Medicare for all then we can have it. Just get out the vote.
Krugman has opposed Medicare for all stating that “we cannot afford it”. He needs to reexamine his analysis and then support Medicare for all. I look forward to read a column supporting Medicare for all. Yes, taxes will go up, but less than insurance costs. Dr. Krugman?
3
Thomas Frank answered the question, why the Rublicans keep winning on failed economic policies that drive inequality to record heights, in his book “What’s the matter with Kansas?”
Those failed policies never brought jobs, or wages, in-line with basic essentials’ costs: food, shelter, clothing, and actually drove wages down. At the same time there has been a steady drumbeat that government is a bloated loser, and its saviour is the for-profit private sector, with no pesky prevailing wage regulations, and with fewer and fewer unions, Americans middle class shrank and shrank a little more, as Americans embraced the Republican messaging.
Opponents of Obamacare are perfect examples of this mystifying trend: the very people who would benefit most from universal healthcare eat the news that Obamacare is baaad! That it will bring Socialism to our shores, that it’s more big government telling you which doctor you’ll get to see. Real newsflash: the U.S. pays more, far more, for its patchwork healthcare that leaves millions with no care at all than any other developed country. We are also the only developed country where people go bankrupt due to medical costs, and we pay so much more for our drugs because we lack the ability to negotiate drug prices. Instead the pharmaceutical industry tells us it needs to make a profit so it can do research.
3
"American politics being what it is, opponents of a stronger safety net also tap into racial resentment, convincing white voters that new programs will benefit only Those People."
Adverts for programs, as well as the media are to blame for this.
I rarely see promotional mat'l for these programs that feature photos of whites. And it seems like most articles/news shows feature only minorities in their hardship stories.
This stereotypes minorities, and does a disservice to the millions of whites who also are at risk of losing the safety net.
Whites are the biggest beneficiaries of the social safety net, maybe it's time to feature them, also.
1
"conservatives still cling to the dream of denying health care to another 20 million or 30 million Americans.ut" Americans have been conditioned to fear & hate anything Republicans call "socialism" even while their children are attending public school, driving on the interstate, etc. What was more idiotic than Reagan's comment, properly from G.E., about MEDICARE! ACA is an expensive hybrid, better than nothing, but as Andrew Biemiller of Canada, how lucky he is, commented below, what is needed at least is MEDICARE for every American and below an income level of poverty to cover 100%! You know, like other advanced countries! With that said, Dr. Krugman stated the an obvious issue, racism!
2
Right on-target on all points except for Dr. Krugman's sunny suggestion of effective Democratic Party politicking. It is not effective. The Party might have humane, humanity-affirming positions, but today's typical voter hardly knows this.
This year, there should be no doubt about who will win either house of Congress this November, given the hideous mutant that the GOP has become. But the outcome is no slam-dunk. The blue tide is turning purple, and this is no formula for a November victory.
As distasteful as it might seem, the Democratic Party should start behaving like Republicans -- early, often and loudly -- while continuing to focus on Democratic policy goals.
3
Hmmm I thought the ACA was insurance not healthcare....
I feel like the healthcare system remains in crisis mode and it’s much bigger than insurance coverage.
Where is the vision? Things aren’t working right. Anyone with two brain cells can see this.
What is in the GOP DNA that spends all of its time attempting to make life worse for Americans. Now, if they had a better alternative, great, but no, it is all about getting rid of any policy with Obama in the title, and, who cares if millions of Americans are harmed by this personal vendetta.
4
Funny how the untold trillions poured down the rat holes of Middle East military adventuring goes mostly unquestioned, while anything that benefits the people who actually pay the taxes is subject to the strictest scrutiny and resistance.
11
Republicans figured out long ago that it's cheaper and more profitable to impose pain than alleviate it or cure it.
They'll even provide you dirty air and water.
It boggles the mind that Republican voters have not figured out who the real welfare queens are : the banks, huge corporations, insurance companies, fossil fuel industries, fake think tanks. You can even put proper names by the biggest welfare queens, aka Kochs, the Waltons and their likes.
2
The real question in this debate is - How do we get republicans to CARE about all Americans?
The “pro-life” Republican Party is trying to kill health care. Can we please all agree that it is time to drop this descriptive of the political party that refuses to support medical coverage for all Americans?
3
The fragility of America's social safety net programs lies in white privilege. Many, maybe most, white Americans don't want to see their tax dollars spent to help blacks, hispanics and other minorities who "don't deserve it." America's history is fraught with these denials of the benefits of citizenship to minority groups. Jim Crow laws, the post WWII GI Bill and FHA loan program, the gutting of public sector unions, and present day Federal community redevelopment program. MAGA is code language for Make America White Again and that leaves no place for universal healthcare.
1
Premiums went out of control under OBAMA forcing many to just pay the fine and Krugman conveniently left out the facts. The mandatory part of ACA is dead and allows poorer folks to buy policies that match their ability to pay or their risks instead of the government dictated policy characteristics. Krugman, the "economist" knows full well that his goal is socialized everything in his totalitarian vision. He and the Socialists are losing because the truth is that this philosophy is a utter failure globally and always has been.
Health care, health care, health care. That's the issue every Democrat should be running on, in local and national elections. Virginians proved it's a winner, and it will be a loser for every Republican who tries to take it away. Please Trump, run against health care and see where it gets you.
1
Let's not forget that John McCain's vote against the repeal was crucial, and he will likely die very soon. If his replacement is in place before the 2018 midterms and in favor of repeal, Ryan and McConnell will have another repeal attempt ready for House and Senate vote in about 5 minutes.
Like all apologias for Obama care this piece uses language like "health coverage" and "access to care" to imply that the system provides a practical level of affordable care for individuals not covered by their employer. It does not and until at least self styled liberals like Dr. Krugman come out definitively for universal single payer it will continue not to do so.
Here is a comment by Mr. C that should have been included in the NYT Picks:
"I agree with everything in this column except that "America will become like every other advanced country".
Americans are being ripped off by the health industry. We pay more than twice what other countries pay for the same service and the quality metrics show a worse outcome in terms of life expectancy, live births etc.
The health industry spends more on lobbying than the defense and oil industries combined. Health costs account for over 60% of personal bankruptcies. "
The health insurance and pharmaceutical companies are parasites that will bankrupt our country and need to be reigned in. The solution? Medicare-For-All .
7
Let us remember that every republican in congress has a gold plated healthcare plan in the Federal Employees Health Benefit Program. NOT ONE of those parasites has renounced their benefits. This is paid for by all American tax payers. Yet they deny health care to others under fraudulent ideological pretenses.
10
This intentional misconception that if you are healthy and do not have need of medical services then your premiums are paying for someone else overlooks the simple fact that, if you or someone in your family gets sick or seriously injured tomorrow, you have coverage..you are, in other words, paying for your coverage not for The Other..so, be happy your healthy...and quit trying to take other people's health coverage away..
3
We're one (God forbid) Ebola or other lethal pandemic away from our political leaders caring about healthcare.
You can have the most privileged of lives and don't believe others "deserve" government provided healthcare.
The person who passes you with a cough at the mall does not have access to affordable care. She can't afford insurance, and only seeks treatment when she's at death's door. She is sick, and now so are you. Unknowingly, you infect your loved ones.
Your money, your insurance and your top of the line healthcare can't separate you, your family or your friends from the disease. Now, caring about the health of others seems a whole lot more important than it did before you contracted a disease.
Karma, they say, is a boomerang. Caring for others is caring for all.
5
The GOP isn't interested in freedom for the American people. Freedom from the worry about injury and disease is the most basic of all freedoms. The only freedom the Republicans care about is the freedom for the rich to keep every penny they can get their grubby little hands on.
5
Employer paid healthcare started as way to compete for scarce workers. By the law of unintended consequences, employer paid healthcare is now the reason we lack a popular demand for national healthcare.
Booming jobs numbers today so PK needs to complain about something else.
Remember: he predicted a economic meltdown after Trump election victory.
2
I guess the "death panels" the Republicans were referring to were in essence themselves.
3
I keep coming back to a brilliant moment in a debate between Jon Steward and former FOX conservative talking head Bill O'Reilly. In a particularly fascinating exchange Stewart notes that O'Reilly's own father retired from his company with disability benefits to help offset the cost of colitis treatments. At first O'Reilly denied that his own father received payments from a so-called entitlement, but then pivoted to emphasize that the payments came from a private employer. O'Reilly then argued these payments came from a private employer and therefore were not sourced from an entitlement program, but Stewart rightly argued that millions of hard-working Americans have similar illnesses but are not fortunate enough to work for employers that offer disability benefits (think of the millions of people working in the "gig" economy today).
This exchange is an important example of the double standard that conservatives hold for gainfully employed people who work for companies that offer comprehensive benefits packages, and other workers who lack access to comparable benefits.
4
Heaven forbid the rich would have to pay more in taxes so the poor and middle class can have affordable healthcare and their higher education or trade school covered.
About 4 million people have lost their health insurance thanks to Trump's ACA sabotage, on its way to 13 million vs. the Obama baseline. Republicans in the House passed a "healthcare" bill (the AHCA) that would have taken it away from 23 million. The 17 Republican states that haven't expanded Medicaid (many in the Old Confederacy) keep affordable care away from another 3 million or so.
Contrast that with Democrats, who expanded coverage for 20 million funded by moderate tax hikes on the top 1%.
Let's keep that in mind in November.
5
Krugman writes: "And this gets at the heart of conservative opposition to social safety-net programs: It’s not about the belief that they will fail, but about fear that they will succeed, and in so doing become irreversible — which means that they must be stopped before they can start showing results."
