Getting Paid to be Contrarian is One Thing....

Part of how you get commentary published, it seems, is coming at issues from an angle that at least some of your audience hasn't seen before. But sometimes, perhaps often, the angle tells us more about the person writing the commentary than about the issue they're addressing. Case in point, Megan McArdle's self-described counter-factual on why she would have preferred for Hillary Clinton to have won the 2008 election. The first counter-factual,

I think that Hillary Clinton would have been more cautious when dealing with Republicans, and therefore ultimately more successful in some ways. At the very least, she would not be facing the same level of vehement opposition in Congress.

Certainly there is no reason to believe that the Republicans would have opposed Hillary Clinton, ginned up fake controversies over her past or present actions, or ridiculed and sabotaged her health care reform. That is, if you ignore pretty much everything in Hillary Clinton's past, as it relates to the Republican Party. The party that is still wailing "Benghazi!" would have been deferential to Hillary Clinton? Really?

I think liberals really do not understand emotionally the extent to which the Tea Party was created by the Affordable Care Act and the feeling that its government was simply steamrolling it.

Except that the Tea Party movement did not grow out of healthcare reform. It grew out of the financial industry collapse and bail-out. It was carefully steered in the direction of healthcare reform through Republican demagoguery and strategic misinformation. There is absolutely no reason to believe that they would not have been led to oppose modest healthcare reform, or that their energies would not have been directed at other significant initiatives -- as has actually occurred with issues such as immigration reform.

(One suspects that McArdle has spent little if any time talking to actual liberals.)

From the Tea Party's perspective, you had an unpopular program that should have died in the same way, and for the same reasons, that Social Security privatization did: because sensible politicians saw that, no matter how ardently they and their base might desire it, this was out of step with what the majority of the country wanted (and no, you cannot rescue the polls by claiming that the only problem with the law was that it wasn’t liberal enough; when you dig down into what people mean when they say that, the idea that there was ever a majority or a plurality that was secretly in favor of Obamacare collapses).

Except... no. Social Security privatization died because the then-President's own party wouldn't get behind it. We're talking there about something that was easily recognized as benefiting a relative few, those privileged with "managing" our money, while creating significant risks for everybody else. While it's reasonable to say that you cannot sustain an argument that a "more liberal" plan would have been more popular, that question is moot for the same reason that the question of Social Security privatization is moot -- a "more liberal" plan would not have been voted into law. If you look at the actual content of the PPACA, other than the mandate (which we all know to be a necessary aspect of keeping private insurance companies on board while requiring them to insure people with pre-existing conditions) you'll find that the individual components of the bill are largely popular. You'll find that the most contentious aspects of the bill, such as "death panels", are Republican fabrications.

The rage was similar to what progressives felt as they watched George W. Bush push the country into a war in Iraq. That defined and animated the anti-war movement (which is why said movement collapsed when Bush left office, and not, say, when Bush agreed to a staged withdrawal of our forces).

For the most part, the anti-war movement collapsed when the war started. Whatever anti-war movement continued after that point was quite modest. Also, no, the rage and demonstrable ignorance of the Tea Party was nothing like what one saw in a typical anti-war protest, nor were Democratic politicians out, en masse, pushing misinformation or refusing to correct misinformation embraced by anti-war protesters.

Yes, those people would still have hated Republicans, even if there had been no Iraq War. But they would not have been as passionate, as organized or as powerful without it.

Who are "those people"? When I look at the Tea Party, I see a movement that has sent ripples through the Republican Party, has toppled incumbent politicians and had its own elected in their place, and has caused some of the most absurdly ignorant people to be elected to Congress since... I'm not sure when. The anti-war movement, by way of comparison, unsuccessfully advocated against the Iraq war and then... nothing? I'm not even sure where McArdle comes up with her canard that the anti-war protesters "hated Republicans", but hers seems to be a classic "hollow man" argument -- putting words into the mouths of "those people" in order to easily swat down an argument that few (if any) made, rather than having to address actual people and actual arguments. Counter-factual, indeed.

Liberals tend to write off this anger as racism, as irrational hatred of Barack Obama, or as perverse joy in denying health care to the poor, but at its root, it’s the simpler feeling that your country is making a mistake and you can’t stop it because the people in charge are ignoring the obvious.

It's not an "either, or". You (and by "you" I apparently mean, "anybody except McArdle") can recognize the actual racist statements and actions of people associated with the Tea Party, and can recognize the racism implicit in birtherism, the suggestion that President Obama is not a "full blooded" American, and the like, while also recognizing that the Tea Party is at its heart a fear-driven organization. It was quite obvious that when the Tea Party was screeching about death panels, or carrying around signs to the effect of, "Keep your government hands off of my Medicare", that they were afraid of change. It was also apparent that they were not approaching the issues in a rational manner, and that the monied interests and Republican politicians affiliated with the movement liked it that way.

Yes, a lot of money and energy was poured into the Tea Party by rich backers, but rich backers cannot create a grassroots campaign unless the underlying passion is there in the voters (paging Karl Rove and Crossroads). The Obama administration created that passion with Obamacare.

