Tuesday, October 29, 2013

Fwd: qotd: Michael Lind expands on Konczal’s concept of government versus private social insurance

Quote-of-the-day mailing list

-------- Original Message --------
Subject: qotd: Michael Lind expands on Konczal's concept of government
versus private social insurance
Date: Tue, 29 Oct 2013 13:13:30 -0700
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>

October 28, 2013
Here's how GOP Obamacare hypocrisy backfires
By Michael Lind

The smartest thing yet written about the botched rollout of the
Affordable Care Act's federal exchange program is a post by Mike Konczal
of the Roosevelt Institute at his "Rortybomb" blog at Next New Deal.
Konczal makes two points, each of which deserves careful pondering.

The first point is that to some degree the problems with the website
have been caused by the overly complicated design of Obamacare itself.

Konczal's second point is even more important — the worst features of
Obamacare are the very features that conservatives want to impose on all
federal social policy: means-testing, a major role for the states, and
subsidies to private providers instead of direct public provision of
health or retirement benefits.

This point is worth dwelling on. Conservatives want all social
insurance to look like Obamacare. The radical right would like to
replace Social Security with an Obamacare-like system, in which mandates
or incentives pressure Americans to steer money into tax-favored savings
accounts like 401(k)s and to purchase annuities at retirement, with
means-tested subsidies to help the poor make their private purchases.
And most conservative and libertarian plans for healthcare for the
elderly involve replacing Medicare with a totally new system designed
along the lines of Obamacare, with similar mandates or incentives to
compel the elderly to buy private health insurance from for-profit

Will the flaws of Obamacare really hurt the right and help center-left
supporters of universal social insurance? I doubt it.

To begin with, this implies a willingness of the right to acknowledge
that Obamacare, in its design, is essentially a conservative program,
not a traditional liberal one. But we have just been through a
presidential campaign in which Mitt Romney, who as governor of
Massachusetts presided over the creation of the most important model for
Obamacare, rejected any comparison of Romneycare with Obamacare

Nor are progressives likely to press the point in present or future
debates. Unlike conservatives, who are right-wingers first and
Republicans second, all too many progressives put loyalty to the
Democratic Party — most of whose politicians, including Obama, are not
economic progressives — above fidelity to a consistent progressive
economic philosophy. These partisan Democratic spinmeisters are now
treating Obamacare, not as an essentially conservative program that is
better than nothing, but as something it is not — namely, a great
victory of progressive public policy on the scale of Social Security and

In doing so, progressive defenders of Obamacare may inadvertently be
digging the graves of Social Security and Medicare.

If Obamacare — built on means-testing, privatizing and decentralization
to the states — is treated by progressives as the greatest liberal
public policy success in the last half-century, then how will
progressives be able to argue against proposals by conservative
Republicans and center-right neoliberal Democrats to means-test,
privatize and decentralize Social Security and Medicare in the years ahead?

I'm sure a number of token "centrist" Democrats will be found, in due
time, to support the replacement of Medicare by Lifelong Obamacare. And
with neoliberal Democratic supporters of the proposal as cover, the
overclass centrists of the corporate media will begin pushing for
Lifelong Obamacare as the sober, responsible, "adult" policy in one
unsigned editorial after another.

Once Medicare has been abolished in favor of Lifelong Obamacare, perhaps
by a future neoliberal Democratic president like Clinton and Obama,
Social Security won't last very long.

The conservative Republicans and centrist Democrats will argue that the
success of Obamacare, in both its initial version and the new and
improved Lifelong Obamacare version, proves that a fee-based,
means-tested, privatized and state-based system is superior to the
universal, federal, tax-based Social Security program enacted nearly a
century ago in the Dark Age known as the New Deal.

The genuine progressives will respond with a defense of Social Security.
Whereupon the faux-progressives, the neoliberal heirs of Carter, Clinton
and Obama, will reject the option of preserving Social Security — why,
that's crazy left-wing radical talk! — but insist that the subsidies for
the poorest of the elderly be slightly increased, as the price for their
adoption of the conservative plan to destroy Social Security. Throughout
the process, the right-wing Republicans and neoliberal Democrats will
ask, "How can progressives object to means-testing, privatization and 50
state programs, when those are the very features of the Obamacare system
that our friends on the left celebrate as a great achievement?"

