Tidings of Comfort (Krugman article)

[dtotire]

Tidings of Comfort



By PAUL KRUGMAN
Published: December 24, 2009

Indulge me while I tell you a story — a near-future version of Charles Dickens’s “A Christmas Carol.” It begins with sad news: young Timothy Cratchit, a k a Tiny Tim, is sick. And his treatment will cost far more than his parents can pay out of pocket.Fortunately, our story is set in 2014, and the Cratchits have health insurance. Not from their employer: Ebenezer Scrooge doesn’t do employee benefits. And just a few years earlier they wouldn’t have been able to buy insurance on their own because Tiny Tim has a pre-existing condition, and, anyway, the premiums would have been out of their reach.

But reform legislation enacted in 2010 banned insurance discrimination on the basis of medical history and also created a system of subsidies to help families pay for coverage. Even so, insurance doesn’t come cheap — but the Cratchits do have it, and they’re grateful. God bless us, everyone.

O.K., that was fiction, but there will be millions of real stories like that in the years to come. Imperfect as it is, the legislation that passed the Senate on Thursday and will probably, in a slightly modified version, soon become law will make America a much better country.

So why are so many people complaining? There are three main groups of critics.


First, there’s the crazy right, the tea party and death panel people — a lunatic fringe that is no longer a fringe but has moved into the heart of the Republican Party. In the past, there was a general understanding, a sort of implicit clause in the rules of American politics, that major parties would at least pretend to distance themselves from irrational extremists. But those rules are no longer operative. No, Virginia, at this point there is no sanity clause.

A second strand of opposition comes from what I think of as the Bah Humbug caucus: fiscal scolds who routinely issue sententious warnings about rising debt. By rights, this caucus should find much to like in the Senate health bill, which the Congressional Budget Office says would reduce the deficit, and which — in the judgment of leading health economists — does far more to control costs than anyone has attempted in the past.

But, with few exceptions, the fiscal scolds have had nothing good to say about the bill. And in the process they have revealed that their alleged concern about deficits is, well, humbug. As Slate’s Daniel Gross says, what really motivates them is “the haunting fear that someone, somewhere, is receiving social insurance.”


Finally, there has been opposition from some progressives who are unhappy with the bill’s limitations. Some would settle for nothing less than a full, Medicare-type, single-payer system. Others had their hearts set on the creation of a public option to compete with private insurers. And there are complaints that the subsidies are inadequate, that many families will still have trouble paying for medical care.

Unlike the tea partiers and the humbuggers, disappointed progressives have valid complaints. But those complaints don’t add up to a reason to reject the bill. Yes, it’s a hackneyed phrase, but politics is the art of the possible.

The truth is that there isn’t a Congressional majority in favor of anything like single-payer. There is a narrow majority in favor of a plan with a moderately strong public option. The House has passed such a plan. But given the way the Senate rules work, it takes 60 votes to do almost anything. And that fact, combined with total Republican opposition, has placed sharp limits on what can be enacted.

If progressives want more, they’ll have to make changing those Senate rules a priority. They’ll also have to work long term on electing a more progressive Congress. But, meanwhile, the bill the Senate has just passed, with a few tweaks — I’d especially like to move the start date up from 2014, if that’s at all possible — is more or less what the Democratic leadership can get.

And for all its flaws and limitations, it’s a great achievement. It will provide real, concrete help to tens of millions of Americans and greater security to everyone. And it establishes the principle — even if it falls somewhat short in practice — that all Americans are entitled to essential health care.

Many people deserve credit for this moment. What really made it possible was the remarkable emergence of universal health care as a core principle during the Democratic primaries of 2007-2008 — an emergence that, in turn, owed a lot to progressive activism. (For what it’s worth, the reform that’s being passed is closer to Hillary Clinton’s plan than to President Obama’s). This made health reform a must-win for the next president. And it’s actually happening.

So progressives shouldn’t stop complaining, but they should congratulate themselves on what is, in the end, a big win for them — and for America.


http://www.nytimes.com/2009/12/25/opinion/25krugman.html?_r=1&ref=opinion

[Liberation Angel]

1. A Very high rec!

I am among those who say we MUST keep the pressure on for MORE progressives and MORE progressive dems in Congress.

"Politics is the art of the possible"

As a self-described progressive I am disappointed in what we did nt accomplish but pleased with MUCH of what was accomplished.

