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[Demeter]

3. COMMENT Ned Ludd

March 14, 2013 at 5:13 am

I think “cajoled” is the wrong word. Ezra Klein, who acted like an unofficial spokesman for the Obama administration during the push for the ACA, says complete privatization was the plan all along.

If Republicans can make their peace with the Affordable Care Act and help figure out how to make the Affordable Care Act’s exchanges work to control costs and improve quality, it’d be natural to eventually migrate Medicaid and Medicare into the system. Liberals would like that because it’d mean better care for Medicaid beneficiaries and less fragmentation in the health-care system. Conservatives would like it because it’d break the two largest single-payer health-care systems in America and turn their beneficiaries into consumers. But the implementation and success of the Affordable Care Act is a necessary precondition to any compromise of this sort. You can’t transform Medicaid and Medicare until you’ve proven that what you’re transforming them into is better. Only the Affordable Care Act has the potential to do that.

I would guess that Obamacare was drafted in order to lay the foundation for the eventual elimination of Medicare and Medicaid. “Only the Affordable Care Act has the potential to do that.” Obama was, as it turns out, thinking several moves ahead. He and his administration, however, thought the exchanges would need to be set up before they could “migrate Medicaid and Medicare into the system”. The governors aren’t cajoling him. For Obama, this is an opportunity to end Medicaid as we know it, earlier than he planned.