It makes no sense *why the GOP won't support Medicare-For-All, because it is one of the most fiscally responsible programs we could implement to save monumental amounts of money. In other words, a very "conservative" idea.
18% of our economy (i.e. GDP) is now spent on health care---- the highest of any developed country----- while other developed countries pay an average of 11%. If we only paid 11% of our economy for health care we would realize nearly $1 Trillion in annual cost savings. THAT my friends, is not a trifling amount!
Krugman is right-----Medicare-For-All would succeed "bigly" and that is why the GOP dows everything in it's power to see that it does not happen.
* It is simply because they are bought and paid for by the health insurance and pharmaceutical companies who largely fund their campaigns.
8
It's not only because they are bought and paid for by the health insurance and pharma companies. It's because the fundamental linchpin of conservative capitalism is to keep the people in a constant state of economic insecurity. As long as people cannot count on health care, social security, and any public safety nets, they will have to work desperately all their lives, on terms set by employers. They will also be persuaded to sink their savings into the stock market (lest they lose value to inflation), thus propping up the profits and paychecks of the Wall Street economy.
Racism has always been a reliable tool in persuading people to act against their own self-interest, lest a dime goes to "Those People," who are blamed for the problems brought upon all of us by the American oligarchy. As Upton Sinclair said, "Fascism is capitalism plus murder" -- because the kleptocrats could not get away with it unless they had a scapegoat to distract people and divert the blame. If we didn't have blacks to scapegoat, we'd have Muslims (oh, we already do!), Jews, Catholics, Mexicans, Asians, etc. For politicians and for priests, "others" are necessary for their public consolidation of power and hidden theft of common resources.
For once, let's not cut off our noses to spite our faces -- and the faces of "others" demonized to distract us as we are robbed. Health care deprivation is not a financial argument -- it's part of a political strategy to limit our freedom.
1
The reason for hatred of the ACA is because it was rolled out poorly and the mandate that Republicans hate wasn't strong enough.
You can't have universal coverage without universal participation. The ACA would be much stronger with a stronger mandate. The Republicans have killed the mandate.
If more sick people buy health insurance and more healthy people opt out the only way to keep insurance premiums lower is to get rid of standards and reduce coverage for the sick people buying it. That's exactly what's being done by Republicans.
The ACA with a strong mandate that made it universal and high standards of coverage would be fantastic. It would allow people who have great coverage from their employer to keep it and allow people who want to start their own businesses or who don't have coverage from work to buy it or get subsidies for it if they are below a certain income.
I fear that if we make a jump to Universal coverage in a single payer system the Republicans will reduce benefits and those who had good insurance through their employers will be very angry at democrats. A strong mandate with a public option would have made the ACA work as intended and be a very popular program.
4
Too bad GW Bush didn’t get his way in allowing a portion of Social Security proceeds to be invested in capital markets.
That would have been a game changer.
1
Yeah, right.
1
What worries me most is not the in-the-open votes in Congress on the ACA and other healthcare measures. It is the hidden attacks. And the one that is looming is the automatic spending cut that could be triggered by the huge deficit caused by last year's tax cut. The Republicans will suddenly care about those deficits again because they can aim them at healthcare spending.
6
Social Security has been with us since 1940 and despite the fact that it has worked for three generations of Americans the Republicans have been dedicated to ending it.
That Medicare has been working since 1966 for millions of Americans who might otherwise be destroyed by lack of access to affordable care means nothing to Republicans.
Polls repeatedly show Americans support and value these programs and over time they will feel the same for the ACA if it is given any opportunity to operate without constant Republican sabotage.
Even when the recipients of these contribute their income into SSN and Medicare, Republicans still whine as though the “users” are in their pockets, robbing them blind.
The central facts are the that today’s Republican party embraces the ideology of the John Birch Society and with that the idea that only the wealthy should hold unfettered power. The rest of us are peons to be regarded as an ugly threat to their wealth.
9
From what I see the Republican idea is that if you have money to pay for it then you can have it, meaning child care, health care, education etc. What can be paid for is war, destruction, welfare for corporations.
6
ACA is far from perfect, but I do appreciate that I have comprehensive coverage for a mild pre-existing condition that wouldn't have been covered in the free market prior to 2014. However, the monthly premium costs have become completely unaffordable. And these premiums are just the tip of the iceberg as we all know, since that just gives you the privilege of paying the entire $6500 deductible as well before the insurance company picks up a dime. How crazy is that?
SO, the problem is that neither Party is addressing the MANY underlying root problems & causes of our skyrocketing healthcare costs - fee-for service, outdated technologies, hospital monopolies, medical-related tort, high administration & advertising costs, poor lifestyle choices, and lack of cost consideration from patients themselves. All we are doing is moving money from one bucket to another with winners and losers in the end.
Address the root problems and causes or nothing will ultimately be accomplished with any healthcare policy change.
13
The thing is, a major reason premiums are rising is the number of GOP efforts to undermine the law - because while they haven't been able to repeal it outright, they've been able to do enough little stuff that won't make the front page, and that absolutely will drive up premiums.
Cutting funding for the "risk corridors" program, which helped give insurers support as they adjusted premiums in the early years of the law? That was the GOP. Killing the individual mandate, which pushes more and healthier people to get insurance, and which helps keep premiums lower? The GOP tax bill did that.
Obamacare wasn't perfect, for sure, but it's far less perfect now that the GOP has started "legislating" (quotation marks mandatory).
5
Thank you for pointing this very obvious component to the cost of our health insurance/care. Something must be done about the greed and out of control price gouging in the delivery system. But both sides get large amounts of campaign contributions from these very entities. Which is why you hear nothing.
1
1. All studies analyzing the effects of the ACA have shown that overall, and as the CBO has predicted, it has CURBED cost increases, compared to the previous system. And this was from the very beginning one of its main goals, so it's false to say that both parties don't care about this, as the passage of Obamacare proves that Democrats care a lot about this (whereas the GOP tax reform bill contains passages that are now ADDING a 30% premium increase, on top of the normal, slower increases caused by Obamacare). So on cost increases both parties couldn't be further apart - ten years ago, and still today, as it's thanks to the Democrats and they alone that the ACA still stands today.
2. Democrats have always wanted to add a public option to Obamacare, and continue to campaign on it, as it has been proven that this would be one of the most effective ways to drive down costs even more. Republicans strongly oppose it, and it was an Independent, GOP leaning Senator (Lieberman) who forced Democrats to take it out of the Pelosi House bill - bill that passed without any problem in the Dem House.
3. Single payer would certainly address many of what you correctly call "root problems & causes". Democrats know this. That's why Obamacare allows ANY state to switch to single payer already today. The only reason why on the federal level we have Obamacare and not single payer already, is because "we the people" didn't vote for a 60+ majority in the Senate that supports single payer too.
1
Newt Gingrich in the 1990's pronounced the death of the republican party if Democrats ever succeeded in providing universal medical coverage.
And so the vilification of Hillary Clinton, who had made a push toward universal health care then as First Lady, began in earnest via right wing radio/ propaganda outlets, and continued through to 2016 and (amazingly) beyond. A large slice of the US population (even those not yet born at the time) carries a vague, indiscriminate sense that Hillary is untrustworthy or somehow tainted, completely unaware that they've been influenced by a decades long disinformation campaign. Similar to those undertaken, by the same professional actors, to undermine the hazards of smoking and global warming.
The GOP knows universal health care will stick, and be popular, and be a Democratic achievement - and it scares them to death.
14
The must-buy insurance part of ACA wrankled a lot of people, me included. No other government law has had the same degree of requiring a resident of this country to actually buy something, to the perceived degree this did. You are supposed to have insurance when you drive, but you can opt to ride a bicycle or take public transportation.
I understand that without healthy folks paying in, there will be a deficit, just like any other insurance.
The disconnect that all lawmakers seem to have made is their simplistic approach that this be funded by directly associated taxes or fees paid. That has derailed the moving forward of providing basic health care, at reasonable prices along with drug price controls, to all citizens.
There is an enormous amount of money that can be pledged to having health care. We just need to make sure even the most bullheaded legislators know we demand it. The military spending, along with countless other examples of government funding, could be trimmed to allow as great of a benefit as would be had by building and operating another submarine.
The enormous reduction in stress and worry for so many people, by knowing they have basic coverage or complete coverage if we decide, would have benefits to this country which would be worth it.
4
This is just an artefact of the US's peculiar public culture.
Your income is taxed; you pay social security and Medicare taxes. So what's the real difference?
2
My state, Virginia, shows the playbook for the way forward. It turns out to be pretty simple: raise the percentage of people voting, and then vote for, and be supportive of, all sensible candidates. In November, we elected a very diverse set of new State House representatives and a new governor - some `traditional Democrat' (our governor) and some from the much for progressive end of the party. Finally getting much needed Medicaid expansion is a result.
9
In my office, health insurance premiums have almost doubled from last year. I'm guessing it has to do with the tax bill that tried to kick the legs out from under the ACA. Combine that with rising gas prices( and the inevitable rising food prices) and rising prices of steel and aluminum and we have inflation. Now combine the household debt that rising costs creates with the deregulated banks and we may be facing a Trump-republican slow down or much worse.
7
But Medicare, Medicaid and other health care spending cumulatively is breaking the budget, raising the debt and squeezing out other needed public expenditures.
Things like the Republican/Trump bill that lavished tax cuts on the 1% and their corporations, and which will drive up the deficit by trillions for the working and middle classes, is what "breaking the budget, raising the debt and squeezing out other needed public expenses."
10
Republicans break the budget then Democrats fix it. Also it is interesting that the bloated military and unnecessary wars are not budget busters. constructive programs that help people are.
