A Christmas Carol for 2014

A few excerpts from Paul Krugman's op-ed in today's NYT.

It begins with sad news: young Timothy Cratchit, a k a Tiny Tim, is sick. And his treatment will cost far more than his parents can pay out of pocket.

Fortunately, our story is set in 2014, and the Cratchits have health insurance. Not from their employer: Ebenezer Scrooge doesn’t do employee benefits. And just a few years earlier they wouldn’t have been able to buy insurance on their own because Tiny Tim has a pre-existing condition, and, anyway, the premiums would have been out of their reach.

But reform legislation enacted in 2010 banned insurance discrimination on the basis of medical history and also created a system of subsidies to help families pay for coverage. Even so, insurance doesn’t come cheap — but the Cratchits do have it, and they’re grateful. God bless us, everyone.

It's off to a fine start, isn't it? But despite all the happy ending overtones, there are still people who are grousing. Whatever are they grousing about? Let's look in again.

First, there’s the crazy right, the tea party and death panel people — a lunatic fringe that is no longer a fringe but has moved into the heart of the Republican Party. In the past, there was a general understanding, a sort of implicit clause in the rules of American politics, that major parties would at least pretend to distance themselves from irrational extremists. But those rules are no longer operative. No, Virginia, at this point there is no sanity clause.

Yes, it is awfully challenging to take the complaints coming from right field too seriously. They simply aren't cogent, and often aren't even coherent.

A second strand of opposition comes from what I think of as the Bah Humbug caucus: fiscal scolds who routinely issue sententious warnings about rising debt. By rights, this caucus should find much to like in the Senate health bill, which the Congressional Budget Office says would reduce the deficit, and which — in the judgment of leading health economists — does far more to control costs than anyone has attempted in the past.

But, with few exceptions, the fiscal scolds have had nothing good to say about the bill. And in the process they have revealed that their alleged concern about deficits is, well, humbug. As Slate’s Daniel Gross says, what really motivates them is “the haunting fear that someone, somewhere, is receiving social insurance.”

I have had this conversation with people. They are foaming at the mouth about "socialism" and "fascism" (and I have to repeatedly challenge them to look up fascism in the dictionary and report back to me just who in this debate sounds like the fascists). They generally get a pole-axed look when I point out that public schools are a socialist benefit. If I think they are particularly bright, I ask them to imagine a scenario where they call 9-1-1 in an emergency and the dispatcher responds, "An police cruiser will be dispatched momentarily. But first, will that be Visa or Mastercard?" Ah yes, that sort of socialism is fine. But not the kind that benefits someone else, especially if they are poorer than me.

Finally, there has been opposition from some progressives who are unhappy with the bill’s limitations. Some would settle for nothing less than a full, Medicare-type, single-payer system. Others had their hearts set on the creation of a public option to compete with private insurers. And there are complaints that the subsidies are inadequate, that many families will still have trouble paying for medical care.

There is a longer reach option that would have been best. Imagine (after reading the bill rather than listening to "Headline News" or "Screaming Head News") just how many people are actually covered, and subsidized, who have been out of the game until this point. It will still be a challenge for some people. Many will have something when they had nothing. People like me who are new small-business owners with little income will be able to afford something (my current health care costs are about 100% of my gross income).

My real gripe is reserved for Republicans. They have had decades to create policy about health care but chose instead to merely talk about it and stonewall any efforts by the Dems while simultaneously spending un-budgeted money on misguided wars and the single largest unfunded expansion of Medicare in its history while reducing taxes on Corporations and the wealthiest Americans. I would have loved for genuine conservatives to have created a plan for comparison. But neocons are not conservatives, and the GOP, appearing to be led from the loudest loonies mentioned above, became the party of "No", and had nothing to contribute. Perhaps they will get their act together and curtail the worst of the fiscal concerns, though I suspect their answer will be to trim benefits from the neediest so that the likes of Cigna and Blue Cross can make more profit. That is the wrong answer for this problem, and they will find little support at the moment, but they could get more traction if the economy remains tough. Watch for the GOP to start stonewalling job creation efforts and you will know where their true heart lies (I would love nothing more than to be wrong about this prediction).

For now, I feel a little disappointment well-tempered by a greater sense of (if you'll forgive the pun) general relief.