Saturday, April 30, 2016

Obamacare's "Camel Nose"

The camel's nose under the tent.  A frequently-employed metaphor for a program, a proposal or even just an idea that gives the appearance of a compromise, but is in fact the first step toward a full victory for one side in a debate.  Unsurprisingly, the Affordable Care Act (a/k/a "Obamacare") was criticized on the far right as being just such a camel's nose in the context of health care reform.  Let this "dreadful" bill become law, they said, and we'll have single-payer health insurance in no time at all.  Here's but one example; the critics are so repetitious in their rantings, however, that one is more than enough.

Well, I don't know about no time at all, but it's quick possible that the ACA just might lead to the "nightmare" that its critics fear.  And there's a very simple reason for that, tucked into the language of the waivers that the law provides.  There are six in all, but one very important one for supports of single-payer:  1332 waivers, or state innovation waivers.  These allow a state to apply for an exemption from the federal government of "Obamacare's" main requirements, provided that the state can develop and implement an alternative that would cover at least as many residents as would be covered under the ACA's full provisions.  You can read more about these waivers here.

I've always regarded 1332 waivers as something of a dare to conservatives.  They allow state governments, those supposed "great laboratories of democracy" to experiment with a variety of ways to address health care needs and other public issues.  With the vast majority of states controlled entirely by Republican-led governments, you would think that they would have already used 1332 waivers to come up with their supposedly better, free-market methods of delivering the level of care now being provided through the ACA.

And you would be dead wrong.

Because Republicans aren't interested in solving problems, or otherwise serving the public interest. I've said it many times, and I suspect I will say it many times more before things are different:  they are only interested in power for themselves, and their patrons.  By definition, this excludes most of you.  And, as  it turns out, they regard the waivers as a menace, precisely because they would require an alternative to be superior to "Obamacare."  The only reason for allowing the waivers, in their eyes, is an excuse to--wait for it, wait for it--implement single-payer health insurance!

There's no intellectually honest way to consider this line of "reasoning" as being anything but tantamount to a confession--a confession that, if the goal of policy is to serve the people, then the only policy alternatives are liberal ones.  But I repeat:  they do not want to serve all of the people,  or even most of the people.  They just want to serve the ones that send checks to their already-swollen campaign treasuries.

I'm happy to accept this confession.  And it now appears that the people of Colorado, as purely a "purple" state as there is, as much an anti-tax-and-spend redoubt as exists within the Union, is potentially now on the verge of choosing the "greater" of the two evils, by asking for a 1332 waiver and replacing the ACA's requirements with single payer.  Take a look.  Vermont almost did this earlier and got a case of fiscal cold feet.  Perhaps it takes a less liberal state than Vermont to embrace and demonstrate the value of liberal ideas.  Canada, after all, got its single-payer policy through the efforts of a conservative Prime Minister; no one in Canada would choose now to go back to the way things were.

And, if Coloradans can shake off any cases of fiscal cold feet, and green-light a 1332 waiver, I am convinced that it will be the beginning of the end of for-profit health insurance in this country. Once people realize that their will be net fiscal savings, as well as fewer bankruptcies and less social and medical-related stress, state-sponsored single-payer health care will spread across the country.  And conservatives should rejoice at this; at least it will mean the end of "Obamacare."

Then again, "Obamacare" was their idea in the first place:  developed by a right-wing think tank, promoted by a Republican Speaker of the House, and enacted by a Republican governor who couldn't stop Barack Obama from winning a second term.  Leave it to Mr. Obama to find a way to add a camel's nose to it, and use it to pave the way for the health insurance this nation should have had decades ago.

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