5
One can make the same arguments about the US Defense budget which is equal to the next six largest country's military budgets COMBINED. And the US Defense budget raises the Federal budget and squeezes out other needed public expenditues - the major differnce is that HC spending provides the benefits of a healthy population.
Though I consider myself liberal, I cringe when I see liberals claim that health care is a "human right." I disagree; rights are guarantees that you will be left alone, for example, to speak your mind, worship (or not) at your own discretion, etc. It should not be used to describe access to services that cost money. Not all societies can afford health care for all. That said, in our enormously rich country, we CAN afford health care for all, and I support the single-payer model. That's a choice we can decide to make, not because it is a "right," but because a healthy population benefits....everyone! Personally, I have always had access to affordable health care. But it gives me no pleasure to know that others cannot. What possible benefit to society as a whole is provided by having a potion of the human population in chronic ill health?
2
So do you believe that, if someone with life-threatening injuries is brought to a hospital, the hospital has the right to refuse to treat him if he has no insurance? If so, I will concede that your view is at least consistent. But if like most people you think that it would be unacceptable to turn him away, you are already conceding that he has a "right" to expect reasonable efforts at care. A society has a moral obligation to do the best it can do to care for the sick and injured. The interpretation of that responsibility as a "right"may sound a bit presumptuous, but it is effectively the same thing.
8
I hear nothing from the Republicans about bending the healthcare cost curve down which is rising at around 2x inflation, they just tout free market, shop around, it's the insurance companies that are gouging you. If they repeal the ACA, then the people who used to be on it will start neglecting their primary care and use emergency rooms which are 10x the cost, and being they have no insurance or little money , the hospitals pass the cost off to private insurance which keeps going up every year. And the Republicans are pushing Medicare Advantage because they know that Medicare is running out of money. Now that fewer people are buying insurance thanks to the new tax reform, private insurance costs will go up for people who need insurance, like the ones on Medicare Advantage. But if you're rich or have a government paid Cadillac plan, who cares.
5
Hurrah! This is about insurance. The nature of insurance seems to be difficult to grasp. I once has to deal with an economist who did not want to contribute to an escrow account that might be used to cover the cost of the deductible in an accident, no matter who caused it. He said he did not want to pay for someone else's accident. Even when I reminded him that his car insurance, homeowners insurance, health insurance, and life insurance, were doing exactly that, he continued to rant. He seemed incapable of grasping the idea of sharing risk.
6
My husband and I are currently on Medicare. It is not cheap. We pay an additional $110 per month – and that’s the lowest amount available – for Medicare B. We pay $50 or more a month for our prescription program, and $300 each for the supplemental that picks up the cost that Medicare does not cover. Those costs are substantial - up to 20% of your medical bills. My spouse tried a Medicare advantage program and was paying a considerable amount out-of-pocket. We decided not to take the risk that a major illness would put us under, and so opted for the supplemental plan from AARP.
Therefore, each of us pays about $460 monthly for health insurance, even on Medicare. So those who believe Medicare is a free ride should think again. If anything, Medicare should operate more along the lines of Medicaid. A relative of ours who has a mild disability and works part-time receives Medicaid, and his treatment is free. He would not be able to afford treatment without Medicaid.
I am lucky to have Medicare, despite the costs, because the private insurance that we bought on the health exchange after I lost my full-time job was more expensive and offered less coverage. What we need is Medicare for all, with lower premiums, paid for over a lifetime by payroll taxes. We should all be guaranteed medical care, at affordable premiums. Other nations do this and it is simply untrue that we could not. We are living in a Third World country where the distribution of medical costs is concerned.
26
It's ludicrous that Trump administration officials now contend that taking away health benefits from individuals who are unable to find qualifying employment is a policy that may improve health outcomes.Virginia legislators have fought Medicaid expansion for years and now agree to it only because the work requirement was added.
It's important that the USA understand what these policies really mean: they are nonsensical policies pitched by GOP policymakers as improving health that actually do the opposite since people will lose access to health care.
4
Why don't conservatives believe that access to quality, affordable healthcare should be a basic human right? And why do they continue to believe that health care was EVER based on a free market system?
18
There were many provisions of Obamacare. Some provisions were supported by a majority and some were not. Paul refuses to make that distinction. For example, the vast majority were against the insurance mandate. The majority were against coverage of people who already had insurance signing up.
A substantial portion of sign ups were people who already had insurance and found a cheaper alternative. Close to half of those counted in the signups were under Medicaid. In short, people who got insurance with little or no cost signed up. Many others did not.
We started with Obamacare covering the 50 million uninsured and costing $100 billion a year. We still have 40 million uninsured and the costs are $300 billion a year! Where are those facts in Paul's report?
The Virginia governor's race was about a lot more than medical issues. Where is that fact in Paul's report?
1
What in the world are you talking about?
The Republicans made over 170 amendments to the ACA
before it was signed into law. They sabotaged "many provisions" and with the weakened and hobbled plan they renamed it "Obamacare" to put a blackface on it and make it easy to blame the president for its shortcomings.
As for "many people" against the mandate- well that's how insurance works. We all are forced to buy car insurance and some file claims and others never are in an accident but maybe we should ask "the people" if we should continue forcing people to buy car insurance.
I assure you Mr. Krugman knows a lot more about the state of healthcare in America than you or I do.
3
And people continue to believe that their employer provided healthcare is free when in fact a contributor to the flat income curve is that they already got a raise and a big one when the employers had to foot a larger health insurance bill. As a self employed contractor I get to see the bill directly and it is not pretty.
Reading about couples who have relocated to nice international locales they mention health insurance costs of $2-3000 which pales in comparison to my families $20,000 annual bill. I see the problem as multi faceted with both government and the medical industrial complex being at fault. However, the Republicans have been no help at all and truly do not have any clue about how to improve peoples lives here or anywhere else. Time to fire the GOP!
23
"A push that will succeed if Republicans hold the House.", Which will be determined by the voters and nonvoters in 2018. Too often in American democracy and perhaps in all democracies citizens have no idea what is best for them.
5
Krugman neglected an important point re the VA Medicaid expansion - it reflected a compromise between liberals and conservatives. Sure, more of the poor or near-poor will now receive health insurance (a liberal priority). But VA will now be one of several states which insist that most Medicaid recipients work in order to receive benefits. (The work requirement is waived, of course, for those who cannot reasonably work - children, elderly and those caring for small children.) But most are expected to work.
This is an important fundamental idea. Krugman is happy to talk about "a society in which access to essential health care is considered a basic right." But he doesn't speak about the responsibilities of citizens. Do we still believe in a free market where each adult must at least try to work to provide for themselves and their families ? If not, then what is to stop the thief from taking the shirt off your back on the basis that he needs it more ?
I'm not dismissing the idea of taxes to pay for common services. Liberals often miss the point that while Europe offers broad services, they also pay for it using broad taxes like a VAT (sales tax) of around 20%. This isn't that foreign. It's how our towns pay for their schools using property taxes set at the same rate for everyone. But the problem is that liberals are fearful that most Americans do not want to pay broadly higher taxes to pay for more government services. It hasn't happened since Medicare 50 years ago.
2
Most Medicaid recipients are elderly or children, and those who aren’t elderly or children are either already working (sometimes more than one job) or are taking care of children, elderly or sick family members. The insistence on work requirements generally adds little to society and tends merely to punish “Those People” who are assumed to be lazy, but in fact, are simply largely unlucky. Conversely, if you’re going to insist on work requirements for government largess, let’s impose them across the board so that before an investor can take advantage of preferential tax breaks like capital gains treatment, he or she must show that he or she has actually produced something of value (or taken a course on ethics) every month.
14
Let's get the facts straight. Per Kaiser (a well regarded and quite liberal health thinktank), only 12% of Medicaid recipient adults are not working because they are caring for someone else. And only 42% are working full time. That leaves about 12 million adults who are not working full time who could be.
https://www.kff.org/medicaid/issue-brief/medicaid-and-work-requirements-...
At some point, poverty is not about be unlucky or even being lazy. Many of the jobs taken by the poor are quite arduous. Rather, the key (per Isabell Sawhill of Brookings) is the choices that people make - getting an education, getting married before kids and (yes !) working full-time.
The cognitive dissonance among affluent liberals is just amazing. They actually understand Sawhill's "Success Sequence" quite well and insist on these things in their own children. But somehow, they choose to forget or excuse these lessons for "Those People". Bush called it the "soft bigotry of low expectations". Your intentions may be good - but the effect of your "soft bigotry" is no less destructive.
Finally a policy article. Trump sells, so that is what we read about and see on tv. Policy is boring, but so much more important.
10
In talking to my conservative friends, what really grinds them is not so much that it is a Government program, but they "they" are paying for 'them". They really hate paying for a benefit someone else gets without paying. That just doesn't seem fair. Why should I pay for your health care. Or as the T-shirt slogan goes: How much of my money are you entitled to.
To be be clear, I am not espousing these views. I am just saying we need to address these concerns and beliefs if we want to make any headway.
8
As a conservative being punished for my success with Obamacare surcharges, you are right. I detest Obamacare as redistribution and will resent it for all time.
19
The issue is we want to pay for those we love.
2
Until a person or someone in their family gets a serious illness and actually sees the bills that would immediately bankrupt them, they don't realize that "someone else" is effectively paying for their potential health care costs as well.
It is the nature of insurance. We all pay for our collective coverage, whether it be through a private or government program.
And, for the small percentage of people who cannot cover their insurance premiums, it is less expensive to subsidize their insurance than bear the direct costs when they delay care or need hospitalization. That is the nature of a caring society.
