Poor Dean Baker. Putting up the good fight against the propaganda, but I'm not sure he's doing too well.
I just caught this, from today, on my facebook feed, Dean Baker saying the ACA didn’t raise healthcare costs, (which is correct to the best of my knowledge):
But, look at the comments! (Don’t forget to click “all comments” to avoid facebook’s auto-anger-inflamation algorithm.)
We’re not doing too well, unfortunately, at least in the subset of people who chose to comment.
We do have to bear in mind that many, possibly almost all comments, may from paid Republican disinformers! (Or disinformer-bots.)
My favorite false economics misinderstanding comment appears (for which the person commenting feels so clever):
“If it was AFORDABLE it wouldn't need subsidies”
Similarly:
“If cost have decreased why do we need a tax credit? How does the credit cut cost out of the ACA?”
and
“BULLS**T... If the object of the "Affordable Care Act" was to make insurance "Affordable" why are democrats demanding hundreds of billions of dollars in subsides for the same overpriced plans people couldn't afford in the first place, 15 years later? …”
In fact, if you run through the comments, you get a whole load of stuff that’s easy to quickly refute if you know the ACA and have your head around the health insurance system and its mechanisms. But, I think that includes me, but I do not think it includes that high a proportion of the people.
With propaganda mechanisms being what they are, and the analytical thinking of so many being poor, it seems to be a losing battle! (As I’ve commented on at least one recent Dean Baker somewhere.)
—
Related, on false accusations against the ACA by Republicans, I call attention to, that I’ve pointed out here in comments, and elsewhere on substack, and even now in comments in the NY Times, such as:
that a graphic used by Thune (speech) and Mike Johnson (tweet) both, recently, to claim a cost problem with the ACA, is likely wildly deceptive or grossly in error (up to I request a double check to avoid impugning the already-elsewhere-impugned for different reasons Paragon Health Institute, which produced the graphic.
I’ve also posted versions of the issue recently on Dean Baker and Jared Bernstein’s comment section, and factcheck. Also Jonathan Cohn and Krugman. A decent version of that is, on factcheck:
(with some explanation of the cost-sharing-reduction finance changing that is necessary to fully understand the problem, if you don’t already know the detail, here:
Hopefully, if it will be useful, one of my comments has caught a high-level Democrat eye, or a high-level Democrat eye has already, independently, caught the problem with the Paragon graphic.
We also lived in Japan for a number of years, although not under the Japanese health care system. We did visit a local clinic several times, and never filed an insurance claim because the bill was so reasonable it didn't seem worth the paperwork. We always found the care to be readily available and highly professional.
It is scandalous that the US, which seems to consider itself the world leader in everything, has been unable or unwilling to provide cost effective health insurance to all.
Good article - and I am glad someone is reflecting on how our health care "system" compares to other, more intentional systems in other countries. I read T. R. Reid's "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care" years ago, and it still forms the core of my understanding of how there are so many ways to get proper universal health care, and how to view our own chaotic systems. Glad to have the pointer to your Taiwan article as well, I missed that earlier.
Are health insurance companies in Japan for profit companies or non profit? Putting shareholder dividends over patient care is a big problem in the US. I remember seeing a Frontline piece years ago about the universal healthcare plans in 5 capitalist democracies. The minister of health in Switzerland noted that their plan is similar to ours except that insurance companies are required by law to be non profit because profit causes a conflict of interest. Seems like that would be a good place to start for us. We shouldn't be talking about markets and consumers when discussing healthcare.
Working as an inpatient oncology nurse I have seen so many truly horrifying circumstances created by the fragmented and exploitive system we have in the US. So many people are convinced they have great healthcare until they need it. The patients that most often receive the care they need in a timely manner are on Medicare. For everyone else, roll the dice.
