Brad Delong is puzzled about the state of healthcare discourse in this country and he looks at a former Heritage bigwig for his puzzlement:
Can someone point me to something Stuart Butler has written in the past three years that has turned out to be correct?
I mean, it seems to be blinkered, partisan, wrong–and obviously wrong at the time, both in its analysis of the political forces and of the policy substance…..when I look at what Stuart Butler is writing today, I see no talk about how his root-and-branch opposition to Medicaid expansion, unwarranted budgetary and health-care spending-growth pessimism, and belief that the politics were still favorable for ACA repeal were all misjudgments. I see no talk about how the fact that the world has turned out to be a different place from what he claimed it was back in 2012 and 2013 has led him to rethink.
As a historical note, 2001 to 2015 contains an interesting case study of policy implementation and formulation by reactionaries and liberals in the United States. The liberal policy project was to greatly expand health insurance coverage while reducing total societal cost growth of health care spending. The conservative goal was to break and remake Iraq. One is succeeding, the other is a Hydra headed cluster-fuck.
The project that is successful in its stated goals was built from an effective pilot case (Massachusetts) in a shared cultural and political mileau. It took elements of a known society activity (private health insurance) and tweaked it a bit but not too much. The policy makers saw that subsidized private insurance worked in the S-CHIP program, it worked in Medicare Advantage, it worked in Massachusetts, it was just brought to scale. The other major component of coverage expansion was Medicaid expansion where the greatest barrier to expansion would literally be ordering sufficient ID card stock in some states. Other elements of the plan have significant structural impacts (guarantee issue, community rating etc) but those elements have a history of both policy examples and judicious study by experts who were listened to.
Have there been problems… yes, but the basic analytical insight that this is a fairly straightforward build out of tested programs and things can be muddled through as problems emerge. And that is basically what has happened.
The conservative big policy project was the invasion of Iraq with the goal of making it a Heritage Foundation designed paradise. Experts who knew better were shunted aside, evidence was ignored, interns who were ideologically reliable were given tasks of rebuilding foreign institutions where the local stakeholders were ignored, and the project was managed for television and not reality. Purple fingers were far more important than actual governance and institution building.
Basically any one who cheerleaded for the invasion of Iraq and believed that there was exclusively Good News ™ and painted schools in Iraq for the first decade of this century and then argues that a fairly straightforward health care coverage expansion is impossible should be ignored as they’ve proven that they have anti-judgement.