Government Versus Private Insurance

At the Plum Line today, Paul Waldman makes the obvious but oft-forgotten point that while conservatives shriek about the Affordable Care Act as some sort of monstrous expansion of government involvement in health insurance, it’s dwarfed by the government-supplied Medicare, Medicaid and VA insurance programs that continue to expand.

To be clear, there are quite a few people in the supposed single-payer programs who actually have private plans. I haven’t seen any reliable numbers for a while, but roughly half of Medicaid beneficiaries have private plans negotiated by the states (that percentage is surely going up via some of the Medicaid expansion “deals” being accepted by the Obama administration). About a fifth of Medicare beneficiaries participate in Medicare Advantage Plans created and heavily subsidized under the Bush administration as a privatization-camel’s-nose-under-the-tent (one of the few actual “Medicare cuts” in the ACA was a reduction in these subsidies).

But the most profound part of what Waldman is talking about is wild hypocrisy involved in Republican demonization of the private-insurance-exchange aspects of Obamacare, which resemble nothing so much as where Republicans want to take Medicare and Medicaid. A few conservative wonks have acknowledged this: most notably Avik Roy and Douglas Holtz-Eakin, who suggested over a year ago that Obamacare could become the linchpin of a universal system of government subsidized but privately operated health insurance. This has not, to put it mildly, caught on among Republicans. But the disconnect in how the Right views the government role in this or that program leads to two strong suspicions: the first and most powerful one is that Obama’s name on the ACA is what makes it so outrageous; the second and more important one is that conservatives favor publicly subsidized and regulated private insurance only when it’s a way station to complete privatization.

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Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.