Steve Klingaman

Steve Klingaman
Minneapolis, Minnesota,
January 01
Steve Klingaman is a nonprofit development consultant and nonfiction writer specializing in personal finance and public policy. His music reviews can be found at

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FEBRUARY 2, 2012 8:28AM

Health Care Reform Comes to Comics

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health comic 

Jonathan Gruber is a policy wonk after my own heart. Detailed, relentless, fact-based, and possessed of a sly sense of humor as evidenced by his new oeuvre:  Health Care Reform:  the comic book.  Gruber, an MIT economist, was a chief architect of RomneyCare in Massachusetts and served as an advisor to the Obama administration on the Affordable Care Act.  So where does he stand on Romney’s stand on health care reform?  It is “disingenuous” in Gruber’s words.  And that’s just word one.

            Gruber’s perspective is the smoking gun that the Mitt Romney of 2005 was serious about health care reform, knew its permutations and reasons for being, and his shrill disavowals of 2011 are a canard.  The reason?  Gruber, who know both bills intimately, says the federal bill is the same bill.  It is simply more aggressive on cost controls, an aspect the state-based plan did not have the leverage to address.  And yes, the Affordable Care Act does incorporate rudimentary elements of systemic cost control, especially for subscribers, which the Massachusetts plan did not include.

            What does this say about Romney?  The term “intellectually dishonest” comes to mind.

            In an interview with online magazine Capital in November, Gruber got real when asked about Romney’s disavowal of the Affordable Care Act:

"The problem is there is no way to say that," Gruber said. "Because they're the same f***ing bill. He just can't have his cake and eat it too. Basically, you know, it's the same bill. He can try to draw distinctions and stuff, but he's just lying. The only big difference is he didn't have to pay for his. Because the federal government paid for it. Where at the federal level, we have to pay for it, so we have to raise taxes."

Gruber, who was interviewed on The Bob Edwards Show on Sirius XM on Monday, is a cheerleader for the Affordable Care Act.  He says that the only way to look at the bill is to compare it against the status quo, rather than to critique it for not going far enough.  That strikes me as reasonable.  Too much is at stake with 45 million uninsured and rapacious industry tricks as a status quo benchmark.  When the Affordable Care Act is phased in beginning in 2014, insurance companies will no longer be able to refuse you coverage due to pre-existing conditions.  Nor will they be able to charge you more for that coverage.  Nor will they be able to drop you if you get sick.  These, says Gruber, are real benefits that we should fight to retain. 

            He points out that the number of people under the age of 26 who are covered by health insurance has already risen as a result of the clause that they must be covered under parental work policies.  He points out that little-known nondiscriminatory high-risk pools known as the Pre-Existing Condition Insurance Plan (PCIP) —a program I wrote about here—have already been phased in nationwide.  In addition, the annual well visit allowed under Medicare is now free.  Baby steps, I know, but Gruber is begging us to accept that major reform is in the pipeline.

            While Affordable Care Act systemic cost controls are baby steps, at best, I am inclined to agree with him that we should make the best of what we have. We need to overcome Supreme Court challenges with commerce clause arguments.  (Really, as if the federal government has no history in mandating the need for indemnification to avoid liability to taxpayers!)  Then we need to get health care exchanges up and running so they begin to make difference in people’s lives.

            Of course the real test to the law comes with the election of 2012.  Gruber feels, and I tend to agree, that if the Republicans to win the trifecta—the White House, Senate, and House of Representatives, they will either repeal the bill, or, if they can’t surmount a 60-vote threshold in the Senate (remember that?) they will bleed it to death by crippling or eliminating key provisions.  A damaged bill, without, say, a universal mandate, will lurch toward failure and lose the public support it would never had had time to win were it to be allowed good-faith implementation.

            If the act dies through electoral execution, we should make no mistake, says Gruber, nothing will replace it.  So what’s it gonna be?  Four more years and hold the Senate, win some seats in the House, or a weak, collapsing, shell of a plan that will lose all public support and usher in an era of profound pessimism and inaction.  I know.  Many readers argue we are already there.  But, believe me, it can get worse, really, really worse, when it comes to health care.

            The central issue, as Gruber puts it, is do you want to continue the regime of untrammeled insurance company discrimination against people in need?  Having written long and often about health care reform, I believe the term I used to characterize my support for the Affordable Care Act was “tepid.”  But that doesn’t mean it isn’t better than nothing.  It is better than nothing.  And those who say half-measures are worse than nothing at all should tell us their solution for assisting the unfortunate people who are facing lack of care, medical bankruptcy, or death, in the interim.  And I’m thinking it may be a long, long interim.

            As I have argued before, we should look at the birth of Social Security to fully appreciate the story of an unformed, toothless, tiny, program that grew to meet the needs of multiple generations, and still can, if we play our cards right and don’t kill it with abuse and cynicism.  But that’s a story for another day.

            So, about “ObamaCare,” if you can’t remember anything but the buzzword, check out Health Care Reform:  the comic book.  If politics is the art of half a loaf, we’ve got ours in the oven, and it beats starving. 