47
I agree with everything in this column except that "America will become like every other advanced country".
Americans are being ripped off by the health industry. We pay more than twice what other countries pay for the same service and the quality metrics show a worse outcome in terms of life expectancy, live births etc.
The health industry spends more on lobbying than the defense and oil industries combined. Health costs account for over 60% of personal bankruptcies.
65
I have no problem with the GOP repealing the ACA, provided they immediately replace it with something better (by way of improved health coverage and lower cost). But we already know they just want it gone and do not have the slightest idea how to come up with anything remotely more robust.
When people have a chance to be healthy and lead more vital and potentially longer lives with their families, they understandably don't want to give that up. It would have to be taken from them, and that is what Republicans are trying their hardest to do.
Why are they doing it? To get more money for themselves from lobbyists and donors and to shower ever more wealth on the richest of the rich.
When you cast your vote, you should ask yourself this one question: when it comes to my well-being, are these the kinds of people I want making decisions for me?
I know how I plan to vote. It will be a single party down the ballot, and it won't be the GOP.
36
The republicans have made the ACA a whole lot worse for middle class people who don't get assistance. My insurance doubled this year to $1100 per month after they took the requirement away and allowed insurers to raise prices as much as they wanted. Although, as you have pointed out in the past, that only affects a few million people who work in the gig economy or own very small businesses. The ACA is now crippling us. If it continues on this trajectory, it will become as unpopular as republicans desire.
6
Comparing Medicaid to Social Security and Medicare is a false narrative. Though Social Security and Medicare include heavy redistribution from rich to poor, at least everyone pays a fairly uniform flat rate as a percent of their income. (It's not entirely flat since SS taxes are capped above $128,000 while the affluent pay proportionally more Medicare taxes due to the Obamacare 0.9% Medicare premium.)
In Medicaid, however, the recipients mainly pay nothing in federal income taxes which funds Medicaid. (By contrast, almost everyone pays state taxes which are far more flat and historically paid half of Medicaid. But Obamacare tried to change this by making 90% of the Medicaid expansion a federal responsibility.)
But even with Medicaid, Krugman is largely correct. Even if most people in the middle neither pay most of the taxes nor receive Medicaid, they feel generous by giving something to the poor. But the point Krugman misses is that people put the brakes on when they need to pay for such largesse. A poll by AP showed that support for single payer craters to 28% vs 39% when they were told that their taxes would increase to pay for it.
https://www.theatlantic.com/health/archive/2016/02/people-have-no-idea-w...
So that's the liberal conundrum. Americans may warily accept more government benefits. But they don't want to pay for it.
3
"In other news, there are multiple reports that Republicans in Congress may make another attempt at repealing the A.C.A. this summer..."
Oh please, please, please do this Republicans. Nothing will serve to turn the coming "blue wave" into a "blue tidal wave" come November than a timely reminder that Republicans want to take away health-care coverage for tens of millions of Americans.
12
So, the question we should all ask is why Republicans work to thwart social safety net programs in the first place, especially since they have historically turned out to be successful and popular? Understanding the answer to that question would go a long way towards exposing the basis for their tactics.
2
There are 2 answers to your question. First, Republicans are philosophically opposed to government programs in general. They think that the larger and more helpful government is, the less free we are. But second, larger, fiscally responsible government requires higher taxes, and those tend to get paid by businesses and the very rich, who, coincidentally happen to own the Republican Party. From the point of view of the corporate masters, anything that interfere’s with their ability to make a buck is anathema and must be opposed.
3
Because we hate redistribution and want to live in a free society, where people succeed or fail in the marketplace. It’s called freedom from government. Government has a few legitimate purposes, basic infrastructure, military, police, etc, but social programs should not exist. I resent having the government take my money - yes, mine - and give it to someone else who doesn’t deserve it as much as I do as the one having earned it. It’s offensive and wrong.
1
DRS your selfishness is breathtaking. People born with a lifelong illness or disability, people who get cancer or in a serious accident want to live their lives in freedom. Freedom of not going bankrupt over healthcare expenses.
As a Brit. all I can say is only in America and FYI you don't know the meaning of freedom. It takes a village mate.
Republicans continue to push against the majority of voters on health care, the Dreamers and sensible gun regulation. It's time they pay the price for ignoring the will of the people.
19
"Once social programs have been in effect for a while, however, and it turns out that they neither turn America into a hellscape nor break the budget —"
This ignores the fact that our budget is dominated by entitlements. I guess we can continue to increase the amount and fraction of the entitlements with an aging population until there is nothing available for infrastructure, education, research and other items to improve rather than maintain.
What you call derisively call "entitlements" is something that I paid for through FICA taxes during my life, not a handout.
Republicans need to fix the system if it needs fixing, not creating "deficit emergencies" by lavishing tax breaks on the 1%, which they say then needs to be "fixed" by cutting Social Security, Medicare and Medicaid.
228
our budget is dominated by our military empire.
7
Right. The Defense Department is the biggest entitlement boondoggle of all time. Let's get rid of it.
7
Truer words were never spoke "It’s not about the belief that they will fail, but about fear that they will succeed, and in so doing become irreversible". I knew if the ACA could start and last a few years, it would be no more likely to be killed than Social Security or Medicare.
11
I agree with most of the comments on Dr. Krugman's OP.
But neither they nor Dr. Krugman have mentioned the incredibly more expensive medical care in the U.S. At present, overall medical care absorbs about 18% of the U.S. GDP--compared to around 10% in the other OECD nations. For this added expense, Americans get to die younger. Some reward!
A shift to public funding of medical care, combined with reasonable constraints on medical costs, should in time release about 8 percent of GDP for other purposes--infrastructure, education, etc. for ALL Americans. But that would not please the really high income citizens--some of whom are among the recipients of high American medical incomes.
Andrew Biemiller
42
Affordable access to a decent public education for our children and affordable access to decent medical care for ourselves--why on earth aren't democrats campaigning through the nose on these two issues. Tell all of us that republicans treat education for our children and our access to health care just like they treat broccoli. You decide if you want it and if you do, go ahead and pay for it. Go bankrupt if you don't spend all of your money on health insurance coverage and then need it when you or your family get seriously ill. That's your choice. Why should I have to pay for your health insurance coverage, say the republicans. Because everyone pays for your access to emergency medical care whether you can pay for it or not. And everyone pays taxes for the police to protect your property, regardless of whether anyone likes you. So why don't democrats start campaigning again on these themes and brand Trump to be a Russian stooge who got paid off a long time ago and has to hide it by calling everyone else names. And the republicans who lie down with Trump now all have rabies.
18
Dear Paul,
You shouldn't be so melodramatic. If history is any guide, the bulk of the ACA will remain intact. Once a benefit program is enacted, it is virtually impossible to kill it.
1
"...voters are, rightly, blaming Republicans for rising premiums." I sure hope you're right about that. It's certainly the case that if the GOP hadn't undermined the ACA it would be a better program but their public relations scams obscure a lot of that.
9
I have tp believe that all the people who support taking away health care must have nice policies from their job.
9
I suspect you're correct on that. Unfortunately, year-by-year many employers find increasingly creative ways to shift the burden (e.g. premiums, deductibles, and co-pays) of such policies from themselves to their employees.
3
Why are you blaming Republicans for rising premiums? Don’t you realize it’s due to insuring the uninsurable? And I notice there is no mention of the increasing cost to taxpayers.
1
@Jackson
No it's due to the elimination of the mandate. Do you know how insurance works?
29
Jackson:
A big reason premiums went up is because Republicans managed to undermine mandatory enrollment, thus guaranteeing that younger and healthier people could opt out of coverage. If you can't spread the risk, the price goes up for everyone else. This isn't complicated and "insuring the uninsurable" is a nonsensical explanation.
Another Republican-based problem relates to blocking the Medicare program from directly negotiating prices with the pharmaceutical firms.
As for the main reasons for our over-priced system--too much administrative overhead, over-priced medications/procedures/tests, over-sale of all sorts of health care--that requires a bipartisan effort to solve. The Republicans have hardly been committed to anything in these spheres (other than raiding Medicaid for tax breaks).
32
My wife had her own business policy prior to the ACA. It covered both of us, for $684 per month and a $3000 deductible. When the ACA came in and I qualified for Medicare, she had to get an ACA policy. To match the coverage of her previous plan it cost $960 per month with $3000 out of pocket. The next year it cost $1160. Then it cost $1320, and now it is $1560. The mandate or its abolition can have had nothing to do with first three increases.
I'm not sure that killing the ACA on the sly won't work. Having enough healthy people in the insurance pool is the only way to make it work. Republicans are succeeding at undermining this.
4
President Obama failed america. He should have held out for the public option. There were enough votes to pass it in reconciliation if not otherwise. It would have led to single payer health care.
10
One reason Republicans want to make healthcare for those in the bottom 50% almost impossible is rarely mentioned. They want those people to volunteer for the military - just about the only institution these days which both gives people affordable health care and which Republicans support. If you want the biggest military in the world you need cannon fodder.
16
Yes, what we need to do is to cut spending on medical care so that we can spend another trillion or so on our weak military, which is so underfunded and neglected. And infrastructure? Please! Who needs it? More guns, more bullets, more nukes, more guided missiles, What makes a country great is the size of its military.