Think about it, progressives. The real "suicide caucus" may consist of
those on the center-left who, by passionately defending the Affordable
Care Act rather than holding their noses, are unwittingly reinforcing
the legitimacy of the right's long-term strategy of repealing the
greatest achievements of American liberalism.

(Michael Lind is co-founder of New America Foundation.)


New America Foundation
The Next Social Contract
By Michael Lind

The Affordable Care Act, backed by President Barack Obama, focused on
the problem of coverage rather than costs. The ACA rejected the New
Deal/ Great Society tradition of universal, taxpayer-based social
insurance for the conservative alternative of tax expenditures and
individual mandates to purchase private health insurance.

While some elements of the law are laudable, as a whole the ACA combines
all of the faults of the bad approaches to public policy, while
rejecting the sound approach of universal federal social insurance.
Means-tested subsidies, tax expenditures, and elaborate federal-state
hybrid systems (in this case, health care exchanges) are all united in
an overly-complicated system. For working-age, non-poor Americans, the
Affordable Care Act (ACA) envisions a transition from system of tax
expenditures based on employers to another indirect system based on tax
subsidies to individuals purchasing insurance in state-created exchanges.

In the long run, the health insurance system should be integrated into a
single, life-long, comprehensive social insurance program. As a step in
that direction, Medicaid and SCHIP, two inefficient and unfair
federal-state hybrid programs, should be completely federalized and
merged with Medicare.

The U.S. health insurance system is likely to move either toward
efficient social insurance or toward inefficient and costly
voucherization of the social insurance elements like Medicare and
Medicaid, combined with rationing of health care of a kind unknown in
other advanced industrial democracies. For reasons of solvency and
fairness alike, health insurance needs to be absorbed into an expanded,
comprehensive American social insurance system.

Report: "The Next Social Contract" (44 pages):

Comment: Mike Konczal's article covered in yesterday's Quote of the Day
message has received considerable attention in the blogs, since his
concept was a real eye opener. While most are distracted by the
temporary kludge of the opening of the federal Obamacare exchange
website, the real lesson is that the complexity of coordinating all of
the entities that are involved in enrolling individuals into the
exchange plans confirms the complexity of Obamacare itself. The
computers will be fixed, but Obamacare can never be.

Michael Lind of the New America Foundation elaborates on Konczal's
observation that the neoliberal Democrats have adopted the
conservatives' model of reform - "a fee-based, means-tested, privatized
and state-based system." Even though neoliberals and conservatives
theoretically are bitter enemies (witness the insults hurled over the
shutdown of the government), and battle publicly over Obamacare, they
are silent partners in delivering to the nation the
Heritage/Romney/Clinton/Obama model of a largely privatized health care
financing system.

The New Deal/Great Society approach to our social insurance programs -
Medicare and Social Security - was to make them federally administered
and federally financed, an approach then supported by centrists and
liberals. Now we have a conservative program - Obamacare (that really
isn't social insurance, especially when considering how many are left
out) - that is now supported by centrists and silently by conservatives
(e.g., Ryan's Republican voucher plan for Medicare).

Publicly, only the liberals are standing up for expanding an improved
version of Medicare to cover everyone. Many of the centrists also
support it but are toeing the neoliberal line of Democratic Party
loyalty by remaining silent (not to mention the fear of offending their
health industry campaign contributors). Most conservatives recognize the
superiority of the single payer model in achieving the goals of
universality, equity, and affordability, but many are also libertarians
and are opposed to those goals simply because of their ideology.

We need to abandon the process of trying to meet on common ground
through the Democratic and Republican parties. Virtually all liberals,
most moderates, and some conservatives agree that everyone should have
health care and that it should be financed equitably through an
administratively efficient program. When we vote we should ignore the
candidates' political parties, but instead vote based on their advocacy
for health care justice (and other forms of social justice). For those
who do not think that is feasible, all we need is more visibility (a
cryptic comment if there ever was one, but use your imagination).

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