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#Obamacare
liberalsarecool · 1 month
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"Since the ACA was passed, the percentage of uninsured Americans has been cut in half. And thanks to the investments the Biden-Harris Administration has made to build on the ACA, more than 21 million Americans now have access to quality, affordable health care." - Barack Obama
Every Republican prediction is a piece of shit.
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reality-detective · 2 months
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Is this 👆 they pushed Obamacare through 🤔
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mysharona1987 · 4 months
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He wants to end abortion, overturn the 2020 election, criminalize gay sex, repeal Obamacare, slash Medicare and Medicaid, and much, much more.
🖕
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realtsceline · 16 days
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Be ready for meetup before dm....💝 Buh is she's really Hot Hun?....🥵 Straight to deal....✨
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godblessobamacare · 5 months
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ridenwithbiden · 2 months
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simply-ivanka · 3 months
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In defense of Deliverism
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There are many ways to slice up the coalition that is the Democratic Party, but one important axis are the self-styled adults-in-the-room, who declare themselves to be realists, and the party's left wing, who are dismissed as idealists who don't understand politics: neither how to win elections nor how to wield power.
The "realists" are the ones telling us that we can't have nice things. They say that if the Dems promise bold action - protecting abortion, controlling assault weapons, funding infrastructure, raising the minimum wage, providing health care - they will lose elections. When Dems do win elections, they insist that none of these things are possible: the Supreme Court will strike them down, or the GOP will filibuster them, or the business lobby will subvert them.
For these realists, every negotiation is a grand bargain in which all the grownups meet in smoke-filled rooms where they niggle and cajole and flatter their way into tiny, incremental policy changes, "signature achievements" that are so modest that the enemy can't possibly weaponize them as the deeds of radical socialists who will bring the country to ruin.
To do otherwise, the realists say, is to court catastrophe. Wielding power will destroy the "comity" that makes the legislature effective. It will "delegitimize" the institutions whose trustworthiness is key to enacting sound policy. When they go low, we must go high - not out of a sense of decorum, but to preserve the republic itself.
This kind of politics - the "triangulation" politics beloved of the consultant class - took over the Democratic Party in the Bill Clinton years (see also: UK Labour under Tony Blair). But its foremost practitioner - the Triangulation GOAT - was Barack Obama.
Obama's inside/outside game was indeed remarkable. He assembled and steered a massive, grassroots get-out-the-vote campaign that leveraged his skills as a once-in-a-generation orator to inspire huge numbers of historical nonvoters to show up and cast their ballot (recall that nearly every US election is won by "none of the above," so GOTV is a winning strategy, if you can pull it off).
Then, after the election, he switched off that grassroots.
Literally.
At the time, Obama's grassroots was the most successful netroots in history. Talented coders and digital strategists figured out how to leverage the internet to identify, mobilize and coordinate volunteers across the country. And while netroots activists did their work across the whole internet, their home base was a server the Obama campaign controlled. Once Obama won, they switched that server off.
You see, the rabble is useful when you're out there, trying to turn voters out to the polls. But if you plan to spend your term in office playing eleven dimensional chess, you don't want the mob jostling your elbow and shouting in your ear.
If FDR's (possibly apocryphal) motto was "I want to do it, now make me do it"; Obama's was "I want to do it, now go away." Rather than surrounding himself with the great unwashed, Obama created a cabinet of technocrats, grownups from the upper ranks of industry and the consultant class.
Think of Tim Geithner, Obama's Treasury Secretary, who counseled that the banks should be bailed out with no strings attached, not even a requirement that they halt the seizure and liquidation of swathes of Americans' family homes. When Geithner told Obama he had to "foam the runway" for the crashing banks with the roofs over everyday Americans' heads, there were no grassroots organizers foaming at the mouth in outrage. Thus did Obama end the Great Financial Crisis - by creating the Great Foreclosure Crisis:
https://pluralistic.net/2023/03/06/personnel-are-policy/#janice-eberly
But Obama's signature achievement wasn't his economic policy - it was his healthcare policy. The Affordable Care Act was a carefully triangulated compromise, one that guaranteed a massive flow of public cash to America's wildly profitable health insurance monopoly and steered clear of any socialist whiff that Americans would get their care from the government.
