Advice for my friends on the left. Worth every penny you paid for it.

[kirisutogomen]

If I were you, I'd restrain the urge to whip out the bullhorns and lead your comrades in an invigorating round of "YES WE DID". I'd hate to see you so soon forget the lesson of "MISSION ACCOMPLISHED"; you might want to think about the idea that maybe all that's happened is really the easiest, smallest step of the process, not the whole kit and additionally caboodle. Passing a law (overthrowing a government) is much much easier than actual reform (nation-building).

It's one of the most common political mistakes to think that passing a law is the solution to a problem. You really need to be a bit more careful about follow-through. Check to see if the law is doing what you thought it would. I especially suggest this because the just-signed law is in fact not going to do anything like what you think it's going to.

Comments

[algorithmancy.livejournal.com]

I have no illusions that this law is anything other than a first step.

As far as the law doing what I think it's going to, I think it's presumptuous of you to think you know what I think. People's track record is pretty poor when it comes to this kind of large scale extrapolation of cause and effect. Sometimes I think that if we could just agree on cause and effect, politics would be easy.

It doesn't help that most people's policy opinions are impervious to evidence. This law could be a terrible failure causing startling increases in avoidable mortality, and its champions would be trumpeting how much worse we would have been without it. Likewise it could be a rousing success and its detractors would go on about how it was holding back and even greater success.

The biggest thing this law does is serve as a proof of concept for some potential second step, in a climate where stepping at all is often described as impossible. The second biggest thing it does is change some experimental variables so we can have some hope of learning something.

That said, you seem to be calling for some clay pidgeons to shoot down, so here goes: I'm optimistic that the individual mandate will eventually succeed at bringing premiums down and making coverage affordable. I expect that the limits on medical expense ratios will probably cause an initial flurry of accountancy gamesmanship, as companies search for an ever more Orwellian meaning of "medical expense." Once the dust settles on that, I'm hopeful that Wall Street will eventually correct its weird systemic biases and actually reward good business. I think the expansion of Medicaid will actually help some people. There you go. Take your shots.

[psychohist.livejournal.com]

"I'm optimistic that the individual mandate will eventually succeed at bringing premiums down and making coverage affordable."

Massachusetts has had an individual mandate for some years, and it did not bring premiums down; quite the opposite. I see no reason to believe anything different will happen with the federal law.

The Massachusetts individual mandate did, despite failing to make premiums come down, make them more affordable in one way: by making individual insurance tax deductible on state income tax. My understanding is that, unfortunately, the federal law fails to do the same on the federal level for federal income taxes.

[kirisutogomen.livejournal.com]

Nope, no shots coming. Not looking for a fight.

I will say, though, that I don't think it's all that presumptuous to make assumptions about what people think when those people are a self-selecting group based on what they think ("on the left").

[tirinian.livejournal.com]

Eh.

I am very pleased that a law passed. That has basically nothing to do with what's in this law and whether or not it will be a good one, and everything to do with the fact that the Right spent a year turning this from a policy fight over "how do we improve health care in this country" into a Fight to Destroy Obama's Presidency, and it turns out they failed at destroying it.

On the issue of whether this law is a good one, I am much more agnostic. I expect it will fix some things and break some other things, as most laws do, and whether the ratio of fixes to breaks is worthwhile or not, I have no idea right now.

[psychohist.livejournal.com]

The Republicans know that this administration isn't interested in real compromise. That was clear when Obama's willingness to "compromise" on the stimulus bill was limited to continuing to prohibit hospitals receiving any medicaid or medicare funding from performing abortions, which had nothing to do with the stimulus bill.

[fredrickegerman.livejournal.com]

I feel like this can rapidly degenerate into a "he hit me first" kind of debate. I have seen no evidence of a desire to compromise on either side. Who started it? It sounds like we might disagree on the answer. But at this point it's pretty well ceased to matter who's at fault.