11
Just two additional points. First, as Rachel Maddow noted last night, it was Republicans in Virginia, who still barely control the state house, who joined with the new insurgent Democrats to overwhelmingly pass Medicaid expansion. All the Democrats ran on health care and it seems that, at least in Virginia, the Republicans got the message--support Obamacare or be voted out. Republicans in other states are on notice. Second, it seems clear from the recent failed attempt (and "Thank you, John McCain") to repeal Obamacare in Congress that it's simple greed on the part of Republicans that is at the heart (or probably some other less noble organ) of their opposition to any social safety net programs. They don't want to pay the taxes to support a program that doesn't benefit them, but want that money back in the form of tax cuts that require social safety net cuts. And that's everything you have to know about Paul Ryan (until we find out why he back's co-conspirator Devin Nunes).
9
The Republican’s aim in health care is to prevent any kind of universal system from taking effect — ever. The ACA has many flaws, and it is nowhere near providing universal coverage, but the GOP attacked it with ferocious intensity. Trump’s role in this assault was to make it personal, by attacking Obama for having the audacity to propose a better way to bring down health care costs.
Yet Democratic support for Obamacare has largely been tepid, ceding the political discussion to the left-progressive wing and Bernie Sanders. The mid-term election offers an excellent opportunity for Democratic candidates to give voice to ideas that build upon the ACA but fix its flaws and open the path to universal coverage. A good first step might be to support the gradual expansion of Medicare, paid for by raising the Social Security withholding tax ceiling. The cap made sense 50 years ago, but it needs to be adjusted upward to capture more tax from (you guessed it) the nation’s wealthiest individuals, who pretty much aren’t paying near enough in any kind of taxes, courtesy of the Trump Destruction.
18
Medicare and Social Security are separate insurance plans and only Social Security has an income withholding cap. Removing the cap would buttress Social Security but it would take an act of Congress to divert funds from it to Medicare. At current withholding rates, Social Security is in better long term fiscal shape than Medicare with projections that it will pay full benefits (be solvent) until 2035 while Medicare is projected to be underfunded by 2029. Two fundamental problems for both are that more people are living longer and getting benefits while their offspring are having fewer children, resulting in less workers paying into the system. One partial but substantial solution to this would be to allow more immigrants to come here, work and pay taxes. As our clueless President said about healthcare reform: "Nobody knew it was so complicated."
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Raise the cap on SS = Raise the payout.
The wealthy will get even more money out of SS which frankly the deserve if they pay more in.
Support yourself in retirement.
I've stopped listening to the political rhetoric, which can also be referred to as gobbligook or gibberish, and started looking at legislators' actions. The results have been more than startling. Had single payer been initiated rather than ACA, I dare say, we wouldn't be having this conversation today.
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You would then be talking about the line you would be standing in for your care.
At some point, the drive to repeal the A.C.A. was so monomaniacal with House Republicans that it became a joke; remember the literally dozens of votes they took to do so knowing full well that it would never go anywhere in the Senate. Mr. Krugman spells out the reasons why they keel coming back to the same dry well, but I'd like to add one more.
Being a Republican these days means being in fervent denial. They fight against Obamacare for the same reason they insist climate change doesn't exist: because of the possibility that liberals are right about the issue. And if they're right on one issue, Heaven only knows what ELSE they could be right about. So every political argument is a last-ditch battle to be on what they consider to be the right side for conservatives.
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Mr. Krugman, you tout Medicare as a great example of an economically efficient, well-run, low-cost popular healthcare plan. And it is. So where is your, and the establishment Democrats, support to get behind Bernie Sanders Medicare For All plan? A plan, by the way, that is overwhelmingly supported by Americans of both parties. I hear Hillary and other establishment Democrats rail and scoff against it as wanting a pony. Yet, Canada has a pony. Great Britain has a pony. Japan has a pony. Germany has a pony. Sweden and Norway have a pony. Russia has a pony. Geez, even Syria has a pony for God's sakes. It seem like everyone has figured out a way to have this elusive pony, yet here in America, the richest country on the face of the earth, no pony. We have a corporate healthcare system with sky high premiums and outrageous drug prices. Other than progressive Democrats advocating for a single-payor/Medicare For All system, the Democratic party has not only been resistant to such a plan, but has been actively undermining progressive Democrats pushing for such a plan. If you really care about people having not only 'access' to medical insurance but actually 'having' medical insurance you would be calling out your establishment/corporate Democratic friends and colleagues for not supporting a Medicare For All plan. Please do so.
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Remember when Bill Clinton was President, and Hillary Clinton tried to get s health reform bill approved? The insurance companies joined the Republicans and successfully got the legislation voted down. President Obama learned from this, and worked out a solution that won insurance industry approval- and it barely passed.
Medicare for All is now possible because of these past battles. Incremental change is easier to implement- it lets people get used to the idea, and let’s flaws get patched before they can be exploited by opponents intent on making sure the proposal fails.
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Your confusing the myth of incremental change with the Democrats desire to please big $ donors first and foremost.
The ACA was crafted to ensure corporate profits first and healthcare second . It was fatally flawed from the outset even as I must acknowledge it had some key protections as part of the package .
The bottom line is the ACA is a conservative healthcare plan that the GOP cynically used opposition to to decimate Democrats coast to coast and take over governance of America . They don’t have any real beefs with it , they just saw it as a vehicle to achieve their real aim ~massive tax cuts for the wealthy.
If Democrats want to regain their relevance and purpose , they need to embrace MedicareForAll .
It’s great politics , the foundation of a Democratic resurgence, and it’s even greater policy .
Millions without health insurance and scores of milllons more with onerous out of pocket costs that dissuade needed care is not a condition that calls for gradualism , it’s a crisis and only the privileged and well heeled have the luxury to see it any other way .
We tried the GOP/Corporate approach and were spat upon and subsequently lost control of the entire Congress to RW barbarians.
Time for a bold Democratic approach. Time for MedicareForAll.
I hear you, but I think you mistaken in your strategy. Remember, the minute Obamacare was passed you had Chuck Schumer apologizing for it rather than fighting for it. The Democrats and the milquetoast Obama allowed the Republicans to set the narrative. A single payer system (Medicare For All) is hugely popular with the country (70%?), yet Democrats still won't run with it as a winning issue, instead calling it a pony. Well, we all know how that turned out for Hillary as she walks her dog in the woods. This is a winning issue for Democrats if they would just ditch their corporate donors and consultants and advocate for what the American public overwhelmingly wants. It takes political courage, something the spineless Democrats lack. It's an open secret that they stand for nothing and fight for nothing.
Conservatives still cling to the dream of denying healthcare to 20-30 million Americans because their Party subsists on two general types of citizens: The very well to do and comfortable middle class types who fear sharing the economy because in their mind, its a "loss" for them; the Fox news devotees, many of whom might benefit from expanding Obamacare, but who long ago lost ( or never had) the capacity to understand the republican scam of pitting social groups against each other on the basis of race, religion or economics.
To the extent that everyone has to assume some responsibility for election outcomes and ultimately legislation which affects their lives, it' never been more clear, if citizens in the Divided States actually want affordable healthcare, they may have to swallow their pride and vote for the Democrats in 2018. If they don't, they will knowingly be conceding away another social benefit, which the republicans will most graciously accept.
After the election they will have no one left to blame but themselves.
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Anyone who defends Medicare or Medicaid is complete disconnected from reality. All they have done is drive up prices by increasing the ratio of consumers to providers. USA today reported that a retiring couple will spend $275,000 on out-of-pocket medical expenses. Think about that; after paying into Medicare for an entire working career the benefit from the Democrats 'best' program is to pay more for healthcare than you would if you had no insurance at all. Good job Democrats.
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I am on Medicare, with a prescription plan from AARP and a medigap plan. I had cancer surgery at Sloan Kettering and a followup. I had to pay the immense sum of $280. If I have another 500 such operations, and my wife does too, I might reach your total. How likely is that?
I do have to pay about $100 every quarter for prescriptions, so if I live a really long time I could reach your total. Methusalah better look out!
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I'm assuming that the figure you quoted means the retiring couple did not purchase a supplemental policy to cover the 20% that Medicare does not cover. That is Medicare's only failing--that seniors are required to turn to the insurance company thieves to buy a supplemental policy.
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That figure you quoted, assuming it is correct, would cover medical expenses over many years. My wife and I have been on Medicare for 9 years, and both of us also have supplemental policies. I calculate it would take at least 25 years of medical costs to equal the amount you quoted. In the absence of Medicare, we would not remain healthy enough to live that long.
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Medicaid is the safety net for granny's nursing home care. After grandpa dies and she runs through the savings accounts, sells the house and spends that, Medicaid is all that is left to support her in her dying days. This applies to all families, not just "those people."
Of course people do support Medicaid.
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Without Medicaid for my mother my family would be in dire straights financially. I LOVE medicaid and am happy to pay even more taxes for it.
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For several years toward the end of her life, I helped support my mother, who had only SS to live on. I paid for "assisted living" ($4000/mo) activating my own retirement early to pay for it. Finally, she needed "memory care" ($10,000/mo), and I had to seek Medicaid for her. For her last few months, she was safe and well cared for. (And no, I could not quit work and care for a physically frail woman with a penchant for wandering.) Anyone with aging parents should think very carefully about gutting Medicaid.
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You do realize that granny is on MEDICARE, right?
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Mark Twain once said that the problem with Baptists is that they were afraid that someone, somewhere, might be enjoying themselves. In the same vein, the problem with Republicans is that they are afraid that someone, somewhere, is being helped by a government program.
The party's opposition to ACA is proof positive of this.
You touched on the key reason the GOP is desperate to kill off Obamacare: As with their opposition to Social Security and Medicare, they know Democrats will be campaigning on its success for decades to come.
