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ACA Agonistes
Clinton Sending Subtle Signals on Obamacare

Hilary Clinton gave a lecture yesterday at UCLA, and in the midst of her full-throated defense of the basic benefits of the law, some interesting subtext emerged. Politico:

Clinton suggested she’s open to different ways of achieving the health law’s goals. She praised Arkansas — the state where she and her husband rose to political fame — for carrying out a new approach to expanding Medicaid coverage, by using the federal money to buy private health insurance for more than 100,000 low-income residents […]

Clinton has already suggested she’s open to changes in the law, particularly for small-business owners who are worried about the impact of the law and for people whose work hours are being reduced so their employers don’t have to offer them health coverage.

Of course she’s not going to come out and disown Obamacare, and its likely that much of her support for the law is genuine. But in signaling her willingness to revisit certain provisions, she’s embodying a new Democratic approach to the law. Democrats are increasingly open about admitting the flaws of the law even as they continue to defend it against repeal.

Some of where this newfound flexibility takes them still poses a problem for conservative ACA critics. They think, for example, that the Arkansas approach praised by Clinton is a mess. But nevertheless the left’s new willingness to cop to the law’s flaws is definitely a shift the critics can appreciate.

If this keeps up through the midterms, it could become a nexus joining some of the more moderate critics of the law to its supporters. As left-of-center wonks like Matt Yglesias have argued, the most plausible conservative replacement plans for Obamacare currently out there have some overlap with the ACA. Though Yglesias may be overstating his case, it’s true that there would be ways to tweak the existing ACA so that it became more like a law the center-right could get behind. Perhaps that’s just what we would see from a Clinton presidency.

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  • Andrew Allison

    Or, more likely, HRC is simply trimming her sails in the face of a gathering storm.

    • ljgude

      That strikes me as true. I find it hard to believe that HRC doesn’t have a well above average understanding of the downsides of the ACA and its potential for political disaster. She certainly researched the area in ’92 and must understand that what the President and the Congressional Democrats came up with was flawed in a multilayered way. First, as I always point out it is doomed by the problem that US Healthcare costs twice as much as it should. I remember hearing Clinton era bureaucrats on NPR say that 50 cents of every healthcare dollar is spent before it reaches anyone with medical training. They understood the 2 x problem, and so does HRC. Then it was so poorly drafted that it has disrupted the private insurance industry in a way that in the worst case could create the need to bail out the insurance companies. Then, if I understand correctly, it disrupts the healthcare providers themselves by forcing people to use doctors and hospitals other than the ones they did with their old insurance. Will this damage the business of the top level of medical provision like say – the Mayo Clinic? The ACA is a top down disruption that is shaping to be a far bigger disaster than people realize. Repeal is problematic because the insurance and and healthcare industry that existed before the disruption may be broken.

      All that said there is a simple way to ease toward universal healthcare without breaking things, including the bank. We already have socialized medicine in the US for the medically most expensive age bracket – over 65. Simply lower the Medicare age as the country can afford it and let the private insurance industry do what it does best – provide tailored coverage beyond what Medicare can provide. That’s about what we have in Australia and the way it is structured the two systems keep each other honest. Waiting lists and the other problems of socialized medicine that many countries have been dealing with for over half a century motivate those that can afford it to buy private insurance. But if the private insurers and the private hospitals raise their prices too much people drop the insurance and rely on the public system. Our conservative party has learned not to cut Medicare too much or they get turfed out. And our labor party has learned not to put the squeeze on the private system because it takes the pressure off the public system. I don’t know if moderates in both parties are capable of coming up with such a compromise, but if they can’t come up with something then the ACA seems to me destined for collapse.

      • Corlyss

        “2 x problem”?
        Elucidation, please.

  • Boritz

    “But nevertheless the left’s new willingness to cop to the law’s flaws is definitely a shift the critics can appreciate.”

    Appreciate the hell out of it.
    And don’t forget she also suggested she was shot at in Bosnia.

    • Jim__L

      Well, eye-rolling exasperation and scorn are other possible response.

  • Corlyss

    “Hilary Clinton is open to changing certain parts of the ACA.”
    Hear me now and believe me now: that particular pose wouldn’t last beyond 4PM 20 Jan 17 if she wins. It’s simply more “middle” posturing to make her sound moderate.
    “Could centrist space for compromise be opening up?”
    I don’t want to disillusion you, but the centrists in either party are down to carrier pigeon population size. People of both parties mouth those platitudes to make themselves sound like pragmatists. Vaporware.

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