I am one of those lefties who had many problems with the administrations handling of the health-care debate, from their desperate need to achieve bipartisanship, which basically resulted in Max Baucus writing chunks of the bill, to their view of the Public Option as nothing more than a bargaining chip to dangle in front of Blue Dogs and those imaginary republicans who would support the bill. But in the 2 years since passage, two things have happened that are good and dismaying.
On the positive side, the administration is implementing the law the way we had hoped, meaning HHS is usually erring on the side of consumers, whether it comes to the Medical Loss Ratio(MDL) or contraception access. Consumer watchdog, which is an amazing consumer advocacy group that doesn't hesitate to bash the administration has offered a lot of praise for their rejection of many state waivers from the MDL, with few states being granted waivers temporarily so their insurance market could adjust to the changed regulatory d ynamic. Probably the most underreported aspect of the law has been the Medical Loss Ratio (MDL), which requires insurance companies to spend 85% percent of premium money on patient care, and any of the untapped premium money to get reimbursed to customers. It's expected that 2-3 billion dollars worth of checks will be sent back to customers YEARLY once the law is fully implemented, and just so you know a bipartisan groups of legislators, led by Mary Landrieu, are about to introduce legislation that will gut the MDL requirements, an obvious nod to the insurance industry. In fact, MDL is such a big deal that the two largest insurance companies, Wellpoint and Aetna, are doing drastic changes to their business models, first reported in Forbes but recently also in the Huffington Post. The combination of the MDL along with the consumer protections (no pre-excisting condition ban, no recissions, no annual and lifetime caps etc...) has....GASP...made those 2 companies focus less on a premium based revenue stream and more on a quality care based revenue stream. Thats a big f%^king deal, in the words of the immortal Joe Biden. Along with the MDL, the law has so far outperformed expectations in young adult coverage, Medicare saving for seniors via preventive care and drug costs, and according to Kaiser is beginning change hospital behavior and thus overall growth in the sector. So these are all great stories about the law before even the exchanges, medicaid expansion, subsidies and full implementation come in.
Now this gets me to my second point: liberal apathy towards the law, and complete disregard to its real life consequences while in search of a larger objective, mainly ending the for-profit insurance industry, an objective I wholeheartedly share. I get why liberals were routinely miffed about the sausage making and sometimes the end-result. Now I was never, and still am not, a person who critiques the law for not being single payer because I don't compare it to policy options that aren't available, no matter what you tried to do, and that's what the single-payer advocates are suggesting. But I was, and still am, a big advocate for the public option and I think it could've passed if the Obama admninistration viewed it less cynically. So I have my problems with how the law came to be, and although there are liberal supporters of the bill who argue there weren't other avenues available that could've resulted in a better bill, I disagree with that assessment. There was passable provisions like a PO and repeal of McCaren-Ferguson, with the former obviously being a heavier life and requiring niftier maneuvering. .
That being said, this lack of defense for the law from the expected quarters has resulted in many liberals, from Cenk Ugur to Bill Maher, to flippantly characterize the law as a giveaway to the insurance industry and completely dismiss it as negligible. But what caused me to write this post were 2 things, first was when Armando, a frontpager I have immense respect for, had a piece that essentially described the health care law as not bound in progressive principals and thus not a reason for progressives to vote for Obama, because it ultimately was a marginal step forward...if that. When Armando has the view, someone who isn't perpetually confrontational to the administration like some liberal blogs, it means this apathy is deep and could be systemic. Then Robert Kuttner, someone I hugely admire, wrote a piece about amicus briefs written in oppisition to the healhcare law from single-payer advocates. All you need to know where he goes wrong is a line in the first paragraph:
They point out the inconvenient truth that, contrary to the administration’s representations, the government did not need to require citizens to purchase insurance from private companies in order to meet its goals of serving the health-care needs of the populace. Congress could have enacted a single-payer law.
http://prospect.org/...
What Kuttner and the proponents of the Amicus brief are advocating are not inconvenient truths, unfortunately imo. Lets be clear, congress COULD NOT have enacted a single-payer law...not even close. It was not doable half a century ago when the country and the government were much more amenable to that solution. If you don't think a policy that was LEGITIMATELY a government takeover where people's plans would actually change involuntarily couldn't be demagogued in the crib, you're mistaken. It wouldn't just be a lost, it would be a bad one, and like Bush with SS privatization, if you swing for the fences and badly miss, you don't get a 2nd chance but instead end the debate on the whole political excercise.
Now there are liberals like Jonathon Cohn and Ezra Klein who sing the praises of the law, and Obama's biggest liberal critic on economic issues, Paul Krugman, is a huge fan of the law and routinely says that a single-payer system is preferable, but there is more than one way to skin the cat. So I don't want to make it seem like the critics represent a majority of liberal elite opinion, but they do represent a significant minority in my view. And what this basically tells me is that what liberal elites don't understand that conservative elites do is that incremental success is the name of the game. You never come in whole-hog and try achieve your end-goal in one session, especially on big social domestic policy, its insane. The problem with Paul Ryan is, unlike his earlier republican brethren, he's swinging for the fences..and he will fail miserably. Conservatives would have handled the healthcare victory by building up support and enthusiasm for it while also mainstreaming the idea of public option so it could be pursued legislatavely sometime in the future. They do this because they know that for any progress (or regress in their case) to be made, step 1 needs to work and be popular...and thats how you work your way to step 5. You don't demean step 1 as insufficient and meaningless because it doesn't do what step 5 would've done.
So my point is, with liberals raging on about everything from keystone, to cuts in budget deals as Obama betrayals(some of them legitimate), they need to quit being apathetic and indifferent to the biggest medicaid expansion in history...along with the best consumer protections in history. Arguably a major change, but assuming its incremental, it still needs to success for further change to remain on the table.