> The bill that passes is better than the ideal that doesn’t.
For your resume, sure.
Sometimes reform only works when you fully commit and if half the country isn't on board, it's not better to pass some mutilated and watered down version.
Yes, but it does not provide health care, it provides a subsidy to the health insurance companies (I.e., throwing even more money at lucrative companies that profit by denying coverage). It is sad that it is the best our government can do for us.
That seems like a difficult one to provide evidence for. A major problem in the US seems to be that they've got this impenetrable thicket of legislation around healthcare, insurance and employment that makes it impossible for people to make rational decisions.
Just not having that legislation, letting employment & insurance decouple and a sane market for healthcare develop might easily be better than the ACA.
> Just not having that legislation, letting employment & insurance decouple and a sane market for healthcare develop might easily be better than the ACA.
Maybe? But what is the mechanism by which employment gets decoupled from health insurance? That would require a different law, I suppose?
But that wasn't what I suggested: I said having the ACA is better than not having it, not that having the ACA is better than other possible alternative laws. I can think of quite a lot of alternative healthcare reform laws that would be significantly better than the ACA.
And I think it's reasonably safe to say that in "ACA vs. nothing else", ACA wins, if we judge by the millions of people who will lose healthcare coverage if the ACA were to be repealed and not replaced with anything new.
> But that wasn't what I suggested: I said having the ACA is better than not having it, not that having the ACA is better than other possible alternative laws.
It seems to be the only way to interpret what you suggested. How could it end up in a situation where there aren't other alternative laws? There are automatically laws governing what people do - laws exist. The conversation is entirely about which laws are best. In this case, I'm arguing that generic rules (not specifically tailored to healthcare) are probably better, since a generic market seems to outperforms the US healthcare system.
> And I think it's reasonably safe to say that in "ACA vs. nothing else", ACA wins
Well I can't control what you think but I can point out that it is a hard stance to provide evidence for. Healthcare is fundamentally less important than really urgent and essential services like food production or utilities and they manage to get great coverage with relatively limited fuss. The reports I've heard are that people find the situation in healthcare to be quite substandard.
I honestly don't understand why good healthcare should develop under free rational conditions. Why shouldn't a hospital charge your everything while you are in critical condition? I mean, it's a voluntary deal, take it or leave it, right?
You could ask the same question most things. Food and water for example - both more urgent and more necessary than most medical care. The costs are still low.
For food and water, if you were caught in a tough place, I suppose I could charge you for everything. But most people aren't refugees in a hostile land, so they have the time to drive around.
For a medical emergency it does make sense for a doctor to ask if you would like to voluntarily consider an interesting bargain.
The vast, vast majority of the spending in the healthcare industry is for things that you have time to drive around for.
And I'd still rather have a private option in the event of a medical emergency. Ironically, insurance in a free market is actually really good at sorting out that sort of risk. The insurance company has strong incentives to negotiate what will happen in an emergency and it isn't that hard to make agreements with people in advance.
I'm not really arguing against the ACA in particular, just the general sentiment.
I do, however, think the passage and defense of the ACA has completely stopped any kind of healthcare reform movements from Democrats and completely turned Republicans against the idea.
The ACA was more or less the GOP's healthcare reform plan[0]. They fought so hard against it because they didn't want the Democrats to get credit for it. The ongoing animosity toward it from Republicans is ridiculous, and Democrats are even further from being able to pass any more healthcare reforms than they were when the ACA was passed. The all-too-brief excitement for Medicare For All is somewhat emblematic of that.
[0] To be fair, it did go further than previous GOP proposals. They did include individual/employer mandates and a marketplace, but not stuff like the Medicaid expansion and higher taxes on high earners to help pay for it.
Maybe I wasn't clear. Let me try again. Many of the policies behind the ACA had long been championed by Republicans, or even originated in conservative circles. For example:
1. The individual mandate was something the Heritage Foundation (a conservative think tank) originally came up with back in the 80s, and was presented as an alternative to Clinton's healthcare plans in the 90s.
2. The state-based exchange system was something already present in some red states like Utah, and the concept is very similar to Republican proposals (again) back in the 90s. (This shouldn't be surprising: conservatives tend to prefer that states administer programs like these. Not a criticism; just noting a tendency.)
3. Much of the ACA's framework is similar to Republican Governor Mitt Romney's healthcare reform in Massachusetts from 2006.
Sure, there are parts of the ACA that Republicans genuinely didn't support (e.g. Medicaid expansion, high-income-earner tax increases, requiring insurers to cover contraception). But big, fundamental parts of it were similar to or exactly like conservative healthcare reform plans that had been proposed over the past couple decades.
The only reason I can see to explain why Republicans so vehemently fought and voted against the ACA (and have subsequently repeatedly tried -- and failed -- to repeal it) is because they didn't want Democrats to get credit for enacting it, and once it became "blue policy", it was automatically capital-B Bad to them.
It's also telling that Republicans have failed so miserably at repealing it (though they have done it damage). That's because they have no alternative... because the ACA is more or less what they wanted in the first place.
Actually come to think of it a very similar pole reversal happened in Canada with the "Trudeau/Liberal Carbon Tax" -- a program originally proposed by the British Columbia Conservative Party, first implemented in Alberta by a Conservative Party and proposed federally by Stephen Harper of the Federal Conservatives.
Yup, that's a huge reason why I think all of this is just petty bullshit from the GOP. Granted, even though Romney is a Republican, that doesn't mean that every other Republican has to agree with him.
While Romney has said a lot of mixed stuff over the years about the ACA, starting with pledging to repeal it during his 2012 presidential campaign, his more recent rhetoric has softened by orders of magnitude, voting against some of the repeal efforts, voting in favor of some modifications, expressing the need for a replacement plan before repealing it, and acknowledging that repealing it would cause millions of people to lose coverage. I don't agree with his position overall, but I think he's been a fairly "reasonable Republican" about it, including his belief that this sort of legislation belongs at the state level and not the federal level.
But there are plenty of Republicans in the House and Senate (more in the House, I suppose) that just seem rabidly, irrationally anti-ACA. Even while chanting "repeal and replace", they seem to forget the "replace" part of it.
Republican voters seem irrational as well: while opposition to it has softened since the Obama years, it's still pretty high (~70% or so), but you get weird effects. Like if you refer to it as "the ACA" instead of "Obamacare", Republicans don't hate it as much. Or if you don't mention "Obamacare"/"ACA" at all, and instead take a bunch of parts of the law and ask if they support them individually (like "do you support requiring coverage for pre-existing conditions?"), you see less opposition, and even see a majority of Republican voters supporting some of its provisions.
No, for everyone. Some voters like politicians who pass zero legislation while holding firm to their values. Occasionally they get rewarded. Most often, they’re branded–correctly–ineffective. (And, I’d argue, unfit to lead. If you’re using millions of Americans as human shields to pass an ideologically-pure package, that’s immoral and belongs with Twitter celebrities, not leaders.)
By that logic, we can never pass anything, ever. And that more or less is represented with congredd Grdidlock for the past 20 years. Is that a better outcome?
I see it as Sprint vs. Waterfall. Except Waterfall takes 8-10 years in policy to do and no one is in office long enough to finish the task. So we gotta pass in a lot of smaller tickets until we get there.
This attitude is why Trump is president. Yeah we have a terrible leader, but we could have had a mediocre leader and I guess that is somehow worse in people's minds.
For your resume, sure.
Sometimes reform only works when you fully commit and if half the country isn't on board, it's not better to pass some mutilated and watered down version.