Monday, May 5, 2014

Krugman: Obamacare, For All Its Flaws, Meets The Constraints Any Healthcare System Must Meet


... Here’s the essential fact about health care policy, which in turn fundamentally shapes health care politics:
Obamacare looks the way it does because it has to.
Once again, for those who missed it: if you want to cover people with preexisting conditions, you must have community rating. If you want to have community rating without a death spiral — that is, if you want to keep an acceptable risk pool — you have to have an individual mandate. If you want to have an individual mandate, you have to have subsidies for lower-income Americans. And that’s Obamacare: a three-legged stool, with all three legs essential.

And there you have it, your stool sample for the day.

If politics is the art of the possible, health care politics is the art of the very nearly impossible... and so it is with Obamacare. Originally conceived by old-style Republicans a few decades ago, Obamacare is what is politically possible today. Now it is the intent of today's GOP to use this admittedly clumsy system to bludgeon Obama with a stick they, not he, chose.

Could FDR have compelled a better health care outcome? It's irrelevant; we don't have an FDR in the White House, and we don't have the Republican Party he faced as the opposition. Instead, we have a GOP which has no interest in governing, only in winning an endless series of gotcha games. Obamacare is probably literally the best healthcare system possible... possible in America in today's real world, not in an ideal world, not in a progressive European country, but here and now. GOPers seem incompetent to come up with a replacement, and will probably harm even themselves if they try to uproot the system Mr. Obama succeeded in instituting. Everybody, including GOPers, may as well get used to it.

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