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Romney was certainly all-in for health care reform even if he was nudged in that direction by a Democratic legislature with veto-proof majorities in both houses. He actually asked that a copy of the bill be included in his official government portrait when he left office. However, his current position that the Mass. and U.S. constitutions are different documents is correct--you could do what was done here because it was done at the state level. We'll see whether the Supreme Court agrees that there are limits to the commerce clause or whether (as I once concluded after reading Wickard v. Filburn, the high-water mark of New Deal jurisprudence) that Congress may regulate, in the name of the interstate commerce clause, that which is neither interstate nor commerce.
"the art of half a loaf"...that says it all. Informative post. Thanks.
I'm with you. I'm now looking for the comic book. I will pass it around. We HAVE to take this election. For our own lives.
People who vote against Obama or the Dems because they're not satisfied will be cutting off their noses to spite their faces. Or perhaps slitting their own throats... As a Canadian, I must say "Obamacare" stinks...but it's BETTER THAN NOTHING! And that's what the Repubs stand to give you - nothing.
Great piece. Nobody here in Massachusetts is fooled by Romney's evasions. At least not many! Amazing how four years ago this was supposed to be his signature issue and now he is running away from it. Maybe that is why he's so manic and talks so fast, or faster than normal.
In his attempts to disstance himself from the Affordable Care Act, Romney states that "Romneycare" was never meant to be a national level piece of legislation, "It won't work", he says. But our history is replete with examples of state legislation and policy that served as models or origins for federal level legislation.
That is what we're seeing here. Of course there will need to be tweeks as it works through its growing pains but that is what happens. That's reality. People need to stop judging based on perfection. I think Gruber made a great point, "the only way to look at the bill is to compare it against the status quo, rather than to critique it for not going far enough. "

Thanks for the post Steve!
The cost of employer-based health insurance rose 3 times faster than wages in the last 10 years. Some say this is a big cause of wage stagnation --- compensation increased, but the increase went into the insurance company's pocket, not the employee's.

It now stands at a national average of nearly $14K/year, which is a huge amount of money. Well over half of the country lives in a state where the cost of employer health premiums are over 20% of the average wage. Health care absorbs 17% of our GDP.

Health care costs are still rising. This is unsustainable. If ObamaCare is repealed, the Gov't will have to do something.

If ObamaCare remains as is, many changes will need to be made because Obama's plan doesn't address the root cause of the problem, which is health care costs. The US's costs are way out of line with the rest of the developed world, meaning a different industry structure could produce vastly different results.
Thanks for posting this. I want to send a copy to my right-wing sister. Heck, I want a copy for myself - I don't understand the reforms very well my ownself.
I physically cringe when I think how many people could be insured just with the money health-insurers spend on advertising, let alone the monumental waste that comes with executives salaries and other "administrative" expenses.

The Big Lie in all this is that we already have socialized medicine for those most likely to be in need of healthcare -- the elderly, the disabled, veterans, and children of the poor -- not to mention mandated care for the indigent at every hospital in the country (yes, it's the law, tho the law doesn't address how that care is supposed to be paid for).

So just who are are insurers insuring. Mostly, people who don't need healthcare. That's quite a racket if you can get away with it -- and they do.
This issue is larger than Romney.

The Obama administration has done a poor job of communicating the long term benefits of the Affordable Care Act. Opponents continue to blast it, while this administration and its supports don't seem to know what to say in response. Are there no published "talking points?"

Even though I'm a conservative, I support this legislation because it makes sense.

So, where are the supporters on the national networks?

Criticizing Romney isn't the best way to save the Affordable Care Act.

The Affordable Care Act can stand on its own two feet.
Thank you for a succinct and clear explanation of the importance of this legislation!
Gerry, I appreciate your comment. Obviously you are a conservative who thinks for yourself. While I cannot overlook Romney's garguantan flip-flop on this issue--I think it speaks to the issue of fundamental integrity--I agree that few are out there pointing out the benefits of the Affordable Care Act in the face of an onslaught of ill-defined criticism and ideologically-based opposition. That's one reason I try to provide such and have done so in a number of blogs, including this one.
Steve - I just now came to read it....besides the humour and the "let's compare it to what we have now", the Affordable Care Act should be the first comma of the much quoted "......and the pursuit of happiness....." if not an outright amendment to the Constitution
Tom Cordle has, as usual, made an important point. More to the point, the Obama administration has been spectacularly inept in its use of and dealings with the media...maybe I should say incompetent. Obama did it today when he said that he thinks he deserves another term. These people are all tone deaf when it comes to the nuances in political discourse. No one deserves a term of office. You need to earn it. If he had said that he thought his accomplishments should earn him another term, that would have been a much more palatable statement.

To the issue of health care itself, what we have in America today is a health system that supports the health of the wealthy by providing mediocre care to everyone else because the institutions that provide health care to the wealthy could not exist without the daily infusions of revenue for services for the rest of us.