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Healthcare Humility
ACA Failure Forces a GOP Rethink

The Affordable Care Act’s rollout disaster has chastened Republicans as well as Democrats. Spooked by the uproar over cancelled plans, the GOP is rethinking its support for policies that experts predict would cause even more cancellations. The WSJ reports:

Some Republicans are now worried that a GOP proposal to begin taxing health-care benefits offered through employers—which would affect some 160 million Americans—would cause market disruptions far more severe and expose the party to its own political peril….

“There’s an acknowledgment that massive overturning of the employer-sponsored system is something people just aren’t ready for,” said Douglas Holtz-Eakin, a leading Republican economist and chief policy adviser to Mr. McCain’s campaign.

This story underscores the fact that health care is a huge, extraordinarily complex system. The fantasy that there is one big, seamless reform that will make everything work beautifully leads a lot of people on unicorn hunts. Wonks of both sides might wish they could push through their pet reforms, convincing people to bear with lots of short-term disruption, but politics and public opinion just don’t allow that.

The next steps in health care policy may involve thinking small. The federal government needs to rebuild public confidence in the concept of health care reform by way of discrete changes that make small but important improvements. In time, modest changes could point to larger, incremental approaches to guide federal policy. But lurching from one top-down reform to the next won’t get us anywhere.

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  • Bruce

    The public doesn’t need to restore confidence in the government to reform healthcare. The government has proven, and will continue to prove, to be absolutely damaging to healthcare in the U.S. Why would we want to have confidence in that?

    • Corlyss

      What needs to happen but won’t is to get government out of health care from top to bottom. Government with it’s domination of the eldercare market and the veterans market have done more to drive up costs than anything else. And let’s not forget government’s unfunded mandate that hospitals not turn away anyone seeking treatment regardless of their ability to pay. That’s done more to destroy the hospital network in Ca. alone than any other factor, thus limiting even more severely the availability of services to people whose insurance companies could pay for the services.

      • Fat_Man

        The Federal government alone represents 50% of the healthcare system spending. Any withdrawal will have to be in slow stages.

        We need to do lots of little things to expand supply, reduce market distortions, and realign incentives. But this is a long range project that will involve many small steps.

        As the Tao Te Ching says:

        Governing a large country is like frying a small fish.
        You spoil it with too much poking.


    • Pete

      As it is with health care, so it is with the K-12 public schools. The federal government should not be involved; it only degrades the schools and makes them more costly.

  • Anthony

    Healthcare as established (sellers, providers, insurers, clients, etc.) in America will never reform itself – just too much money in it and no incentive to give it up. In line with the small thinking concept, the doctrine of subsidiarity may have relevance to delivery, provision, and selling of healthcare. But on macro level,l healthcare suffers from same factors cited in Fukuyama’s essay.

    • Corlyss

      Health care hasn’t suffered any from the system. That’s just propaganda that we’ve been bombarded with for nigh onto 50 years.

      • Anthony

        You need to be more specific and less circular.

  • lord acton

    The doctors, the drug companies, the insurance companies, the hospitals and the medical equipment industry were not content with 18% of the economy; they wanted more. The politicians were just the tools. It isn’t going to be pretty watching this unravel over the next 12 months. I say this as a family physician who has been practicing for 20 years.

  • PapayaSF

    Personally, I’d like a Ludwig Erhard, 1948-style deregulation of health insurance and medicine, but there are things we can do on the margins. Start decoupling employment and insurance by taxing benefits, but only for people entering the workforce. Start reining in the FDA and the trial lawyers. Allow policy sales across state lines. Allow nurses and pharmacists to do more. Make price transparency mandatory. Ban certificates of need. Overall, focus on lowering costs and allowing competition and let the market work.

  • Boritz

    Which party is always clamoring for ‘comprehensive reform’ for the issue de jour whether it be immigration or health care or whatever, and always bad-mouthing the very notion of an incremental approach?

  • rheddles

    What would Buchanan do?

