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Paul Krugman: Republicans Have No Ideas At All

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Paul Krugman: Republicans Have No Ideas At All

Paul Krugman

Reprinted with permission from Alternet.

We’ll find out soon enough if Republicans are craven enough to sell out their constituents’ health care in the name of tax cuts for the rich. What we do know is that they’re every bit as terrible at governance as they are effective at obstruction. As Paul Krugman writes in his Monday column, one reason they can’t come up with a credible alternative to Obamacare is that, “You can’t change any element of the Affordable Care Act without destroying the whole thing.”

The ACA is incrementalist by nature, an acknowledgement that many Americans enjoy their employer-provided insurance and that the insurance industry, with all its lobbying clout, would not allow a single-payer system. To provide better plans at a lower cost to more people, it offers a three-legged stool approach. The first leg, Krugman explains, requires “insurers offer the same plans, at the same prices, to everyone, regardless of medical history.” This addresses the problem of pre-existing condidtions, arguably the most-beloved part of legislation, even if Republicans want the public to believe its “death spiral” is imminent.

Without additional legs, they’d be right: “Healthy people would wait until they got sick to sign up, so those who did sign up would be relatively unhealthy, driving up premiums, which would in turn drive out more healthy people, and so on.” The solution was a much less popular leg of the stool, the individual mandate, which Krugman explains is, “a requirement that people sign up for insurance, even if they’re currently healthy. And the insurance must meet minimum standards: Buying a cheap policy that barely covers anything is functionally the same as not buying insurance at all.”

For those who can’t afford the individual mandate, the government provides sudsidies. Americans at the very bottom of the economic ladder receive a 100 percent subsidy in the form of Medicaid. This constitutes the third leg of the stool.

It’s a delicate balance, and one that requires extensive cooperation from state governments. According to Krugman, “where states have in fact cooperated, expanding Medicaid, operating their own insurance exchanges, and promoting both enrollment and competition among insurers, it has worked pretty darn well.”

But red-state governments have proven largely uncooperative, refusing Medicaid expansions, de-incentivizing competition among insurers, eliminating the individual mandate, and generally cutting off any leg of the stool they can.

Now Republicans are trying to do the same at a national level. Take, for example, Ted Cruz and his Cruz Amendment, which would allow insurers to offer skeleton plans with minimal coverage and sky-high deductibles. That’s fatal to people with pre-existing conditions, effectively cutting off the most popular leg of the ACA and pushing the sickest Americans into the most expensive insurance market.

“Obamacare,” Krugman reminds us, is “a well-thought-out law that works where states want it to work.” Sure, it should be made to work better and more effectively, but Republicans are hell-bent on killing it. It’s a tragedy for Americans that they don’t have anything in its place.

Read the entire column.

Ilana Novick is an AlterNet contributing writer and production editor.

This article was made possible by the readers and supporters of AlterNet.



  1. FireBaron July 11, 2017

    “and that the insurance industry, with all its lobbying clout, would not allow a single-payer system.” Actually, that is incorrect. The CEO of Aetna wanted a single-payer system. It’s just that he wanted HIS company to hold that position. However, as it has been proven in the past when left to the “Marketplace” the people do not benefit, especially in things like health care.

    1. kep July 11, 2017

      Yes, Obamacare has worked sooooo well.

      1. Sand_Cat July 11, 2017

        Thanks for once again confirming your own ignorance and dishonesty. As the article says, where the state wants it to work, it does.

        1. kep July 12, 2017

          As in working well, do you mean deductibles that are into the thousandsbof dollars? Or maybe premiums that were supposed to go down, yet have become so high, that no one can afford coverage? Or maybe how a tyranical government MANDATES that Americans must buy a product from said corrupt government?

          1. Sand_Cat July 12, 2017

            You have not the faintest clue what I mean by “working well,” or much about reality, and you never will. Good-bye https://uploads.disquscdn.com/images/f6e683b50b12c5cacc80a5703324c792763512604b89a3b1f034cf5a705f2524.jpg

          2. dtgraham July 12, 2017

            Premiums have only gone up 22% in 2017 so far. The 2017 premiums are actually a pretty good match for what the Congressional Budget Office forecast back before the Affordable Care Act passed in 2009. The thing is though, that this 22% number is an average with a huge variation built in. While R.I. saw a 14% decrease, Phoenix has seen a 145% increase for example. Some of it comes back to the states who purposely chose to sabotage the ACA, as the article points out.

            You also have to remember that more than 80 percent of ACA customers get subsidies that help them pay the cost of their premiums. Those people don’t pay the full cost of premium increases out of their own pockets, and they won’t feel the full brunt of the increases, as long as there is a less expensive plan available in their market and they’re willing to switch.

            People who don’t get subsidies will be the ones hardest hit by the increases but I guess the thinking was that they should be able to afford it at their income level, although I’m sure that’s not always the case. There are still 11.3% of adults without health insurance, but that’s at least better than the 18% that were uninsured before the ACA exchanges and subsidies kicked in.

          3. 788eddie July 13, 2017

            I wonder if anyone remembers the double-digit yearly increases for health insurance premiums that took place before the 2008 economic crash.

          4. dtgraham July 13, 2017

            It’s the classic red herring isn’t it? Premium increases under the ACA are different than pre-ACA, how? There were also no ACA subsidies available before when premiums increased greatly.

            Well, that was the cost of designing a new health care bill 8 years ago that was so heavily reliant on private health insurance companies. Still better than what was though. I guess it’s coming to an end now.

          5. Aaron_of_Portsmouth July 12, 2017

            Kep, your inability to think clearly is the stuff of legend, and it amazes me that you insist on parading your ignorance like some demented peacock that doesn’t realize it no longer has plumage.
            Instead of being thoughtful and reasonable, you keep falling back on the old tiresome FOX methodology. That is, just spray your thoughts in a mindless, random fashion, and hope that something makes sense.

          6. dpaano July 13, 2017

            Apparently, Kep hasn’t heard that FAUX NEWS is the major purveyor of false news along with Breitbart, etc. It’s unfortunately that so many people listen and believe everything they hear from this ridiculous media outlet! They are so uninformed that it’s sad!

          7. 788eddie July 13, 2017

            I am amazed at your continued ignorance, kep.

            Truly amazed!

      2. 788eddie July 13, 2017

        Actually, it has. Except for the Republicon’s subterfuge. Millions more Americans had health insurance for the first time, and many paid far less than they previously had for health insurance.

        They could have fixed the problems that cropped up, instead of “throwing out the baby with the bathwater.”

  2. Aaron_of_Portsmouth July 12, 2017

    It’s always of interest to me to have anyone point out the collective short-sightedness of the GOP. Not that Democrats are inherently better at thinking and collaborating(or at least making an attempt to collaborate).
    The GOP’s refusal to get with anyone else outside its narrow-minded field of vision, to consult and hear different opinions, is why they fail to project themselves as thoughtful and possessed of intelligence. Oh, they know how to look out for their own self-interests while ignoring others, and are quite able to know the ends and outs of setting up a bank account in which to deposit their pay checks, are masters and obfuscation and delaying tactics, and are well-versed in being mean-spirited.

    Always concerned about money before people.

    1. dpaano July 13, 2017

      Agreed….the 13 old white men on the committee were paid handsomely by insurance lobbyists, etc. It’s no wonder they came up with the most ridiculous plan ever! It has to do with money in their pockets and not about the health of the people in this nation! We need to vote out these idiots…..we pay them to do their jobs, and they are NOT doing what they are being paid to do, which is to look out for the citizens of this nation’s wellbeing!


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