Paul Krugman loses his way on the incremental path to reform

What’s Next for Progressives?

By Paul Krugman
The New York Times, August 7, 2017

For now, at least, the attempt to repeal the Affordable Care Act appears dead. Sabotage by a spiteful Trump administration is still a risk, but there is — gasp! — a bipartisan push to limit the damage, with Democrats who want to preserve recent gains allying with Republicans who fear that the public will blame them for declining coverage and rising premiums.

This represents a huge victory for progressives, who did a startlingly good job of marshaling facts, mobilizing public opinion, and pressuring politicians to stand their ground. But where do they go from here? If Democrats regain control of Congress and the White House, what will they do with the opportunity?

What would I do instead? I’d enhance the A.C.A., not replace it, although I would strongly support reintroducing some form of public option — a way for people to buy into public insurance — that could eventually lead to single-payer.

Meanwhile, progressives should move beyond health care and focus on other holes in the U.S. safety net.

So if it were up to me, I’d talk about improving the A.C.A., not ripping it up and starting over, while opening up a new progressive front on child care.

I have nothing against single-payer; it’s what I’d support if we were starting fresh. But we aren’t: Getting there from here would be very hard, and might not accomplish much more than a more modest, incremental approach. Even idealists need to set priorities, and Medicare-for-all shouldn’t be at the top of the list.


NYT Reader Comment:

By Don McCanne, M.D.
San Juan Capistrano, CA

Improving ACA?

None of the incremental proposals would cover everyone.

None of the incremental proposals would remove financial barriers to care.

None of the incremental proposals would return choice of your physicians and hospitals.

None of the incremental proposals would recover the profound administrative waste in our health care financing system.

Single payer?

Everyone is covered for life.

Obtaining care does not create financial hardship.

Patients can choose their health care professionals and institutions.

The efficiency gains would be enough to pay for the gains in coverage.

We need to quit pretending that patching our fragmented, dysfunctional system is almost as good as single payer. It doesn’t come close.



By Don McCanne, M.D.

Perhaps the greatest fraud in health policy today is being perpetrated by the politicians - Republicans who say health care will be more affordable and accessible by taking away coverage, and Democrats who say that incremental additions to the Affordable Care Act are almost as good as enacting single payer - an improved Medicare for all.

We will continue to spend over $3 trillion on health care. That is enough to pay for a system that would be superior to those of all other nations that spend on average half of what we do. Why should we accept less, far less, which is what we would be doing if we merely patched our system - the poorest performing financing system of all wealthy nations?

Once more. Incremental changes to ACA will not fix the fundamental flaws in our financing infrastructure that may leave people sick, broke, and even dead.

We cannot let Paul Krugman rest on his Nobel laureate status as he pontificates for “a more modest, incremental approach,” while acknowledging he would support single payer “if we were starting fresh.” Well, apparently a fresh start is precisely what we need.

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