    • Smee

      More thought, what would a president do that had military service in their past?

  • Verinder Syal

    Could it just be he is in over his head?

    He does not have a sense of how the world works, his election gave him the delusion that with a speech here, a wink and nod there, his charisma and intellect would win the day. His intellect may be more limited than is commonly assumed; his self- awareness is non-existent.

    He is not a leader who sucks it in and gets the job done. He is a pseudo intellectual who loves to whine, blame his predecessors, blame the crazy world, blame social media, blame reporters, blame …. you fill in the blanks. He keeps looking out of the window rather than looking in the mirror.

    America is in trouble.

    • Ernst Bloefeld

      I have long thought his alleged intellectual capabilities were more myth than reality. in my opinion if one swaggers around claiming intellectual horsepower, one should be prepared to present evidence of excellence.

  • Anthony

    “The real criticism of the President isn’t that his foreign policy is too deliberative, it is that his deliberations don’t seem to end with policies that, well work…it is a substance issue, not a style problem….” Thus its ever been. Indeed WRM, “there is more than inexperience or lack of character that defines this presidency: Mr. Obama came of age in a bubble of post 60s liberalism that conditioned him to be an adversary of American exceptionalism…Mr Obama did not explicitly run on an anti-exceptionalism platform. Yet once he was elected it became clear that his idea of how to apply presidential power was shaped precisely by this brand of liberalism.”

    Finally WRM to your reference of drama and spectacle as components of power exercised, I’ll restate by saying that mores constitute the playing field of power. Stepping out of bounds too often disrupts the game’s momentum. Successful world leaders historically have acted accordingly..

  • Arkeygeezer

    President Obama’s problem is that he lies a lot; especially to himself. Consequently nobody believes him; not us, not our allies, and especially not our enemies.

    He has banned American “boots on the ground”. Consequently we now have a lot of Iranian boots on the ground in Iraq and Kurdistan. He did not want to help the Kurds, so the Iranians filled the vacuum.

  • Duperray

    “America has the right to perpetrate any military actions on in Syria, even without syrian official government OK”: This is a violation of a sovereign state rights.
    Why not officialize this first with a UN vote? All small bribed states would vote OK.
    Otherwise, declare the state of War with Syria.
    Is it contempt ? Arrogance ?

    Ach so: I forgot that “America is so exceptional” ! Hitler was thinking the same about “Germany über alles” up to no longer respect international law.
    To the american persons who do not support present drift to this kind of totalitarism: “Please show up”

  • S.C. Schwarz

    He’ll never learn. The question is, will the liberals who elected him, and the elites who blindly support that election, learn?

    • Corlyss


    • Thirdsyphon

      Maybe. What lesson do you think they should take from all this?

      • S.C. Schwarz

        The lesson should be not to elect people with no experience and no qualifications just because they look good on TV.

        • Thirdsyphon

          Ouch. That’s not quite what happened, but there’s enough truth in it to sting. If it’s any consolation, you might have just shifted my primary vote.

          • Farbar

            That’s exactly what happened in 2008.

        • jimb82

          Unfortunately, the Democrats’ track record tells them to do the exact opposite. The Presidents they have managed to elect in recent years — Kennedy, Carter, Clinton, and especially Obama — all fit the latter category (Johnson being the lone exception in ’64, and the Democrats could have run anyone in ’64 and won). When they nominate someone with experience and qualifications — Humphrey, McGovern, Mondale, Dukakis, Gore, Kerry — he loses.

          • S.C. Schwarz

            If we were to stop voting for unqualified people behaps that would change. I say that as someone who, to my eternal regret, voted for Obama the first time.

      • fishaddict

        Thinking and feeling are not mutually exclusive. One must temper the former with the latter through reason/logic and compassion. So I agree with Corlyss.

