I’m hardly the only progressive writer who’s noticed Ross Douthat’s warnings to conservatives about the implications of a Obamacare federal exchange failure, or its implications for liberals. Rortybomb’s Mike Konczal has written an impressively clear indictment of the exchange problems as reflecting “non-liberal”–or at least non-New Deal Liberal–features of the Affordable Care Act. These are specifically means-testing, private insurance providers, adverse selection risks, a strong state role, and reliance on choice and competition. He characterizes these features as “neoliberal” (and groups them into a set he calls “Category A Social Insurance”) as opposed to “liberal” principles of universalism, direct government service delivery, compulsory participation, federal monopoly, and reliance on government’s scale and efficienecy (“Category B Social Insurance”). Here’s his conclusion:
Some of the more cartoony conservatives argue that this is a failure of liberalism because it is a failure of government planning, evidently confusing the concept of economic “central planning” with “the government makes a plan to do something.”
However, the smarter conservatives who are thinking several moves ahead (e.g. Ross Douthat) understand that this failed rollout is a significant problem for conservatives. Because if all the problems are driven by means-testing, state-level decisions and privatization of social insurance, the fact that the core conservative plan for social insurance is focused like a laser beam on means-testing, block-granting and privatization is a rather large problem. As Ezra Klein notes, “Paul Ryan’s health-care plan — and his Medicare plan — would also require the government to run online insurance marketplaces.” Additionally, the Medicaid expansion is working well where it is being implemented, and the ACA is perhaps even bending the cost curve of Medicare, the two paths forward that conservatives don’t want to take.
I’ll be discussing this more, but the choice between Category A and B above will characterize much of the political debate in the next decade. It’s important we get more sophisticated analysis of what has gone wrong with the ACA rollout to better appreciate how utilizing “the market” can be far more cumbersome and inefficient than the government just doing things itself.
Konczal thus absolves “liberalism” from any responsibility for Obamacare’s problems, and moreover, suggests Obamacare illustrates the fault lines for a momentous upcoming fight not only with conservatives but with “neoliberals” (presumably including staunch supporters of the last two Democratic presidents and possibly the next one, too). This is obviously a line of argument I’ll be following closely.