That, again, is nonsense. There's an element of truth to the notion that you can't astroturf your way into a massive grassroots movement, but what anybody but McArdle would have noticed is that the monied interests she mentions spotted an early opportunity to co-opt and direct the anger of the Tea Party movement. Those backers weren't interested in stopping the financial industry bailout. They were -- and remain -- interested in harming Obama's agenda. As with Mitch McConnell's stated goal, the priority was to try to make Obama a one-term president. They were not interested in educating Tea Party members about the issues -- to the contrary, they helped maintain a constant feed of misinformation. They would have been every bit as interested in harming Hillary Clinton's agenda.

I think that Hillary Clinton would have pulled back when Rahm Emanuel (or his counterfactual Clinton administration counterpart) told her that this was a political loser and she should drop it.

That may be true, but where McArdle sees that as a good thing I do not. Why not? Because unlike McArdle, who likely enjoys platinum quality employer-provided health benefits and sits on considerable family wealth, I actually needed to purchase insurance for my family. The PPACA permitted me to purchase insurance of a quality comparable to a good employer-sponsored plan at a fair price -- not necessarily at a cost savings over the cost of such a plan but with a more favorable pricing structure than what I had paid for COBRA coverage. Between the expiration of my COBRA coverage and the January 1 start date of the PPACA, I purchased a comparatively overpriced plan on the individual market, riddled with exclusions, and had to deal with the absurd arguments that insurance companies use to jack up premiums over "pre-existing conditions". For people not as lucky as McArdle, that's a big [Biden's Word] deal.

I’ve written before about how my Twitter feed filled up with comparisons to 1932 the night that Obama took the presidency, and it’s quite clear to me that the Obama administration shared what you might call delusions of FDR. It thought that it was in a transformative, historical moment where the normal rules of political caution didn’t apply. The administration was wrong, and the country paid for that.

So McArdle has looked down her nose at Obama from the start? And the country has "paid for" the president's pressing forward with the high-priority Democratic agenda item, healthcare reform, by actually getting healthcare reform? The horror!

That’s not to say that Republicans would have somehow been all kissy-kissy with Clinton -- they weren’t very nice to her husband, after all.

Not very nice.... That's quite a way to describe the constant attacks, inquisitorial approach to his background, and the use of impeachment as a political tool.

But I doubt she would have had the debt ceiling debacle or the deep gridlock of the last four years, because it was Obamacare that elected a fresh new class of deeply ideological Republicans who thought they were having their own transformative political movement, and they were willing to do massive damage to their party, their own political fortunes and, in my opinion, to the country in order to take a stand against “business as usual” -- business that included legislating or paying our bills.

Because using the debt ceiling as political theater, and shutting down the government, was something that the Republicans never dreamed of doing when Bill Clinton was President. That is, if we're again using the term "counter-factual" to mean, "ignoring indisputable fact." Further, if McArdle believes her own argument about the increasing polarization of the electorate, and was paying any attention to the likely outcome of the election, the difference is at most one of (slight) degree -- the odds of the Democrats holding the House were vanishingly small, and one would have expected the Republicans voted into formerly Democratic seats to be part of a new partisan wave. Predictably, McArdle offers no acknowledgement of the fact that the Democrats held the Senate, or the fact that a smaller Democratic loss in the House would not have changed the subsequent power dynamic in which House Republicans refuse not only to compromise, but refuse to legislate.

Besides, I thought McArdle was taking the position that the problem was healthcare reform, not the debt driven by the economic meltdown and financial industry bailout. Why does McArdle believe that the Tea Party would have ignored the issues that underlie their genesis, and become complacent in relation to the bail-out, but for healthcare reform? If they were so obsessed with healthcare reform, how is it that they (mistakenly?) voted into office those who chose to focus on the debt ceiling and force a government shut-down? For that matter, the Republican Party could have easily bypassed its relatively small number of Tea Party members and passed a funding bill, simply by allowing a funding bill to reach the floor -- so how is it that this isn't a problem inside the Republican Party, as opposed to one supposedly driven almost exclusively by the President's being Barack Obama instead of Hillary Clinton?

Of course, in my counterfactual, Hillary also probably wouldn’t have proposed ambitious health-care reform; she’d have done something more modest, like a Medicaid expansion.

More modest... except had McArdle been paying any attention to the Tea Party, she would have heard them complain about any program that directs money to the undeserving poor. She might have noticed the right-wing demagoguery over SCHIP, a program to insure children. She might have even noticed that Republican governors have gone out of their way -- to the point of litigating the issue to the Supreme Court -- to avoid accepting free money to expand Medicaid.

To my mind, however, that would have been a much better outcome for everyone. So there’s my counterfactual for the summer: If Hillary Clinton had won, Obamacare wouldn’t have happened, and Democrats -- and the country -- would be better off.

