Paul Krugman responds to arguably the biggest canard put out by opponents of health care reform: that Democrats could have had it with no argument from Republicans and total support from the American people if only they had written a bill that barred insurance companies from discriminating on the basis of preexisting conditions.
The latest peddler of this utter foolishness is Peggy Noonan in the Wall Street Journal:
The public in 2009 would have been happy to see a simple bill that mandated insurance companies offer coverage without respect to previous medical conditions. The administration could have had that—and the victory of it—last winter.
Instead, they were greedy for glory.
Krugman explains why this piecemeal approach would not work:
Start with the proposition that we don’t want our fellow citizens denied coverage because of preexisting conditions — which is a very popular position, so much so that even conservatives generally share it, or at least pretend to.
So why not just impose community rating — no discrimination based on medical history?
Well, the answer, backed up by lots of real-world experience, is that this leads to an adverse-selection death spiral: healthy people choose to go uninsured until they get sick, leading to a poor risk pool, leading to high premiums, leading even more healthy people dropping out.
So you have to back community rating up with an individual mandate: people must be required to purchase insurance even if they don’t currently think they need it.
But what if they can’t afford insurance? Well, you have to have subsidies that cover part of premiums for lower-income Americans.
In short, you end up with the health care bill that’s about to get enacted.
Steve Benen points out that Noonan’s premise that Democrats “were greedy” is not only untrue, but laughably untrue — completely detached from reality:
It’s hard to overstate how incredibly wrong this is. The most obvious problem is that the president and his allies weren’t “greedy” at all — they gave up on single-payer before the process even started, and then compromised away several important elements in order to get it through Congress. The reform package — like Social Security and Medicare before it — is poised to be both a landmark achievement and a modest, moderate step forward.
Andrew Sullivan deflates yet another hot air balloon in Noonan’s op-ed: her assertion that Pres. Obama prioritized health care reform over all other pressing concerns in his first year:
The following is indisputable. Obama’s first act was increasing national security by ending the torture program, and pledging to remove the biggest recruitment tool for our enemies: Gitmo. His second focus was a stimulus package, which, according to AEI, added four points to economic growth. His third focus – how soon they forget – was on rescuing the banks. Before health insurance reform passed, he initiated and completed and implemented a total overhaul of the Afghanistan war. He maintained rendition and the Bush time-table for Iraq withdrawal. He tried (and failed) to restart the Israel peace-process but was stymied by Netanyahu. His policy toward Iran has seen the regime more vulnerable than at any point in its history. His success at finding and killing many Qaeda operatives, his dispatch of Somali pirates, his intense focus on drone attacks in Pakistan and Afghanistan: these are also simply facts of history.
Derek Thompson puts it even more strongly:
Obama “didn’t notice” the recession? What movie is Peggy watching, and on what planet? If she didn’t like the $787 billion stimulus, or the government takeover of General Motors, or the three months when bank bailout figures were so colossal we forgot what a billion dollars meant any more, that’s fine. Again, reasonable people can debate the administration’s recession-fighting policies. But first let’s agree that there were a lot of recession-fighting policies to debate!
After spending a trillion dollars on the economy, Obama turned to health care reform. That’s because he was overwhelmingly elected after running on health care reform, and in January Americans wanted him to follow through. Noonan’s last sentence is backward: The great recession changed things right away, but it didn’t change everything.
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