My parents were alive when Social Security was being debated in Congress and told me stories about how Republicans were claiming it would end American life as everyone knew it. A Republican running for Milwaukee County Sheriff at the time told voters that anyone cashing a Social Security check would have their names reported to the police. I was alive when General Electric was paying Ronald Reagon to fly around the country warning that Medicare would cause thousands of doctors to leave the profession.
Each time, Republicans were lying and in each instance history (and actual facts) proved them wrong.
GOP opposition to ACA isn't based on facts but lies and deception It was thus when Sarah Palin lied about "death panels," it is now when Paul Ryan and Mitch McConnell lie about the supposed problems of a program that is helping tens of millions of Americans.
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It's really that someone, somewhere *other than them* might be helped by a government program.
When you need help, it's evil socialism. When I need help it's only fair and right.
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We have death panels: they are the health insurance companies.
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I work in healthcare and that is true. Why would anyone feel better about a for profit company being in control of your healthcare decisons.
Republicans don’t need to make another attempt to repeal ObamaCare, thankfully. By repealing the individual mandate, they sounded the ACA’s death-knell, unless they’re just willing to fund it forever at any levels, regardless of an increasingly major part of federal and state budgets that Medicaid consumes. They’ won’t do that; and it won’t be done even if Democrats take the House this November.
I write “thankfully” because it was a mistake to attempt a repeal of the ACA. Once you make the mistake of granting an entitlement without first assuring that you can pay for it, and allow a constituency to become dependent on it, it’s almost impossible to repeal it and survive politically. But it’s perfectly okay to let it strangle on its own monumental inconsistencies and in-built lack of strategic sustainability, blaming a liberal blindness to perfectly-predictable consequences. And when ObamaCare fails by forcing states to dramatically reduce benefits and by closing the queues for people seeking to sign-up, it will be blamed on Democrats … for NOT seeing those easily-predictable consequences.
If it’s a “plot” to let a Democratic program inevitably fated to fail that was rammed despite unanimous Republican rejection … to actually fail, then I suppose it will have to be acknowledged as a “plot”.
Long PAST time to re-imagine healthcare in America into ONE program that works for Americans and that we can afford. Only … keep Nancy Pelosi at LEAST five galaxies from the effort.
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“And if Republicans lose the House this November … America will become like every other advanced country: a society in which access to essential health care is considered a basic right.” (?! … ??!!!) Paul is engaging in spontaneous generation of pipe-dreams. Regardless of who wins this November, anything remotely like that will require a TON of work, and the ACA ain’t the means for such access.
Checked the sustainability of and general prospects for Britain’s NHS lately?
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Well, the thing is that Krugman didn't bother to mention the individual mandate. I guess it was for some solid reason. "We'll see..."
The NHS is very sustainable and as any program it must be improved and updated. And your solution to healthcare is?
Republicans have been working hard to make Americans drop dead prematurely for many decades now.
Republicans would generally prefer that Americans drop dead from poverty first.
But if Americans don't die from poverty, then death from lack of health insurance and medical care would be the next GOP preference.
And if Americans don't die from inadequate medical care, Republicans' 3rd choice would be for Americans to drop dead from one of the 300 million unregulated guns in the country....it could be either by homicide or suicide....the important thing is that Americans die prematurely.
And if Americans don't die from a bullet, then perhaps they'll die early from dirty water, air, earth and food thanks to magic of deregulation.
And if Americans don't die from their poisoned environment, Republicans hope that you'll simply overdose on opiates and pharmaceuticals and from living in a depressing state of Grand Old Poverty.
And if none of that works, then Republicans are always up for starting a war on false pretenses in order to send American soldiers off to die for nothing.
Almost all GOP public policies aid and abet premature death; Republicans want Americans to drop dead...the sooner the better.
But the good news, of course, it that there will be plenty of tax cuts to go around at America's funerals and burials....and that's always a great consolation to dead Americans and their families.
"Take two tax cuts and call me from the morgue !"
The GOP Doctor Is In.
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You nailed it, Socrates.
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This is cruel and cynical but it does have a little bit of truth to it. Many of the 1% want productive citizens whom they can manage to make profits from during their productive years and who conveniently drop dead when they enter their retirement years.
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Socrates, you are preaching to the choir, or at least the 157 million voting populace who have not been conditioned by Fox/Limbaugh to believe tht 2 + 2 equals 5.
The question is: When the Congress finally turns Blue, will it be possible to undo the damage?
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Medicaid is a unique health care program. It provides health services to the poor for free. That is not popular with Republicans. At the same time, the services provided are substantially restricted in many ways. The government spends $10,000/year on Medicare patients while it spends only $5,000/year on Medicaid patients. Medicaid patients lose out on providers, services, and treatment delays. Their emergency treatment is compromised by relatively long waits. And, overall, their life expectancy is less. The same is true of kids insure by CHIP. So the wealthier you are in the US, the better your medical care. Not many Democrats support inferior care for the poor.
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"Medicaid is a unique health care program. It provides health services to the poor for free."
"The government spends $10,000/year on Medicare patients while it spends only $5,000/year on Medicaid patients."
OK, so the takeaway is that Medicaid is free for the recipient but not for the taxpayer. If you think $5,000/year is not enough, what would you recommend? How much do you want to raise taxes (and on whom) to reach your new level of spending?
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You could repeal the corporate tax cuts for starters, a most unnecessary cut given that most corporations were doing just fine in 2017's economy. There's a big chunk of change.
Beggars can't be choosers.
There is an argument to be made that it has always been popular. Whenever a poll was taken on the subject, roughly 33% hated it (the same 33% that continue to hate it, but it's not racial), 33% approved and 33% wanted a more, encompassing, healthcare law, mainly, universal healthcare, But, somehow that added up to a majority disliking Obamacare while approving of all of it's provisions individually. Now that the conversation has moved on from how to implement a healthcare system to dealing with the healthcare system we have now, we see that most Americans have come to appreciate the incremental steps Obama took and don't want to lose benefits they've come to depend on. Meanwhile the Republicans continue to rant, rave and retweet lies about the system without offering a better alternative because Obamacare was their idea to begin with. The mind reels and he cynicism reeks.
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Moving toward universal health care like other developed countries have is not going to happen in one giant step. One way to get there is to start lowering the age for Medicare. The system is already in place and seems to work well. Lower the age to be eligible for Medicare to 60, then to 55 a few years later, then to 50 and keep going. How do we pay for this? Large employers will no longer have to provide medical insurance for a large number of employers. Those savings would then be shifted to new payroll taxes. And the private health insurers are not cut out. The could still offer supplemental insurance plans and Advantage Plans currently offered until Medicare would continue. Seems like a Win-Win for all.
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This would also begin to change the bias against older workers. But it could introduce bias against younger workers.
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In other countries conservatives don't believe in denying health care to citizens. Nor do they believe in ripping up the social safety net. In America we continue to hear how people who rely upon government assistance are weak, are moochers, or are just plain worthless.
The richest in our country just received a huge windfall of money courtesy of government created tax cuts. Huge corporations and industries hire armies of lobbyists to convince our elected officials at all levels of government that their tax burden is killing their bottom line. They get rollbacks on their property taxes, refunds for overpayments after they drop a few million on officials in government. And those breaks are made up by taxing us, cutting back programs that help us, and by cuts in education and health.
It's time for Americans to grow up and realize that access to quality medical care when and where we need it is good public policy. The wealth care industry is not going to care. Health insurance companies do not care about us. But we can elect officials who do and we should. We owe to ourselves and our children to ensure that all of us have access to medical care no matter what our employment or economic status is. This is not the 18th century. It's 2018 and it's time we joined the ranks of other civilized countries when it comes to universal health care.
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Tell all that to the deplorables, who support the destruction of this country and all the programs you just argued for and vote in the Republicans who work to implement the destruction.
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"...there are multiple reports that Republicans in Congress may make another attempt at repealing the A.C.A. this summer. Even if they don’t succeed, you can be sure that they will next year — if they manage to hold on to the House in the midterm elections."
If House Republicans aren't sent packing in November, in serious numbers, then we have lost this country. We will have answered Ben Franklin's admonition upon leaving the constitutional convention,
"It's a republic, if you can keep it."
At this point I am confident we won't have to say, "We're sorry, Mr. Franklin. We lost it."
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Thank you for this review, Dr. Krugman. Meanwhile, we have heard nothing from Republicans on improving access to care or controlling costs, the two biggest hurdles. Whatever happened to trump's 'beautiful health care plan, that costs less and provides better coverage?' Just another empty promise that he and Republicans have ignored. It is obvious that Republicans are not interested in improving our system, but cynically appeal to the small number of people who don't want to pay for insurance. And Republican voters, especially those in 'red' states who would benefit from having insurance, haven't made a peep. A prime example of people voting against their own interests (remember, the people of Kentucky elected the Republican candidate for governor who campaigned on dismantling the state's popular 'Obamacare' insurance program.) At this point, we must realize that our government will make no serious movement toward improving its citizens' lives unless Democrats are in control of Congress and the Presidency. Sad, but true.
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Obamacare has saved lives and prevented bankruptcies. It has also been the greatest political catastrophe this country has ever seen. The very people whom it was designed to help despise it, as can be seen from the way they’ve voted in every election since the law was passed. The Dems should be grateful that the most hated part of the law, the individual mandate, was repealed - they were never going to win another election until it was. If the GOP succeeds in repealing the rest of it, hopefully a lesson will have been learned, so that the next time around it will be Medicare for All.
We depend on public policy experts to investigate the likely consequences of the laws they propose. The smart, hard thinking, dedicated economists and health policy wonks who created Obamacare failed miserably in this regard. The only person who understood the political ramifications of Obamacare and who tried to delay or modify it was Rahm Emanuel but he was shouted down by the horde of do-gooders around Mr. Obama.