The ACA was an technocrat's iron-clad dream policy. It would work! After all, it "aligned the incentives" of healthcare investors and "harnessed markets" to drive efficiency. No one could accuse this policy - which was copypasted from former Massachusetts governor Mitt Romney's RomneyCare - of being "socialist." It was invented by a Bain Capital consultant!
Sure, the left would carp about Medicare For All and whine about the unjust enrichment of insurance barons. And sure, the right would try to convince "low information voter" lumpenproles that the individual mandate was an imposition on their Freedumb (TM), but in the end, more of us would get covered, prices would come down, and America would flourish.
That's not how it worked out. Prior to ACA's passage, 85% of Americans had health insurance. Today, it's 90%. That's not nothing! 5% of the US is more than 16m people. But what about the 85% - 282m people - who were insured before the ACA? Their insurance costs have doubled - from an average of $15,609 for a family of four in 2009 to $30,260 today. Obama promised that ACA would lower the average family's insurance bill by $2,500/year - but instead, insurance costs increased by some $15,000.
ACA wasn't just about cost, though: it was supposed to end discrimination, by forcing insurers to take on customers without regard to their "pre-existing conditions." On this score, too, Obamacare has failed: thanks to the ACA's tolerance for high-deductible plans, the number of Americans enrolled in plans that force them to pay for their chronic care out of pocket has skyrocketed from 7% to 32%. Yes, your insurer can't discriminate against you for having diabetes, but they can make you pay an extra $2,000 in deductibles every year before covering any of your diabetes care.
Now, maybe business-as-usual would have been even worse. Perhaps not passing the ACA would have left Americans poorer and sicker. But we're not comparing ACA with doing nothing - we're comparing ACA with more muscular, direct programs, like M4A. What if Obama had enlisted his grassroots, summoning up a left-wing answer to the Tea Party that turned the GOP into the party of no (including no compromises)? What if he'd jettisoned comity, appointed new judges, sent every executive order the Supreme Court rejected back to the court to be struck down again?
What if he'd governed like Lincoln, or FDR:
https://pluralistic.net/2020/09/20/judicial-equilibria/#pack-the-court
There's a name for this kind of politics: it's called deliverism:
https://prospect.org/politics/case-for-deliverism/
Deliverism is the idea that if you promise things to the voters, they will vote for you. It's the idea that if you deliver things to the electorate, that they will re-elect you.
Deliverism is a subject of hot debate in the Democratic Party, because Biden is an empty vessel that gets filled by different party factions, which means that his policy is incoherent, but includes some of the muscular, get-stuff-done politics of the Dems' Warren-Sanders wing, but that agenda is often undermined by the "responsible grownup" do-nothing Schumer wing.
The responsible grownups say that deliverism is dead, because voters mostly respond to hot-button cultural issues, while material improvements in their lives barely move the needle:
https://democracyjournal.org/arguments/the-death-of-deliverism/
In support of this proposition, deliverism's critics point to Obamacare, lauding it as a policy that made Americans better off, but still failed to win enough support for the Dems to defeat Trump at the end of Obama's second term.
In their rebuttal in The American Prospect, David Dayen and Matt Stoller point out that for most Americans, Obamacare didn't produce any improvement to their health care. The ACA made their care far more expensive, and the ensuing concentration across the sector (mergers between insurers, and between insurers and pharmacy benefit managers and pharmacies) made their care worse, too:
https://prospect.org/politics/2023-06-27-moving-past-neoliberalism-policy-project/
The rise in health care costs is no mystery: monopolies have taken over healthcare. In particular, healthcare is now the domain of private equity rollups, where a fund buys and merges dozens or hundreds of small businesses:
https://pluralistic.net/2023/01/18/wages-for-housework/#low-wage-workers-vs-poor-consumers
Every layer of the healthcare stack is has grown steadily more concentrated since the Obama years: "Hospitals, doctor’s practices, health insurance, pharmaceuticals, ambulances, nursing homes, rehab facilities." As Stoller and Dayen put it:
> Every part of our health care world is increasingly controlled by greedy bankers who kill people for money.