[kirisutogomen.livejournal.com]

Well, I think No Child Left Behind and McCain-Feingold campaign finance reform had not just bipartisanship, but bipartisan compromise. By the time immigration reform rolled around, the Democrats were willing to just wreck shit to score political points. Legislation that would have transformed the lives of millions of the most disadvantaged members of our society? That's usually something the left would go for, but they saw an opportunity to weaken the enemy.

Similarly, there was real bipartisan compromise on Clinton's welfare reform, and bipartisanship on NAFTA, but by the time the Lewinsky thing started, the Republicans had given up on governing and were just in vandalism mode.

But I had some real disappointment with the stimulus bill; I was kind of hoping Obama was serious about this whole post-partisanship shtick, but he didn't even pretend -- he just said "sic 'em, Pelosi" and went to do other stuff.

[psychohist.livejournal.com]

May main point is that it makes no sense to support a health care law that makes things worse just to spite the Republicans, especially when the Democrats are guilty of the very same things one wants to spite the Republicans for. That's cutting off your nose to spite your face.

On the other hand, I wouldn't mind that kind of debate, if people can come up with similarly factual arguments against the Republicans' willingness to compromise. All I've seen in that case has been repeated assertions without evidence.

Ultimately what I think is happening is that the Democrats' unwillingness to compromise had a sound basis in political reality - they had 60 votes in the Senate and a majority in the House, so as long as they maintained party discipline, they could ignore the Republicans.

Now that the Democrats are down to 59 votes in the Senate, the same party discipline on the part of the Republicans means that any compromise would have to draw the majority of the Republican base, and not just peel off a few votes. "The Republicans aren't willing to compromise" is just shorthand for "We want to peel off a few votes the way we did by prohibiting hospital abortions, and the Republicans aren't falling for that any more". Offer a plan that was a half way compromise with the GOP health care proposal, and the Republicans would jump at it.

[tirinian.livejournal.com]

Well, there's the whole "Health Care will be Obama's Waterloo" line:
http://www.cbsnews.com/8301-503544_162-5179427-503544.html

And there's the fact that "Obamacare" is, by all accounts I've seen, Pretty Damn Similar to Romneycare, yet neither Romney nor Brown (who both supported Romneycare) are willing to support it.

Heck, the individual mandate thing was supported by a VP at the Heritage Foundation back in 2003 (http://www.heritage.org/Research/Testimony/Laying-the-Groundwork-for-Universal-Health-Care-Coverage )and there are allegations, at least, that the AEI has squashed it's experts from commenting on health care because too many of them agreed with a lot of what Obama wanted to do ( http://www.capitalgainsandgames.com/blog/bruce-bartlett/1601/groupthink-right-would-make-stalin-proud ).

So from over here, it looks a lot like Obama tried to incorporate the Right's position on things, and the Republicans either moved the line, or decided that it didn't matter if he was agreeing with them or not, they were going to take him down.

[kirisutogomen.livejournal.com]

Do you suppose that we could try to limit symbolic victories to things that cost less than $900 billion?

[harrock.livejournal.com]

I do confess to being a little unclear which of the following is more your point:

...you might want to think about the idea that maybe all that's happened is really the easiest, smallest step of the process...

Sounds like you could be pointing out that the new law has plenty of flaws (including some unrevealed ones), will be gamed and abused by every player who puts in the time to read the rules, and kicks many important problems down the road; hence, excessive celebration is premature. If so, it's a fair point.

...the just-signed law is in fact not going to do anything like what you think it's going to...

Sounds more like you're just trolling, and it's tempting to interpret it that way. But I think you're just annoyed at the victory dance, and you're venting your annoyance by indulging in a half-hearted troll. What I'm trying to say here is that I just don't sense that you were putting your back into this one.

[psychohist.livejournal.com]

He's not trolling. He's simply stating what's correct. It happens whenever the federal government passes laws that affect the economy: they write things that sound good, but end up working very differently than they think they will.

For example, likely the second biggest effect of this law is that it will substantially erode the gains that women have made in the employment market over the last four decades.