If public policy offends the sensibilities of the lower middle-class, they will vote against it, no matter what the economic consequences to themselves might be. So penalizing people for not buying health insurance is out. Assisting poor people without requiring them to “work” is out. Someone should tell Nancy Pelosi.
2
Ask, what is it in the Republican mentality that makes them so organized against good programs for the citizens?
SS came about as most people had no retirement plan, were left destitute and dependent on their family, and worse in 1929 when even the family had nothing to support them with.
Then recently we saw people who had worked for years denied health coverage due to some minor medical fault. Many have been forced into bankruptcy due to emergency care and hospitalization. Rrural emergency rooms were shut down as they ran out of money to pay the health workers. Children, single mothers, even working fathers were put into penury.
This seems to be what Republicans want. As I have said many times before, follow the money, and it leads to the HMO for profit industry, with its execs being paid tens, even hundreds of $millions by keeping costs low and profits high. Keep out those that need it, and enroll those that do not at the moment.
This is the GOP at work, not for you, but for the welfare of their "poor" friends and donors that keep them in office. They tell you it is for your better interests, you do not have to pay to help others. They and their leader Donald1 the Fabulists are engaged in greed that makes the Robber Barons look like public benefactors. Nowhere in our history have we seen such disgusting people in our government.
Theirs is an ideology of the most mean spirited, most anti good for the people wins. They must be declared unfit for our society.
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"SS came about as most people had no retirement plan, were left destitute and dependent on their family, and worse in 1929 when even the family had nothing to support them with."
When the program was enacted I believe the government had been collecting revenues for it for a few years before the first benefits went out. Most people didn't live past their mid-60s, so if you received benefits it wasn't for very long. Also, their were about 15 contributors for every recipient.
Now we not only have SS but also Medicare. People now live into their 70s and beyond. And there are only 3 contributors for every beneficiary. It doesn't take a Nobel Prize in Economics to see that the current system of entitlements is simply unsustainable in their current forms. What are the Democrats' plans to fix this other than raising taxes on the rich?
5
The first beneficiaries did not pay in, or did not pay in most. It was always in essence a Ponzi scheme and now the pyramid's base is crumbling. And it was constantly being expanded to cover more beneficiaries outside the original retirement funds. But SS also had as a purpose encouraging older folks to retire so younger folks had a chance at a job.
SS retirement age has been creeping up. That is one way it will be made more viable. It is also now being taxed -- unfairly because no one got a tax deduction on the amount that they were forced to pay into it. If disbursements are to be taxed the taxation should start only once what was paid in by the individual has been disbursed.
And raising the cap and taxing investment income could also help. Not everyone supports themselves by wage income - but everyone is likely to retire.
Ummm...not raising taxes on the rich, letting everyone pay their fair share based on their wealth. Start with taking back the ridiculous cuts for people who didn’t need them...and I’m not talking about the true middle class, say anyone making under $200 K. I’m talking about millionaires and billionaires. Pretty simple.
If we had true single payer health care instead of the piecemeal coverage and high costs associated with the ACA, the GOP wouldn't stand a chance. Their most recent attack has been to impose work requirements on Medicaid recipients, most of whom already do work. Those who don't, largely can't because of the high costs of employment. These costs include non-livable wages coupled with, to name just two, lack of transportation (either public or private) and lack of affordable child care.
Virginia pols didn't expand Medicaid out of the goodness of their hearts. On the contrary. Medicaid, GOP-style, is defined as punishing the poor, stressing them out, and sickening them even more. The rationale of Trump's HHS is indeed very similar to the racist claptrap spewed out by pseudo-scientists in the Jim Crow era: former slaves, those "experts" insisted, had been so much healthier doing backbreaking plantation work. Once they were freed, the propaganda went, they got sick not because of lack of medical care and education, but because they didn't have enough to do.
Fact-based studies reveal that work requirements to qualify for safety net programs do not improve health, they worsen health. In Wisconsin, where work became a prerequisite for getting SNAP benefits, more than three people lost benefits for every one person who gained employment.
If we had Medicare for All, the punishment factor would disappear. And so would hand-wringing columns about those nasty old Republicans.
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Neither the punishment or the hand wringing columns would go away. With Pubs punishment is in their nature, they will find something to punish the " others " for. If nothing else they will punish us " others " for not being Pubs. The columns will continue as long as the Pubs follow the adage that the beatings will continue until moral, or morality, improves.
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Fact: hospital unions in Colorado pushed for "single-payer" and were forced to explain the costs involved -- 125+ percent increase in state taxes.
Overwhelmingly defeated at ballot, 79%. Vermont won't do SP. Ditto, no on SP in Calif.
As usual, Mr. Krugman leaves out minor facts, such as 35% of adult Medicaid clients still smoking.
If he and BoyNee had the courage of their convictions, they lecture those Medicaid smokers about the costs they are imposing on non-smokers. That would be doing real work.
2
Though I do think that the columns would continue, because those nasty Republicans would have turned to their next prey, and continue to be what they have always been...
13
I think that the Republicans have come to regard themselves as invincible. They control 33 governorships, 32 state legislatures, the White House, the US congress and the Supreme Court. That is a pretty powerful political opponent/component. Admittedly when social safety nets prove to be effective the public is reluctant to give them up or have them tampered with. But the problem is like a person I am acquainted with said to me after several successful operations he has had as a consequence of finally having health insurance under Obamacare, "I don't have Obamacare I have the ACA".
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Steve wrote “I think that the Republicans have come to regard themselves as invincible. They control 33 governorships, 32 state legislatures, the White House, the US Congress and the Supreme Court.”
The problem is that we don’t know if our election results are legitimate. Election integrity advocate Jonathan Simon says that our vote-counting system is no different than the “man behind the curtain.” If we gave our ballots to a man wearing a magician's costume and a pin for his preferred candidate, he then goes behind the curtain to tally the votes, he comes out and says I’ve counted the ballots, shredded them and announces the winner would you trust the result?
"The people who cast the votes decide nothing. The people who count the votes decide everything." — Joseph Stalin
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It’s insane that every other developed country provides comprehensive, cost-effective health care coverage to all its people, yet the richest country in the world remains the lone holdout. The Canadian model of Medicare for all is the way to go. It covers 100% of the cost. 92% of Canadians like their health care system.
Real Canadians Talking Real Health Care https://tinyurl.com/ybunm9s8
Polls show that Americans support progressive policies, yet extreme rightwing Republicans hold large majorities at the state and national level. This makes no sense. In order to reverse Robinhood-in-reverse policies we must be able to hold politicians accountable at the ballot box, and it starts with going back to counting ballots by hand at polling places with observers present.
Germany, Ireland, Norway, and The Netherlands went back to hand counting after realizing the vulnerabilities with computerized voting. It’s the international gold standard.
German Court Rules E-Voting Unconstitutional https://tinyurl.com/za778ju
“The use of electronic voting was challenged by a father-and-son team. Political scientist Joachim Wiesner and son, physicist Ulrich Wiesner complained that push button voting was not transparent because the voter could not see what actually happened to his vote inside the computer and was required to place ‘blind faith’ in the technology. In addition, the two plaintiffs argued that the results were open to manipulation.”
#DemocracyDemandsTransparentVoteCourting
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Why would computerized election fraud be out of the realm of possibility when we have overt manipulation: voter suppression, gerrymandering, and big money?
There used to be concern about the vulnerabilities with computerized voting, but then it became taboo to talk about it.
- NYT: Computer Voting Is Open to Easy Fraud, Experts Say
- Washington Post: [Maryland Governor] Ehrlich Wants Paper Ballots for Nov. Vote
- Wall Street Journal: Reversing Course on Electronic Voting
- NPR: The Approaching 2006 E-Voting 'Train Wreck'
Jonathan Simon: How Much Faith Do You Have in the Vote Counting Process? https://tinyurl.com/yd9p2rg7
“The chickens are coming home to roost because we're seeing the breakdown of our political system. We maintain, those of us that have been looking at election integrity and taking this problem seriously, that a big part of that breakdown is the distortion of the public will that takes place when you don't count votes honestly and accurately, when it's not observable, when it's been outsourced. We as citizens have not just the right to an observable vote count, we have the duty to be participants in that process. If we really want a democracy we've got to work for it. Democracies were never sustained by lazy publics, so a big part of it is on us.”
More Simon interviews: http://codered2014.com/. You will learn new information from each one.
He is the author of "Code Red: Computerized Elections and the War on American Democracy” (2018 edition).
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Reality: Colorado voters overwhelmingly defeated the "single-payer" theory, 79%.
https://www.nytimes.com/elections/results/colorado-ballot-measure-69-sta...
Facts -- don't leave home without them.
3
Are you sure the electronic? votes were not reversed? Seems really strange.
After over 75 years of predicting abject failure of every advance of the social safety net - Social Security, Medicare, Medicaid, & the A.C.A. - one wonders why the Republican Party has any credibility left when it comes to evaluating a new social program. They have fought against each of these programs for years after they were proven to work & they had become depended upon by people. The GOP continues to try new ways to make it harder for people to receive Medicaid to this day.
I'm not quite sure what to make of their positions. I'm 68 & I've watched Republicans oppose every program that might help the less fortunate my entire life.
I've given up trying to understand if they are mean or greedy. Now that Republicans have become the Party of Trump, they have become even more difficult to decipher.
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"After over 75 years of predicting abject failure of every advance of the social safety net - Social Security, Medicare, Medicaid, & the A.C.A. - one wonders why the Republican Party has any credibility left when it comes to evaluating a new social program."