The same corporate concentration has eroded wages, meaning that workers are paying for higher healthcare cost out of smaller paychecks.
Stoller and Dayen argue that the polls show that politicians who make material improvement to voters' lives do win popularity. Take the Child Tax Credit, which lifted more American children out of poverty than any initiative in history. The majority of voters who received the credit favored the Democrats. After Joe Manchin killed the credit, that support flipped, and that cohort now supports the GOP by a 15% margin.
Sure, Biden couldn't order Manchin to support the Child Tax Credit. But he could have gone to WV and campaigned for it with Manchin's base. He could have loaded the bill with pork for WV that was linked to the credit, and dared Manchin to vote against it. He could have "fought dirty" (which is what the grownups call "fighting to win").
The grownups say that if Biden had done that, he might have alienated Manchin and lost future votes, or caused Manchin to run as a Republican in his next election - but that presumes that Manchin won't switch sides anyway, and it presumes that failing to deliver the Child Tax Credit wouldn't also jeopardize the Dems' legislative majority.
The grownups in the Democratic party say we can't win by campaigning on economic issues like monopoly, nor on pocketbook issues like M4A. But when Biden slashed the cost of insulin, his approval numbers shot up.
The grownups' claim that they should steer Democratic electoral strategy is grounded in the idea that they can win elections, and without electoral victories, the Dems can't do anything. The grownups' claim that they should steer Democratic governing strategy is that they can win policy victories, and that these will get the Dems re-elected.
But neither of these claims hold water. Far from being pie-in-the-sky idealists with no theory of change, the party's left is incredibly good at getting stuff done. Take the antitrust enforcers Lina Khan and Jonathan Kanter, as well as the recently departed Tim Wu. They aren't mere idealists - they're brilliant tacticians and proceduralists who have figured out how to use their existing authority to do more than decades of their predecessors combined:
https://pluralistic.net/2022/10/18/administrative-competence/#i-know-stuff
By contrast, the grownups in the party - people like Pete Buttigieg - have notably, repeatedly failed to master the procedural technicalities needed to exercise comparable authority. You can't be a technocrat unless you understand the techniques:
https://pluralistic.net/2023/01/10/the-courage-to-govern/#whos-in-charge
As for electoral strategy, the consultant class puts all its focus into eking out these incredibly marginal wins - the name of the game is to guarantee a 50.1% win and then move on to the next fight, which ensures that governing will be impossible. Meanwhile, union organizers like Jane McAlevey seek out 97% majorities for strike votes, in the teeth of voter suppression, gerrymandering, dark money and disinformation campaigns that are far worse than anything we see in a general election. And yet it's the party's labor wing that is smeared as unserious about electoral victories:
https://doctorow.medium.com/a-collective-bargain-a48925f944fe
It's true that the right has been scoring electoral wins with appeals to ideology and identity rather than by promising concrete, material improvements for their supporters' lives. You can win elections that way - but only by demonizing half the country as the enemy and then promising to make their lives miserable.
That doesn't invalidate deliverism as a strategy for winning elections. People may not have the time or interest to follow politics in detail. They may not understand how the ACA's internal technical workings are structured. The ACA has a lot of deficits - for example, it doesn't allow people to discover which insurance companies deny the most claims:
https://www.propublica.org/article/how-often-do-health-insurers-deny-patients-claims
But even if that data were out there, there's only so much attention people can or want to pay to their insurance policies. People want health care that works: that takes care of their illnesses and injuries, without bankrupting them. Something like the VA (at its best). Or Medicare (at its best).
Improving peoples' lives isn't merely good governance - it's also good politics. Playing hardball is hard and can be unpleasant, sure, but most of the risk from taking big swings while in office is that the voters won't stand with you and give you the political capital to score big wins.
"I want to do it, now go away" guarantees that there will be no polity at your side, giving you political capital. The politics of grand bargains only produces unimpressive, incremental change.