  • Suzyqpie

    “President Obama still has two years on his watch; if he delivers like Reagan he will be remembered like Reagan, and frankly I hope for all our sakes that that is what happens,” that can never happen. Pres 0bama is hemmed in by his own ideology and demagoguery. Hubris is subliminally ruining Pres 0bama and his administration which is composed of sycophant friends who all engage in groupthink.

    • Corlyss

      WRM occasionally suffers from trendy campus delusions.

  • B-Sabre

    “United States will crush his air defenses and leave him so weakened that his overthrow will be certain…”
    So why is this an option now, rather than a year ago when chemical weapons were used? Back then the use of airpower was going to be all show, no go.

    • Corlyss

      The option arises now because Dims have finally realized that their pacifism is making them look bad. They don’t really want to do anything substantive about the status quo. It means merely that they are confident they can fool the voters again. They’re probably right: they don’t have to DO anything. They just have to APPEAR to be doing something.

  • Anthony

    A related thought: social comparisons – comparisons between the self and others – are a fundamental psychological mechanism influencing people’s judgments, experiences, and behavior. A question is what elicits people to constantly engage in social comparisons whenever they are confronted with information about how others are, what others can and cannot do. or what others may achieve and may fail to achieve. Why do people engage in social comparisons? To whom do they compare? And how do social comparisons influence the self? Are comparisons with others so ubiquitous that some unconscious psychological purpose is served?

    • Fred

      My BS sense is tingling here. But to be fair, without further elaboration, it’s hard to tell whether this comment is BS or not. First, what exactly is the “availability bias” you’re referring to and who exactly is engaging in it? Second, who exactly is “anchoring” and exactly how are they doing it? Finally, what does all that primate evolution stuff have to do with anything? Are you saying that critics of Obama’s foreign policy are reacting like primitive primates and basing their arguments on cognitive flaws and are therefore safely dismissed? If so, my BS senses are screaming. I know you have difficulty understanding the concept of ad hominem, but if it helps: if what you are saying (to the degree you’re saying anything at all) is what I think you’re saying, it is a clear instance of that fallacy. If you are not saying what I think you are (again, to the degree you’re saying anything) I suggest you sacrifice a little pseudo-intellectual circumlocution for a little clarity.

      • bff426

        Reading both of his comments, I vote pseudo-intellectual BS.

        • Anthony

          You don’t know me and anonymity of computer screen induces stereotypical labeling for varied reasons. But, U.S. general populace since inception has had an anti-intellectual bias; now, not knowing anything about you, please don’t infer my last statement to be more than a generalize observation.

          • jimb82

            The lack of use of articles and incorrect grammar indicate that you are not a native English speaker, most likely of Eastern European origin.

          • Anthony

            What are you parsing about? And in the English language informally you may use any idiom appropriate to interlocutor. Similarly, your guess is wrong (though I have met many well written and spoken Eastern Europeans). Finally for informational background, my American antecedents go way back (my great grandfather helped to liberate France in WWI).

    • Anthony

      For whomever has an interest: Daniel Kahneman, Amos Tversky (availability bias and anchoring) hidden biases of good people – and they emphasize “good people”.

      • Fred

        I know what availability bias and anchoring are. I was asking for a specific example of a critic of Obama’s foreign policy (a serious, knowledgeable one, not a random internet wingnut) engaging in those errors. Frankly, I don’t believe you can provide one. And bff 426 and I may not know you personally, but we do know English, well enough to know pseudo-intellectual BS when we see it. When one uses abstractions or jargon without concrete examples or showing how it relates to the subject at hand, when one uses said abstraction or jargon to (thinly) veil condescending ad hominems (anybody criticizing Obama’s foreign policy must be a primitive thinker plagued by cognitive errors), and when one drops names without showing how they are relevant to the discussion, one is BSing. And attempting to wriggle out of being called on your BS by asserting that you are “just making an observation” simply won’t do. Without specific examples or showing specifically how they relate to the topic, your “observations” are no such thing. They are a bald assertion of empty opinion, which is a pretty good working definition of BS.

