For reasons that probably have something to do with his toilet training, Barack Obama's consistent negotiating posture is to accept the underlying premises of his opponents, give them a big chunk of what they are demanding, and then sit back and expect them to shower him with gratitude and drop the rest of their demands.
As you may have noticed, it doesn't work.
As you also may have noticed, he's done it again. Now, he apparently thinks that by offering the states the chance to design their own systems before the provisions of the PPACA are fully implemented, he does an end run around the states' rights ideologues and forces Republicans to put up or shut up when it comes to expanded coverage and affordability. Sadly, no. I got this e-mail:
Health Care Compact Alliance's Statement On Change To Obamacare
Alexandria, VA – Eric O’Keefe, Chairman of the Health Care Compact Alliance, released the following statement regarding the news that President Obama announced today that he supports amending the 2010 health care law to allow states the option to opt out of some of the laws' requirements three years earlier than currently permitted.
“We welcome the President’s admission that the states may well be able to do a better job with health care than the federal government. However his small step in the right direction is well short of what is needed to restore citizen control over health care, and fiscal sanity to Washington.
By easing the health care law mandates and giving states the earlier option to opt out, President Obama is pushing responsibility and authority down to the states, where it should be. However, even the President's new changes still keep too much authority and regulation with the federal government. Health care is simply too large and complex to manage at the federal level and that is why several states have introduced the Health Care Compact. The Health Care Compact is a comprehensive state-based solution, which takes health care regulation away from the federal government and leaves it to the states and their citizens.”
So they just say "See, you're endorsing our premises, but not following them to the logical conclusion." Give 'em a mile and they'll take a parsec. If I may get wonky for a minute, it is impossible to solve the problems of health care affordability and coverage at the state level because you just end up with a race to the bottom. If you allow insurance to be sold across state lines, and states to establish their own regulations, then it is impossible to create community rated risk pools. It is impossible to get negotiating power with drug and device suppliers, or with regional medical centers for that matter, at least in much of the country.
Canada managed to get its single payer system installed one province at a time, but that was because a) the provinces are a much bigger chunk of Canada than the states are of the U.S., b) the times were different and the idea was extremely popular, c) the vested interests in opposition were much less powerful than they are today and d) the federal government passed legislation to facilitate and push the provinces into doing it. And oh yeah, Canadians are sane.
Mr. Obama, you must lose the habit of anticipatory surrender. It does not work. It has not worked, it will not work, it is the wrong approach. Unless you are actually a mole. I am starting to wonder.
There is an alternative point of view on this, that it's a shrewd move which allows for a push to create state-level single payer systems. For the wonkish reasons I stated, I don't think that can really work, unless maybe California and New York took the lead, along with other large states. However that may be, the problem is with how it is presented -- that the states are really smarter than the federal government, it's wrong for the federal government to design a system for the whole country, and there is probably something wrong with the PPACA so we should let the states do something better. It's the failure of rhetorical and ideological leadership that I'm objecting to, not necessarily Ron Wyden's political strategy.
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