The Obama Administration Has Numerous Failures. The ACA Isn’t One of Them.

I agree with some of Sawicky’s critique of Krugman’s Rolling Stone defense of the Obama administration. The point about the kiss up/kick down nature of the criminal prosecutions, in particular, is unanswerable. I don’t agree with the Cornel West argument that he pretended to be something he wasn’t — he strikes me as exactly the moderate liberal Democrat he’s always posed as — but I don’t think anything meaningful or interesting turns on the distinction. The record is what it is, and I think despite some oversimplifications Krugman’s bottom line is correct (only two presidents of the last century could even plausibly claim to have a more substantial record of progressive achievement, which is a successful presidency where I live.)

I can’t say, however, that Max’s attempt at a non-Green Lantern critique of the ACA succeeds:

On the big fucking deal of health care, PK tries to get the best of both sides of the argument. He acknowledges the left criticism of relying on health inscos to fill the coverage gap, then implies that the stupid left doesn’t understand a single-payer plan would not have gotten enough votes to pass. What the not-actually-stupid left really wanted and had a right to expect was the inclusion of some kind of public option, which was arguably not a manifestly disabling feature from a political standpoint. And even if it proved to be so, there is no reason to make a rhetorical virtue in the form of bogus celebrations of “the market” out of a political necessity.

First of all, sad as it is the single-payer argument isn’t a strawman. There are otherwise very smart liberals, not just on the intarwebs somewhere but in the New York Review of Books, that we could have had single payer had Obama only Bully Pulpited the Overton Window Under the Bus on Steroids. (There’s a variant of the argument that concedes that single payer probably wasn’t viable, but Obama should have made it his opening bid, on the theory that if you walk into an Audi dealership and offer $500 for their best car they have no choice but to sell it to you for $1,000.)

But I agree that the more common critique was the failure to include a public option. On that, two points. First of all, a public option was worth trying, but I don’t agree that it was a magic bullet that would have transformed the ACA from hopeless neoliberalism to real progressivism. The public option passed by the House would have had, at best, a minor impact on the exchanges. It was not the road to nationalizing the health care industry. But the policy merits are moot, because it’s pretty obvious that the votes even for the weak House version weren’t there in the Senate. I don’t know how anyone could see how Lieberman acted and still think that it could have gotten 60 votes. Max doesn’t even try to outline what leverage Obama had over the many Senate Democratic opponents of a public option, which given how such conterfactuals tend to go is probably for the best.

The fact that Max doesn’t. even. try. to explain how a public option could have passed suggests that this isn’t his biggest issue with the ACA. The more important one seems to be his objection to Obama “mak[ing] a rhetorical virtue” out of the exchanges. (He’s been even more explicit about this before, conceding that Obama got about as much as could have been expected out of Congress but criticizing him for various alleged Bully Pulpit failures.) The theme continues here:

This problem of turning a practical limitation into a rhetorical virtue afflicted the inadequate stimulus plan as well. Instead of taking what could be gotten but acknowledging the level was insufficient, the Administration acted as if it was all good. It wasn’t. PK again agrees. He can say it but you can’t.

Well, anyone can say it; the question is whether the inadequacy is plausibly Obama’s fault, and Max doesn’t really argue that it is. But leaving aside that I don’t think that presidential rhetoric matters very much, I don’t understand this particular criticism even on its own terms. Obama is supposed to run down the important legislation he signed? I’m not really inclined to urge that presidents demonstrate political incompetence.

On a final point, on the ACA I continue to reject the idea that it reflects “neoliberalism.” As always, missing from these arguments is the Medicaid expansion. As far as I can tell, none of Obama’s critics from the left would disparage the original Medicaid that covered a fraction of a fraction of the poor as “neoliberalism,” and yet a Medicaid that covers everyone within 138% of the federal poverty line is not seen by Obama’s left critics as an accomplishment worthy of any particular note. The focus is on the exchanges, suggesting that had Obama (like Great Society Democrats) just done nothing for the uninsured who don’t qualify for Medicare or Medicaid he would somehow be more progressive than he was because he used more regulated and subsidized markets to insure people. This doesn’t make any sense. If the U.S already had single payer or national health, you could call it “neoliberal” reform. If single payer could plausibly have passed, you could call it “neoliberal.” But given the actually existing status quo ante, it’s not “neoliberal” in any sense. When Obama touts it a a major progressive achievement, he’s not just doing what any politician would, he’s right on the merits.