How is left as an exercise for the reader. I plan to explain in a post on my own blog, but I don't have a good track record of actually making the posts I plan to make.

[shaggy-man.livejournal.com]

It sounds like you're arguing that because nothing ever turns out just the way one designs it to, one should never do anything. If you could correct me on that, perhaps we could go from there.

[treptoplax.livejournal.com]

I can't speak for psychohist, but... some problems are hard, and some are impossible - the universe is under no compulsion to accommodate us. Building a space rocket is a fine endeavor, but I wouldn't load a billion-dollar (or trillion dollar!) satellite into one until it that model has had a few successful launches - and perpetual motion machines never work at all.

We require environmental impact statements to pave a new parking lot while blithely ignoring second and third-order affects of vast social and economic engineering schemes... and the solution is always more of the same.

[psychohist.livejournal.com]

I'd certainly like to see a lot less government interference on economic issues. As treptoplax says, some problems can't actually be solved the way you think you'd like to solve them at first.

I'd also like to see solutions implemented incrementally. That way the departure from expectations is smaller and easier to correct.

[kirisutogomen.livejournal.com]

If I were to say, "It happens whenever the federal government passes laws that affect the economy: they write things that sound good, but end up working very differently than they think they will," it would be an empirical statement, not a Universal Truth.

It's entirely possible to do economic legislation well; we have a long and storied history of doing it badly. There things are hard, often very hard, but we have a lot of very smart people who think about this stuff a lot; if the experts were listened to, the laws would be better. But Congress is full of people who are either idiots or are acting like idiots.

[kirisutogomen.livejournal.com]

That last bit wasn't intended as trolling; it came out of recollection of the "MISSION ACCOMPLISHED" atmosphere in 2003. The lofty expectations now for this law are about as unrealistic and oversimplified as the notion that we would be welcomed as liberators by the Iraqi people. And I think it's roughly as easy to see what's wrong with them now as it was then.

[harrock.livejournal.com]

Fair enough. My question was actually straight-up, and not rhetorical. I've developed a habit of trying to run diagnostics on conversations like this, because politics is one of those realms where people say one thing, sometimes mean another, and are interpreted as yet a third thing, especially by those of differing ideologies.

(Which reminds me, only slightly apropos, of a game I played at Origins once, where I was a minor North Korean official, and we had a coup, and started selling our nukes to other rogue states, and then the Chinese tried to take out our nukes, and missed three, which we promptly fired into China before being reduced to glass. On the flight back to Boston after the con, I met the guy who was playing the Chinese defense minister, who told me "I thought if we just took out your nukes, everyone would calm down and we could talk." And he was sincerely baffled about how things went down...)

It seemed to me like you were starting out with a vibe of "you might have taken a step toward a good thing, but without follow-through, it's not a big deal", which I parse as a charitable statement by someone suspicious of liberal projects; and then you finished with a paragraph that I would not have written unless I wanted a defensive reaction. I'm honestly curious about how you saw that when you were writing it.

I agree with tirinian that the real driver of celebration among liberals at the moment has more to do with a feeling of political relief than with any conviction that the mission on health care is over. But I still think that your comparison is instructive. The Iraq war, like this rev of health care, was a topic that started out with some notion of common purpose, and which then became very polarizing and exhausting, leading to an intense desire by its eventual supporters to take *any* milestone and declare it a victory.

[kirisutogomen.livejournal.com]

The diagnostic habit is an excellent habit. I keep meaning to do something like that on a couple of issues which I think are plagued by problems which could be addressed with a little differential diagnosis (e.g., school vouchers/charter schools/other forms of expanded school choice). The more I think about it, the more I conclude that the most common arguments on any given issue are rarely the actual motivations for the positions taken.

(The guy really thought that....huh. Well, I guess if your side had been playing purely rationally, that would have worked, but that's a pretty bold assumption to make about any group of more than zero people, let alone a post-coup North Korea.)