      • Anthony

        I am going to try and end this mysterious computer harassment one last time out of respect for AI and its mission. Now this specific reply is for one party only (someone until 3 or 4 weeks ago I knew nothing of). As Breif2 once said, any other party may easily benefit by skipping this reply.

        To begin, experience, viewpoint, worldview, etc. guide my contribution via commentary at AI. The site offers a smorgasbord of authors and topics to satiate any reader’s appetite for quality and varied subject matter. That said, contentious positions over misperceived views/writings can be misrepresented and taken as some personal affront or challenge (then rhetoric utilized to justify and disguise real nature of unsolicited commentary).Moreover, the role of language in perceived arguments is important and I try hard to make a distinction between “real disputes” and “verbal disputes”. I’ve had some real disputes at AI but not with party of this reply (a dispute is understood to be real when one party believes that a certain statement is true while another party believes the statement is false. Real disputes arise when “genuine” differences of opinion exist regarding matters of fact). Additionally, AI’s open “comments” give readers opportunity to give voice (or not give voice) subjectively and objectively via interpretation of not only topics but also comments to topical materials with expectation of responsible engagement. In that light, I (as AI reader and comment contributor) exercise site privilege to choose when to respond and to whom to avoid. In short, the art of renaming (minor rhetorical false labeling) and shifting terms of discussion are well known to those that use language to conceal, characterize, badger, etc. whatever their true motivation. In spite of that, the use of a word (or words) cannot itself (themselves) guarantee the existence of the thing implied by it. To that end, a third perhaps futile attempt at avoidance will be hoped for (though this time I will keep in mind advise from my grandmother: some things are just part of life and nothing to get upset about or lose sleep over). “Do me a kindness and….”

        • Fred

          It shouldn’t be mysterious at all. I rarely respond to your comments (because they usually don’t contain anything coherent to respond to). But in this case, I agree with critics of Obama’s foreign policy that he is weak, indecisive, and incompetent. The evidence from the beginning of his administration to the present (from Iran to the Honduran “coup” to the announcement of the Afghan withdrawal timetable to Syria to Ukraine to ISIS) bears that out. That is a factual matter about which we presumably disagree. But it is not the disagreement that results in what you evasively call “harassment.” You clearly (or at least as clearly as your gobbledygook gets) implied that criticism of Obama’s foreign policy can be dismissed as being the result of “primate evolution” and cognitive bias. Since that dismissal includes myself, I pointed out (rather sharply I’ll admit) that it is invalid and why. Instead of addressing that issue, you accuse me of “harassment” and spout more nonsense in meaningless abstractions. For some odd reason, that aggravates me, for which I do not apologize. As for ignoring me, that’s probably wise. It’s bad enough to have your BS called out, compounding it with more BS to be called out again could be quite humiliating. Whether you respond or not, however, I will continue to call out the BS when I deem it appropriate just in case anyone here might mistake your pretentious abstractions for knowledge or your snide assertions as arguments. That’s my contribution.

          • Fred

            Btw, You have still not provided a single instance of “availability bias” or “anchoring” in any critic of Obama’s foreign policy or explicitly shown what “primate evolution” has to do with that foreign policy or those critics. That’s not “harassment” on my part; that’s BS on your part. I’m just the messenger.

          • Anthony

            Listen, you’re a name caller operating under disguised motives; 4 days ago you knew nothing about cognitive bias now you want data. If its important find primary sources on your own time. You are quick to label and define comments. Express your views to essays and pieces written daily so readers can glimpse what’s really behind harassment. We humans are generally capable of profound self deception – not even admitting to ourselves what really triggers…especially not someone’s subjectively denoted BS (if you live in world, BS is ubiquitous and from indication you have it mastered). You’ve targeted me and have justified to yourself why. As I have repeatedly told you from your initial contact, I don’t want to engage you (I can’t say I don’t like you because I have such little data to conclude such. But I can definitely say I don’t like your harassment). People have negative qualities that are sometimes deeper than they care to admit and seek ways to discharge unpleasant emotions triggered by said qualities – the seven deadly realities. Passive Aggression comes to mind but who …. At that my man, I’m done you know my sentiments regarding your name calling, false premises, erroneous characterization, etc. but you’re intent to do what it is you do and call it what makes you comfortable – be my guess but don’t expect “any more” direct responses to your BS.

