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Monday, October 28, 2013

Paul Krugman: The Big Kludge

Did Obamacare have to be so complicated?:

The Big Kludge, by Paul Krugman, Commentary, NY Times: The good news about HealthCare.gov, the portal to Obamacare’s health exchange, is that the administration is no longer minimizing its problems. That’s the first step toward fixing the mess — and it will get fixed... But while we wait for the geeks to do their stuff, let’s ask a related question: Why did this thing have to be so complicated in the first place? ...
Imagine ... a much simpler system in which the government just pays your major medical expenses..., you wouldn’t have to shop for insurance..., you’d be covered automatically by virtue of being an American.
Of course ... such a system ... already exists. It’s called Medicare..., and it’s enormously popular. So why didn’t we just extend that system to cover everyone?
The proximate answer was politics: Medicare for all just wasn’t going to happen, given both the power of the insurance industry and the reluctance of workers who currently have good insurance through their employers to trade that insurance for something new. Given these political realities, the Affordable Care Act was probably all we could get — and make no mistake, it will vastly improve the lives of tens of millions of Americans.
Still,... Obamacare is an immense kludge — a clumsy, ugly structure that more or less deals with a problem, but in an inefficient way. ... And the main reason that is happening, I’d argue, is ideology. ...
Republicans still dream of dismantling Medicare as we know it, instead giving seniors vouchers to buy private insurance. In effect..., they want to convert Medicare into Obamacare.
Why would we want to do ... these things? You might say, to reduce the burden on taxpayers — but Medicare is cheaper than private insurance...
No, the assault on Medicare is really about an ideology that is fundamentally hostile to the notion of the government helping people... And this ideology, at a fundamental level ... is why Obamacare ended up being a big kludge.
In saying this I don’t mean to excuse the officials and contractors who made such a mess of health reform’s first month. ... For now, the priority is to get this kludge working, and once that’s done, America will become a better place.
In the longer run, however, we have to tackle that ideology. A society committed to the notion that government is always bad will have bad government. And it doesn’t have to be that way.

    Posted by on Monday, October 28, 2013 at 12:27 AM in Economics, Health Care, Politics | Permalink  Comments (139)


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