For all the failings of the GOP's radical wing (and there are many such failings), there is this one virtue: they get stuff done. The GOP has taken massive swings - seizing the courts, dismantling the administrative states, stacking elections, and siphoning off trillions for its donors:
https://pluralistic.net/2023/06/16/that-boy-aint-right/#dinos-rinos-and-dunnos
The Democrats don't need to copy the GOP's abandonment of material policy for ideological hardlines. Indeed, it shouldn't: when they go low (culture war bullshit), we go high (delivering real benefit to voters). But the Democrats' left wing could sure stand to learn a trick or two from the GOP's right - namely, how to turn "I want to do it, now go away" into "I want to do it, now make me do it."
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If you'd like an essay-formatted version of this thread to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:
https://pluralistic.net/2023/07/10/thanks-obama/#triangulation
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The Clarion Science Fiction Writers’ Workshop (I’m a grad, instructor and board member) is having its fundraiser auction to help defray tuition. I’ve donated a “Tuckerization” — the right to name a character in a future novel:
https://www.indiegogo.com/projects/clarion-sf-fantasy-writers-workshop-23-campaign/#/
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[Image ID: An old fashioned tickertape parade. In an open-top convertible, surrounded by security, is a kicking Democratic Party donkey colored red, white and blue.]
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liberalsarecool · 3 months
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Just remember, Republicans have been promising their 'better version' in 2012, 2013, 2014, 2015, 2016, 2017, 2018, 2019, 2020, 2021, and never delivered a thing.
Long live Obamacare!
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necarion · 7 months
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Been watching Leverage, and came across an episode where a minor character has been denied life-saving coverage because she had a totally unrelated pre-existing condition. And I checked and this show is from 2008.
For all of its imperfections, the ACA stopped that particular bit of bullshit. Even at the time, that was one of those things (like civil asset forfeiture) that normal people think is made up, because of how batshit evil/criminal it sounds. And now, people have forgotten it existed because we actually fixed it.
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tomorrowusa · 2 months
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One word I didn't expect to hear describing Joe Biden's State of the Union speech was "energetic" – but there it was bigtime. 😎
Dark Brandon was in the House and wasn't taking any prisoners. His fervent advocacy for progressive and pro-democracy policies left no one in doubt that he is The Anti-MAGA.
President Biden sounded like an older version of Harry Truman though without swear words. And much of the speech was aimed directly at the Republicans and at the GOP Supreme Court – calling them out right to their faces.
Biden wasn't just energetic, he absolutely taunted Republicans on an issue they've shot themselves in both feet on – immigration reform.
Biden’s Border Taunts Clearly Hit a Republican Nerve
Finally, he arrived at the topic that he knew Republicans couldn’t resist, because it represents that party’s most embarrassing recent failure. He reminded the country that at Donald Trump’s direction, Republicans had killed the strongest immigration bill in years, one that would reduce the flood of asylum seekers and bolster security at the southern border. And immediately the boos poured in from the red side of the chamber. “What are you against?” he asked, finally laughing at the opportunity to expose a bit of rampant hypocrisy. “Oh, you don’t like that bill?” It would save lives and bring order to the chaos at the border, he said, reducing fentanyl smuggling and giving every president the ability to shut down crossings when the surge of migrants became too great. [ ... ] Biden’s provocation on this issue may have been the most successful moment of the evening, one that will be replayed many times in the months to come on the campaign trail. And the power of it could be seen in the downcast face behind him of Speaker Mike Johnson, who wouldn’t bring the border bill to the House floor. All he could do was shake his head and hope Biden changed the subject.
Democrats have reason to feel good about this speech and it showed. His departure from the chamber was delayed by enthusiastic Democratic House members who were asking for selfies and getting autographs from Biden while chatting with him. If they had thought the speech was a dud they would have fled immediately.
On a somewhat funny note, the extended post-speech coverage of Biden's socializing on the House floor delayed the start of the GOP reply by the rather wooden Sen. Katie Britt of Alabama. Many viewers may have tuned out before her speech finally started a little before 11 PM Eastern Time.
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lilithism1848 · 2 months
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