  • Corlyss

    ” But it appears the President doesn’t fully grasp the substance of his critics’ complaints about his leadership.”

    Of course he doesn’t get it! After that comment that he’s ALWAYS and EVERYWHERE been the smartest guy in every room he’s occupied, he REALLY thinks nobody can learn him nothin’. Couple that with the years-long twin drumbeats of his transformative uniqueness and racism as his opposition’s only basis for criticism, and you have what we got: a dangerous combination of stubborn ignorance, absolute conviction in his own ideological judgment as a substitute for knowledge he refuses to acquire, abhorrence of compromise, increasing loss of influence over important events, and unbecoming self-pity at his ineffectiveness. We have been in for hard times ever since the gullible voters by a thin margin gave us this Affirmative Action president.

    • Thirdsyphon

      There’s some merit to what you’re saying. I have to struggle on a daily basis not to dismiss opposing views as partisan hackery, so I can only imagine how tempted Obama himself must be to tune them all out. That being said, it’s the President’s job to listen to domestic opposition (you never know when they might have a point), and to strive to retain some humility. Of course, that last part is easier said than done. . . I can’t think of a single President in my lifetime who’s managed to do it- and all of them had quite a lot to be humble about.

      • jimb82

        Most of them have managed to sit down with the folks on the other side and reach compromise to get things done. President Obama has shown no interest in trying and far more interest in golf.

      • Corlyss

        “I have to struggle on a daily basis not to dismiss opposing views as partisan hackery”

        I know what you mean. I use a standard of information vs. talking points. If a critic shows some familiarity with the policy and its basis, I credit it with being genuine. If a critic relies on code language or talking points, I dismiss it as partisan hackery. Even if the former disguises the latter, I treat it as a serious criticism. What I will not do is persist in trying to convince someone whose job or ego depends on his not being convinced. I used to do that, but I stopped.

    • adk

      All excellent points, Corlyss. I’d only clarify this one, “…abhorrence of compromise…” — O. is more than willing to compromise. The problem is, he wants to compromise with the enemies of the US– the Iranian mullahs, Putin, Assad, and the likes. But it’s the Republicans, Fox News, Netanyahu, etc., that he considers his enemies who deserve no compromise (even though he’s occasionally forced to pretend otherwise.)

  • Ernst Bloefeld

    The real problem with Obama’s foreign policy other than stated in the article is that good foreign policy does not come from polling constituents who know nothing at all about foreign policy. Bomb ISIS may or may not be a good thing but it is the job of the President to decide and then to act. Obama has the attention span of a Gnat and his inability to focus and be decisive play a large role in the lack of success of his foreign policy.

  • RonRonDoRon

    “The real criticism of the President isn’t that his foreign policy is too deliberative, it is that his deliberations don’t seem to end with policies that, well, work.”

    Sometimes, it is that his deliberations don’t seem to end.

    • jimb82

      Deciding not to decide is a decision.

  • Peripatetic

    Obama may talk like a Vulcan — but real Vulcans (well, you know what I mean) don’t suffer panic attacks accompanied by sudden shifts in decision-making. This is not someone who crafts a steely-eyed policy and who then clinically follows it despite all the complaints and emotional carping.