I'm sure that when McArdle and her husband offer their wealthy friends cocktails, perhaps with some sort of dipping sauce McArdle whips up herself in her Thermomix, that's the sort of observation that makes them chuckle. To notice how the PPACA helps actual people? That's beneath her notice. I don't personally believe that Hillary Clinton would have embraced McArdle's notion of modesty, or that she would have so easily folded on a more ambitious plan when faced with Republican opposition -- if I were to accept that counter-factual, I think we have to include the probability that Clinton would have been viewed within her own party as a failure, and would likely have faced a primary challenge after her first term. As Clinton would not have found that acceptable, it's reasonable to conclude that she would have found a way to stick to her guns.

Obamacare Works, Period

The other day, Reihan Salam was on Real Time, but didn't manage to air all of his anti-Obamacare tropes before the host switched to a different subject. One he did manage to voice is the suggestion that the 74% of Republicans who like their benefits under their PPACA health insurance policies are wrong. I'm not sure how the logic of that argument works, as they either like their benefits or they don't. Perhaps he means that they're wrong in principle, as they should instead prefer the status quo ante or some unidentified alternative program, but endorsing that position would suggest that Salam doesn't think the program represents good policy even if it provides people with what they assert to be good health insurance coverage.

Salam did suggest that the only reason Obamacare is working is because it is subsidized. In a sense that's true, as it is the subsidies that help create the volume of enrollees necessary to create the large risk pools that allow the program to work, enrolling all applicants without regard to preexisting conditions. But outside of that narrow context, Salam is wrong. As somebody who has purchased a PPACA policy without a subsidy, I can attest that I was able to choose and enjoy a policy that provides coverage superior to anything I was able to purchase as an individual consumer prior to the Act's effective date, and that the price of the policy was reasonable even without a subsidy. The manner in which the PPACA's policies are priced for dependents allowed me to obtain coverage comparable to that which I had previously received through COBRA but at a lower price.

Although the pre-PPACA policy I had purchased to cover the period between the expiration of my COBRA eligibility and January 1, 2014, cost less than my PPACA-compliant policy, it also offered far less. I also didn't have to try to remember years of detailed medical information which the insurance company could use to find pretextual reasons to increase my rates or deny care. I recognize that many Republicans, perhaps including Salam, believe that having inadequate health insurance coverage is a feature, not a bug, forcing people to pay a greater portion or all of the cost of certain basic care, mental health care, addiction treatment and the like, and that the ideal health insurance policy involves a HSA and only catastrophic insurance coverage, I would have a greater appreciation for that argument if an appreciable number of its advocates were willing to walk the walk -- legislate or contract away their own health insurance benefits for the inadequate coverage they wish to foist off on the rest of the country.

Salam suggested that there is inequity in having a multi-tiered health insurance system, with Medicare being less attractive than PPACA plans, which he asserted are less attractive than employer-sponsored plans. It's important to note that I've seen employer-sponsored plans that are far less attractive than most plans available under the PPACA, and the plan I purchased was quite comparable to the employer-sponsored plan I had been continuing through COBRA, so I don't find his argument of inequity between employer-sponsored plans and PPACA plans to be particularly compelling. As for Medicare offering less than private health insurance, I see no evidence that the Republican Party at large views that as a problem that needs to be fixed. A party whose governors have largely chosen to grandstand, harming their states and large numbers of their constituents by refusing to expand Medicaid. Inequities exist, but it's not clear that we should prioritize their elimination over other healthcare reforms, or even that the people want inequities removed as opposed to the establishment of a reasonable minimum for what health insurance plans must offer.

Typical Republican alternatives to the PPACA have involved either throwing everybody into the individual market, with low-coverage catastrophic insurance and HSAs, or a voucher system where (if you qualify) you get a voucher or tax credit with which you are to pay for your insurance and fund your uninsured care. Those proposals bring back some of the worst aspects of the former system, at best foisting those previously deemed uninsurable or who would face staggering insurance costs due to pre-existing conditions into government programs -- after all, why should we expect health insurance companies insure sick people when that cost can be borne by the taxpayer? To the extent that the Republicans attempt to bridge the gap between the Gingrich-style plans and the PPACA, including large risk pools and exchanges, but most notably preventing insurance companies from raising premiums for people with pre-existing conditions, the more necessary it becomes to impose some form of mandate -- and even if you automatically enroll people in insurance while using the voucher or subsidy they left unused, such that you can argue that "It's not a mandate", somebody has to foot the bill.

On the whole, Salam is one of the more honest and thoughtful commentators on the Republican side. I would like to see him address the issue of health care in light of his abilities. We can start with the fact that there is no actual Republican health insurance reform that is being seriously advanced within the party. We can add to that, the fact that reforms that will shake the system are likely to cause people to lose their current insurance, whether that occurs abruptly or as a new policy is phased in. In other words, unless the Republican Party wants to take an enormous political risk that implicates all of its anti-Obamacare rhetoric, we're looking at incremental reforms, not the reinvention of health insurance and the healthcare market. Within that context, what reform ideas would Salam propose that have any chance of getting passed by the Republican majority in the House, let alone becoming law? If the answer is, "None", then he's reinforcing what many, and probably most supporters of the PPACA already acknowledge -- as flawed as the law may be, it's the best law that could get through Congress.