Matthew Stoller Tweetstorms on Trump.


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14 Responses to The Autocratic Failure

  1. Mike Schilling says:

    Obamacare is for making private insurance available and affordable. Job training is for making better-paying jobs available. Hoe is either of those the dole?

    Bribing a company with tax money to create jobs? That’s the dole.

    • KenB says:

      1) Medicaid expansion — obviously qualifies as “the dole”
      2) subsidies — ditto
      3) mandate + rate limits: instead of taking money from taxpayers, transfers money from the healthier to the sicker.

      It’s not like Obamacare made health care any cheaper overall — at most it (debatably) reduced the rate of growth. Increased affordability came from wealth transfers.

      • Mike Schilling says:

        transfers money from the healthier to the sicker.

        This mechanism is often referred to as “insurance”.

        • KenB says:

          If someone is on dialysis and is guaranteed to have 60K of health care expenses in the year but can buy a policy for 20K, that’s not insurance.

        • RTod says:

          “If someone is on dialysis and is guaranteed to have 60K of health care expenses in the year but can buy a policy for 20K, that’s not insurance.”

          Actually, it is and it always has been — or at least it always has been as long as there has been such a thing as health insurance.

          Since the beginning, premiums have only been allowed to fluctuate so far beyond a means of total projected expenditures. Pretty much everyone who is undergoing treatment for expensive and/or chronic conditions (cancer, MS, HIV, etc) will pay into the system far less than they will take out in services, and everyone (including the insurer) knows that going in to each policy year. That’s not a new function of Obamacare, that’s the way the system works, because there’s no other way *for* it to work. If you had your insurance canceled 0r got $60,000 annual premiums any time you had more than a grand or two a year in premiums, you wouldn’t buy insurance. You’d just pay out of pocket and cross your fingers you wouldn’t have something go terribly wrong.

          It’s why some kind of mechanism that mandates coverage and premiums from younger, healthier people is required in a healthcare system that’s built almost entirely on insurance premiums — not only in order to be able to accept pre-existing conditions, but in order to curb the exponential premium growth of adverse selection.

        • KenB says:

          There’s a difference between a policyholder who ends up using more than he pays in (that’s normal risk) and a policyholder who from the beginning is using more than he will pay in. No one’s going to write me a home policy as my house is burning down or a life policy when I have a terminal diagnosis — if I wasn’t already a customer, any money given to me at that point is aid. Imposing guaranteed issue, community rating, and coverage mandates qualifies as a health care provision system but looks much less like health *insurance*.

          I’m not even arguing against Obamacare, just responding to the idea (here brought up by Mike S) that simply because insurance companies pool risk and flatten the risk curve somewhat for business reasons, that means that any kind of cost-sharing arrangement is just part of the insurance biz. That’s not a serious argument.

        • Kazzy says:

          When treating cancer is as easy as battling a house fire, let’s return to this analogy.

    • Michael Drew says:

      That’s not the dole, either.

  2. trumwill says:

    Irrespective of whether PPACA was a policy success or not, it wasn’t a political one. I disagree with Stoller on whether it’s a “dole” problem, though. I think it’s mostly a clarity problem that resulted from a political miscalculation. They thought that they could simply push it through without regard to public opinion, and people would love it because it would work. The technocratic problem Stoller refers to.

    What it needed was to be more flat-out doleish. Simple, straightforward. Single-payer, or that public option as a backdoor way to it. They’d probably have paid a price for that as well, but I’m not sure how they could have paid more of one than they did. If they had it all to do over again, maybe they would have. But simple, straightforward, and impossible to undo.

    Of course, the main reason they didn’t was because they couldn’t round up all of their party’s votes (perhaps in part due to the corporate friendships Stoller alludes to). And they didn’t know then what they know now (if I’m right), but going forward I think an increased emphasis on simplicity and policy transparency, rather than simply assuming it’ll work and people will come around.

    • Michael Drew says:

      Say they had gone single-payer.

      I’m curious how long it would have had to survive for it to become impossible to undo for a unified Republican government.

      I have a feeling they’d have found ways to get it done long after we’d have thought it was impossible.

      • greginak says:

        Under Bush the R’s made a run at Social Security. Ryan is apparently going to push hard to gut medicare. So no amount of time is enough. There is nothing short of not doing any HCR that would have prevented the R’s from trying to kill it.

        • trumwill says:

          Under Bush they failed before they even really got started, and Part D was added to Medicare. We’ll see what Ryan does, but I like Medicare’s odds better than PPACA’s.

        • greginak says:

          True. But the point is there is really never enough time to prevent R’s from going after a certain program. Nothing is well established enough.

          I think going after Medicare will be a disaster for the R’s but what do i know. Heck they are likely to try to keep the popular parts of the ACA somehow.

  3. Michael Drew says:

    I was kind of rooting for hm to be largely right, because I’m coming from the same general place as he is on this election…

    …But, man, there is a lot of wrong in there. That’s always kind of how it is with Matt Stoller. A viewpoint I have sympathy with, expressed in a torrent of underconsidered rant-parts.

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