  • John Wondra

    There’s way too much assumption, speculation and over-think here; this was all just theater.
    Just as Obama claims he doesn’t need Congress’ approval of his actions against “ISIL” (he insists on this name, despite everyone else using IS or ISIS), he didn’t “need” to speak to the public or with the members of the NYT editorial advisory board. His “guests” were there as an audience, not as participants in a grand discussion. This was little more than his efforts to nudge his best media friends find some back-story for reportage that diverts attention away from his real motivations and goals.
    Things are going exactly as planned for Mr. Obama; they couldn’t be better.
    When his term is over, the U.S. will be severely crippled and its standing diminished far from where it was at the beginning of 2009.
    Read “Dreams FROM My Father;” this man’s objective is nothing less than the total destruction of “imperialist” America.
    His “policies,” domestic and foreign, lead only to one result and it is not the result of hubris, indifference or indecision. This is his plan; he just wants to keep the curtain up a little longer, and his media friends are more than willing to help.

  • GitOffMahLawn

    “Presumably the White House wanted to get a message out about what the President is thinking…”

    Indeed, as it is never too early to start considering those NCAA tourney brackets. And one can never analyze their golf swing too much.

  • GitOffMahLawn

    “This wasn’t an intelligence briefing…”

    Obviously not- Barry Soetero was present at these dinners, wasn’t he?

  • GitOffMahLawn

    “But Reagan, he noted, is hailed as a titan striding the earth.”

    Lil’ Choomie needs to learn some history- there’s a big difference between:

    “Mr Gorbachev, tear down this wall.”


    “Uh, uuuuum…at this point we have no strategy.”

  • GitOffMahLawn

    “Oh, it’s a shame when you have a wan, diffident, professorial president with no foreign policy other than ‘don’t do stupid things,’ ” guests recalled him saying”

    Well, lookee there- the blind (and dumb) squirrel found a nut!

  • GitOffMahLawn

    “… the critics are against him because he isn’t a hot head.”

    Nah, we hate Earflaps the Petulant because he is an EMPTY head.

  • GitOffMahLawn

    ” He put a lot of thought and effort into the reset with Russia…”

    Right, where was that? Between the 12th and 16th holes somewhere?

  • GitOffMahLawn

    “that Abraham Lincoln and George Washington combined couldn’t handle the problems now troubling the world.”

    Oh boo frickin’ hoo- this mincing imbecile campaigned hard for this job twice. Now he wants to whine about how hard it is? Cry me a river, fauntleroy.

  • GitOffMahLawn

    “What the critics (the ones most worth listening to, anyway) are pointing toward is a blind spot in the President’s Spock-like, Vulcan approach to the international situation.”

    Point of order- Spock wasn’t a deranged narcissistic brain damaged dilletante.

    Bit of a false analogy there.

    • jimb82

      Live long and prosper.

  • GlendaleGreyBeard

    Narcisssitic brain damaged dilettante? Say it ain’t so Joe! He’s not a dilettante–more of a doofus.

  • mikeb330

    Reagan admitted his mistake in Lebanon. And many (myself included) would say his “arms-for-hostages” fiasco compares favorably with Mr. Obama’s “5-terrorists-for-a-deserter” trade, especially considering that mere weeks later, word comes out that the US Government refused to allow the Foley & Sotloff families the opportunity to ransom their own loved ones. Methinks most people in their situation would long for the Gipper to be in charge of US policy than the Vulcan-in-Chief (aka “The Great Equivocator”)

  • mikeb330

    Oh, and all this from the man who defended his decision to shrink the US Navy by remarking that we also have fewer “horses and bayonets”.
    And now, thanks to his failure to negotiate SOF Agreements, the main source of our air power in the fight against ISIS is aircraft carriers, not land bases.

  • teapartydoc

    Nice well-reasoned and unemotional analysis, Walter. In sports, no matter if it is basketball, football, boxing, or MMA, one of the keys to winning is to put one’s opponent in the position of having to react to you own initiatives, rather than you reacting to his. That’s why Patton’s strategy was to never hold ground, but to go at the enemy like “crap through a goose” until he was routed. “Let him die for his country.” Playing patty-cake like LBJ will get LBJ-like results.

  • Stephen St.Onge

    Obama has always been an empty suit, good for reading speeches off a teleprompter and nothing else. It just took a while for the damage to accumulate.

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