MANY of these provisions are laws which I would support in any bill.

Whatever ypur position, you must admot that this is better than anything the republicans would EVER pass.

It may be a small, incremental improvement. But it IS an improvement in many many respects.

Cheers.

[Selfevident]

2. Wow

A friend of mine told me to check out this site. I must say I'm slightly disappointed. Everything seems to be the repubs fault or the neolibs fault.Stop buying into the fake right left paradigm. Two wings of the same bird no matter who you choose the flight plan doesn't change. I will admit that getting rid of pre existing conditions is a good thing but thats about it for this bill. There are no cost controls. I don't know about you folks but I didn't want universal health insurance I wanted universal Health Care. Wake up we got sold out to the banks before and the health insurance companies this time.Corporatism at its best

[northernlights]

6. there can't be universal health care until there is infrastructure to support it

and the fact is that we currently lack that infrastructure.

We have the option of paying the penalty and paying for our health care out of pocket. I plan to use that option, since I've been without health insurance most of my life and when I did have health insurance the corporations left me to die anyway. I realize that's not an option for everybody, but I believe that those who can...should. I'm writing this as a Medical Lab Tech student. Imho, you're all putting the cart before the horse.

A major bottleneck to affordable universal health care is the shortage of facilities and trained providers. And the bottleneck to that education is student funding and the critical "clinical" training. Hospitals can only take on so many students at a time given the need for close supervision with a low teacher:student ratio to prevent medical disasters.

I'm pushing for Bernie Sanders 1350 or so new Community Health Centers (which I understand will also be training centers) to remain in the bill to provide low-cost health care to anybody who walks in the door. Increasing the number 4 or 5-fold (over the existing 350 community health centers) will make health care more available. 10-fold would be sweet! (btw, as an aside, building 1350 community health centers is *major* economic stimulus)

And increasing the grants and loans to students -- so weeding out is based entirely on ability to do the job as opposed to ability to finance learning the job -- is critical. Personally, I'm in a situation along with multiple other students, who may be forced out with one year of training to go due to terminated education loans. It's not our doing and at least 2 of us (myself and one other student) are 4.0s. We could face financial ruin and you could be short several providers as we were blindsided by fine-print rules...that were on a financial aid web page that isn't even public!

The bottom line is that health care is a *Community Service* and should be funded by the community. That means infrastructure and training. Fund the training -- train more providers and stop burdening healthcare students with loans the size of a hefty mortgage -- and service fees will come down.

Without the infrastructure to deliver, universal health care and single payer remain impossible. The fact is that until more *health care* is available, in terms of more trained medical staff and more facilities (beds), both universal health care and single payer will remain out of reach. This is a case where supply-side economics will work.

So I strongly recommend that all of you quit whining about the "sellout," recognize where the real problem lies, and help focus on that. The journey of a thousand miles begins with a single step. And that first step is within reach.

FWIW, I can see a scenario in which, as more and more community health centers come on line, providing lower cost health care while training more and more students, people will start "opting out" of the insurance industry and paying the "fine" (think "tax for down payment on community centers")

[ShortnFiery]

9. "Corporatism at its best"

Well put and FWIW = Welcome to DU. :hi:

[BlueMTexpat]

3. +1!

So long as we don't stop here. It is, at least, a start and the status quo is untenable.
The Rethugs ... and by their actions they have shown that is exactly what they are ... must be removed from office. The craven Blue Dogs must also be removed. And LIEberman must be stripped of his committee chair and ultimately join his kindred spirits in the corporatocracy.
Thw 60 votes rule in the Senate must be repealed ASAP to prevent such stasis and watering-down in the future.
The years since 1980 have skewed the US political spectrum much too far to the right. It will take time to get the system anywehre near a functioning track.
But this is a beginning. If nothing else, passage of the Senate bill has made the right wing go truly ballistic; that in itself is a plus.

[DLnyc]

4. "...have to work long term on electing a more progressive Congress..."

Yes, think primaries for 'moderate' (aka owned by insurance companies) senators.

The idea that Ben Nelson and Joe Lieberman are just voting the way the constituents want is, I think, bullshit. They are voting the way their corporate donors want, and AGAINST their constituents.

[Land Shark]

5. Good DU citizens check for duplicates. nt

[shellgame26]

7. excellent article

Strange, this thread is almost silent.

[ShortnFiery]

8. Eat Me Krugman. :P