Social Security spending accounts for over $1 trillion dollars in the budget, and Medicare accounts for over $600 billion. Under their current structure, the government will be spending more in benefits than taking in for revenue in a few years. The introduction of the baby boomer generation will overwhelm it. Then what?
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@hm1342 Then what? Well many proposals have been made to solve this problem. Take the cap off the SS . People with earned income over a $1M (yes take home) only pay SS tax on earned income up $113K. That one tax reform would flood the SS with money.
Yes, raising revenue. Have you ever heard of it? There's a short fall, and rather then borrowing from the future, you raise revenue, from those that can afford it, through TAXES.
If you want a shiny new useless aircraft carrier, someone should pay for it other then raising the deficit.
If the GOP holds on to the House and Senate this November, they'll declare this to be a great victory and a mandate to further cut taxes on the rich and to cut spending dramatically. If the GOP doesn't entirely repeal Obamacare, it will seek to "further repeal" the ACA by ending provisions that raised taxes on high incomes and that increased spending, such as expanded Medicaid coverage. A lot rides on the November election even without considering the future of Trump and his agenda.
39
Tapping into a vein of white resentment has been the template for the GOP for decades. Welfare queens and chiselers prefer the public dole to a steady job and a decent income and Republican lawmakers don’t have to spell out whom they mean when campaigning or holding town meetings.
The intolerant GOP conveniently ignores the fact that millions of white families also benefit from safety net programs. Paul Ryan benefited from Social Security payments after his father died, money that helped to fund his education. It was okay then because Ryan was in need. He was on the dole as much as any down and out citizen who needs a helping hand.
Ryan doesn’t understand that many black and white families are in dire need today, for food stamps so they can eat, Social Security checks to help make ends meet and Medicare to help them with the high cost of aging.
Republicans are obsessed with destroying the ACA. That's more important to them than the health and well-being of Americans, especially senior citizens.
48
"Ryan doesn’t understand that many black and white families are in dire need today, for food stamps so they can eat, Social Security checks to help make ends meet and Medicare to help them with the high cost of aging."
Ryan understands this perfectly. He doesn't care and remains committed to his ambition (since college apparently, while he was on the "government dole") of gutting the safety net.
9
There is only one way to funnel the public's money to corporations: the complete destruction of this nation's safety net, including the life savings of most Americans who've worked a lifetime to retire.
Not only will Republicans try again and again to repeal or otherwise destroy Obamacare, given enough time in control of Congress, they will also finally get their thieving claws into social security. The will also drastically cut food stamps and enact strict work requirement, regardless of the fact that a good portion of recipients already work. It won't matter that millions of children, a majority white, will be even hungrier without food stamps or school lunches.
Meanwhile, we have Democrats who are publicly stating that they believe we shouldn't be talking too much about impeachment, lest the public tire of it. Those are the same wealthy corporate Democrats who've spent the last two years raising their TV profiles on CNN, talking about Trump and collusion.
This is the time Democrats should be out in the states talking to constituents and prospective voters about what Republicans are after. This is the time Democrats should be reminding those angry white voters that they will be losing their healthcare and food stamps - not the imaginary immigrant. Certainly not the imaginary Black Welfare Queen.
This is how Democrats will win, by doing the hard work of dispelling the Republican lie - not foiling Bernie and Elizabeth through the media.
--
https://wp.me/p2KJ3H-2Jr
83
Single payer healthcare is supported by key Democrats and a majority of Democratic voters, but not by the Democratic party leadership. On banking, we just saw 30 Democrats defect and vote for the reinstatements of practices aimed at targeting minorities in auto lending, and rolling back parts of Dodd Frank. Senator Heidi Heitkamp is proudly running on that, as are Joe Manchin and others. Then, the dirty trick of manipulating who shows up on your ballot are back.
This is a mighty strange resistance in these Trumpian times...
https://www.rimaregas.com/2018/05/31/in-trumpian-times-a-mighty-strange-...
32
"There is only one way to funnel the public's money to corporations: the complete destruction of this nation's safety net, including the life savings of most Americans who've worked a lifetime to retire."
When is Social Security slated for destruction? How about Medicare?
6
hm,
My guess is that they'll try to slip stuff into the end of year legislation. I didn't have enough room to spell everything out, but when I wrote social safety net, I meant all of it, food stamps, healthcare, Medicare, Medicaid, Obamacare, social security, SSI, you name it.
The GOP's goal is extraction.
1
I give my employees in my small business 401k and health insurance. I try very hard to be sure they get the same benefits I had growing up. I don't want them to stress.
It would be SO much easier if the government did its traditional job. If I did not have the burden of healthcare at the very least. And, with the tax cuts for the very wealthy, gutting of Obamacare, and a thousand tiny moves, Republicans want to drive me out of business. Or at the least make me flip the cost onto my employees. I won't do it and will cut my pay before that. You work a 40 hour week, you deserve security.
So my questions to Republican is this "what did I and my workers ever do to you?"
720
I'm in the same boat as you and to make matters more complicated I, the business owner, have breast cancer. Republican ignorance and evil threaten my life, my business, my employees' health and financial security. I currently carry an ACA compliant small group policy. Because this policy is ACA compliant, it requires insurance to pay for NIH approved trials and has an out of pocket cap on expenses. And of course the big one it prevents the insurance company from medical underwriting and skyrocketing our prices next year because one member of our tiny group had to actually use the insurance after twenty-five years of never reaching an insurance deductible. While I consider Republican lawmakers a hopeless cause, Republican voters look at yourself and your family, your neighbors, the man or woman trimming the lawn or your hair, your veterinarian in my case, and ask yourself to they deserve to be bankrupted or chased to an early grave because they lost the health lottery.
And for all those Republicans who believe somehow that only those who have poor health habits get sick and somehow deserve it, think again. I have never smoked, never drank, have a normal and healthy weight, exercise daily, and eat more than five fruits and vegetables daily, and I have cancer. Tell me again how I somehow deserve to lose everything because I lost the cancer lottery.
320
It may be that you aren't a billionaire or you didn't give them enough money to get a government contract.
31
I know people whose lives were saved by ACA. I know even more who escaped job lock because they now could get insurance from some place else. For many, the ACA is a life line tossed to a drowning man.
85
Affordable insurance for anything....fire, health, automobile....is a numbers game. Actuarial science is not debatable, it’s not theoretical. To affordably insure one person against a large claim you must have many insured persons who will rarely have a claim. “Medicare for all” accomplishes this and offers the potential to lower cost though administrative simplicity and price and quality competition. Vote informed in 2018.
373
This is exactly right. A single group (all Americans) would spread risk and lower cost. So few articles about American health care access really focus on this central tenet. Democrats must educate voters so they understand how this math works. Bernie, are you listening? This is your message!
23
Absolutely agree! This is a great NYT Pick!
18
From my own experience, "affordable" auto insurance is not a mandate. At least in New York State (that liberal bastion), if a driver has a poor record but still has a license, they are put into the "assigned risk" pool. Each of the insurance companies must take a percentage of these drivers, but the premium is based on age, where one lives, and driving record, and the premium can be quite high.
As for "affordable" fire insurance, I have never heard of any program for that. I know that flood insurance is heavily subsidized by the government (we the taxpayers), and I do resent that. One does not "need" to live by the coast in a flood zone.
3
The ACA was labeled “Obamacare” by republicans in order to attach to it a sense of condescending paternalism. Democrats, including Obama and Krugman should never have taken the bait.
In so doing they play right into the republican strategy and insight that words matter. See “death tax” etc.
81
This is true but the reality is much larger, the ACA or Obamacare was a very well crafted first start where none existed before. Most Americans very slowly began to realize that for the first time they had access to healthcare.
That is why it is so hard for the Republicans to slay this dragon, because they have NO alternative, zip, nada, none. All they have is that Americans will have the freedom to buy what they can afford, if you cannot afford healthcare to bad for you.
It is unknown if are when most Americans will learn that they have been played for fools. Unfortunately, this con involves more than healthcare.
13
Actually, I think that calling it Obamacare backfired on the Republicans. Barack Obama is now considered one of our great presidents by a significant majority of Americans, and I am proud to see his name attached to A.C.A., our nation's first attempt at universal health care.
12
What I find particularly galling is that the health care plan was originally a GOP plan, but they could not allow it to be passed by a Dem president. They objected all over the place and watered it down as much as possible, while the original plan was way closer to universal. So now they're just thoroughly upset that their [derogatory] label of Obamacare backfired and has become very popular.
14
As long as there is an Obama on Obamacare it will remain a rallying call for republicans. The hatred of Obama is visceral. I still get four or five emails a week that discredit or demonize Obama for fantastically false reasons. And if anyone would offer even the slightest dissent they ate thrown out of the tribe. Better to lose your benefits than lose your tribe. Another series of lies will be available to blame the other side
Meanwhile no one is doing anything to deal wuth the real crisis if health care—Cost
129
@ The Wizard
Uh ... how, more precisely?
@ John Morton
1. Obamacare, as the CBO predicted, actually seriously curbed cost increases - which was one of the main goals of the law.
2. Democrats still have lots of proposals that would reduce costs even more, and are ready to vote them into law as soon as "we the people" give them the legal power to do so.
For the rest, I fully agree with what you wrote.
You sound like Reagan. This is not a compliment.
@thewizard.
Private insurance is considered a form of redistribution also. it goes from the worker to the investor who sends it to medical providers and they take a cut for themselves. The US wastes money on a middle man redistributing from your income to a private insurance company. This is known as a private social expenditure it mostly just drives up costs.
https://mises.org/wire/social-expenditures-us-are-higher-all-other-oecd-...