What I was thinking when I wrote the original -- I'd say that I saw my expected lack of follow-through and my expected failure of the project as two sides of the same coin. The reason that there was this feeling of triumph in 1993 was born of the mistaken belief that the military victory was the main event, and the reason that the occupation turned into such a mess was born of the exact same mistaken belief. Similarly, I'd claim that any "YES WE DID" banners stem from the same mistake that's going to cause the lack of follow-through, which is the same mistake that's going to be the root cause of the eventual failure of the project. Thinking that the principal opposition is the Republican party or the insurance companies is the same mistake as thinking that the principal opposition was the Ba'athist regular army or the Iraqi Revolutionary Guard.

Another parallel between the two: they both cost about $100 billion per year.

[psychohist.livejournal.com]

For the record, the aircraft carrier displaying the "Mission Accomplished" banner in 2003 had accomplished their mission and were getting ready to return to the U.S. While the press hugely misinterpreted that, I've not met any military or veterans who did.

Oh, and a nit - you misspelled "2003".

[psychohist.livejournal.com]

What makes you think any "nation building" will actually happen? Historically, what's happened in the case of laws like this is that Congress has declared victory and withdrawn, leaving things to collapse as they will.

[firstfrost.livejournal.com]

A thing I am hoping for from this law (er, is it a law, or a set of laws?) is that when someone like thatwesguy says "I am self-employed, please advise me on getting health insurance for catastrophe" the immediate answer will no longer need to be "The first thing to do is form a two-person company..."

[kirisutogomen.livejournal.com]

Well, until 2014, that's still the answer. In fact, it's even more the answer than it used to be, because while the exchanges won't be working until 2014, the 50% tax credit to small businesses for premium costs goes into effect immediately.

The one good thing I expect to see right away is the new insurance pool for people with pre-existing conditions. It's just too bad it's temporary, because a government-subsidized high-risk pool is a much better idea than the long-term plan of sticking our fingers in our ears and singing la-la-la-I-Can't-Hear-You.

[firstfrost.livejournal.com]

Sorry, I wasn't clear. I don't expect any instantaneous changes; the thing that I meant was "I expect things to eventually change so that in the future, the first answer to the question isn't 'form a company'."

I also think that some of the problem with thinking about the whole thing is that "pre-existing condition" is so crazily variable. If it meant "the smallish percentage of people with serious chronic expensive problems" that would be one thing; when it also means "over 35 and sprained your ankle once" I am less convinced that it's so unbalancing.

[kirisutogomen.livejournal.com]

Well, there's two different factors at play with "pre-existing condition"; there's the first, perfectly legitimate consideration that riskier people are going to pay higher premiums for any kind of insurance. If you don't let insurers charge more for riskier risks, they'll just reject them, or find any way possible to not be their insurer.

Which is related to the second issue; if you let them, they will try to collect premiums but never pay for anything, because that's a very profitable business model -- if I have some "pre-existing condition" clause in my policy and you said you didn't have one, and then you get hit by Skylab and need $6 million of prosthetics, and I discover that you have a history of sprained ankle, sure, I'll try to use that to weasel out of paying, by claiming you were defrauding me by lying about the ankle.

This of course leads to all kinds of confusion. The risk issue strikes people as unfair, because it's unfair, but life ain't fair and it sure isn't your insurance company's job to fix that. I would argue that if it is someone's job, it's the government's job. (And that doesn't mean they do it by putting a gun to the insurers' heads and saying "treat them fairly". It means pay cash money to subsidize the higher risks. The first way is extortion, the second way is the only honest way to redress the inherent unfairness of life.)

The weaseling-out-of-paying strikes people as unjust, due to it being cheating, which needs stomping. Stopping cheating is definitively a legitimate function of government, and if some insurer is trying to claim that your undisclosed sprained ankle is an attempt at fraud, I would applaud the regulator who squashes them for that crap.

Any solution that doesn't clearly distinguish between these two very different issues is likely to treat them both wrong.