My husband collapsed in front of a convention center in Yokohama. ( severe aortic stenosis). He was taken to the hospital er. He was accompanied by an English speaking doctor who helped with translation. My husband had lab work, xrays, Ctscan of his head ( rule out brain bleed, concussion), ekg, echocardiogram, cardiology consult. He was told to fly back to the states and have that valve replaced. When I went to check him out, they gave me a card like a parking ticket. This card had all the fees for his stay in the er, ambulance ride, tests etc. The doctor who accompanied him to the hospital, helped me with the billing procedure. He kept on apologizing that it would be so expensive, because we weren’t on their universal coverage plan and would have to pay out of pocket. I put the card into a machine, ( it was like a parking kiosk you see in garages across the USA.). I thought we would be paying thousands of dollars. As the yen totalled up, it looked like a lot of money. The whole visit came to $467 US dollars. Paid by credit card. If I went to the er with a strep throat in the US it would have been much more than that. We weren’t very pleased with the medical care he got.
My wife is Canadian. She is covered under Canada Health plus a supplementary personal insurance.
She and her family have had a number of medical issues since I got to know her and married her. Sports-related injuries (family is rather active), age-related things.
Sometimes they had to wait for specialized treatment, but they got the treatment and things were fixed--if not as quickly as one might want. Cost? $0 oop.
Stepson, shoulder repair, free.
Grandson, knee repair after snowmobile accident, free.
Wife, ovaries removed (potential cancer), free. She also is part of a regular screening program for that (fre).
My wife just had cataract surgery on both eyes, by one of the leading people in Canada doing it. Turned out wonderfully. Got is done in less than a month from deciding to do it. THAT she did pay for through her supplementary insurance/pocket--basically in order to have it done quickly and have both eyes done at once. Cost about $10 k Canadian--which to my mind was pretty cheap. Cost through Canada health would have been $0, but with a year wait and only one eye.
It cost us more to have surgery done on the cat this summer. LOL.
Medical rationing is a fact of life. Sometimes the waiting is simply a time factor (availability). In the US, it is often rationed by the cost--and the effect it will have on your insurance company's bottom line.
I have psoriasis and psoriatic arthritis. There is a drug treatment for that. It costs about $26,000 a dose (when I searched up the actual cost). I have this extended fight with my insurance company every year getting this approved, which means that I miss one or more doses of medication and I relapse.
Our system has some similarities to Japan's, and is partly the result of historical conditions, such as employer-based healthcare and labor union perks. Given this complexity, why not start with mamageable changes: restore funding for Medicaid; create a public option for the ACA; slowly lower the age limit for Medicare; change re-imbursement for HMOs so that the government doesn't pay more than for standard Medicare.
The Affordable Care Act was hardly flawless, but it looked good in comparison to the GOP's alternative. What was the GOP's alternative? (Insert several blank lines here.)
Since Trump's "Big Beautiful Health Care Plan" in 2017 (Apologies for the satirical reference), the GOP health plan has consisted of several "concepts," a few references to non-existent working groups, and a whole lot of flat-out lies about its imminent activation. Check the Wikipedia entry for "vaporware."
A bit off topic, but I still enjoy the answers given in surveys during the first few months of the ACA. Quite a few approved of the ACA, but disliked Obamacare.
""This is frequently the way health care systems develop—in stages, and by building upon whatever pieces are already in place. It’s also why universal coverage takes more forms than commonly understood or discussed in American politics.""
Perhaps my favorite aha moment within this article. Thank you!
Considering that the Republican created health care plan became the ACA, they'll never come up with an alternative. The Heritage Foundation's alternative to the "socialist" plan they expected Hillary Clinton to come up with ultimately became the ACA, with a boost from Massachusetts where Mitt Romney adopted it and made it work there. Had they claimed it when Obama proposed it, rather than making it worse in the name of bipartisanship then still not voting for it, it might have been better from the beginning. Rather, they decided that they would dub it "Obamacare", trying to make that a four letter word. Now they've got nothing, but feel compelled to tear down the ACA, just because it is fully associated with Democrats. Instead of serving their constituents by claiming it was their concept, then working to make it better, they decided to side with the insurance companies trying to save their gross gouging of the system. They had their shot to get credit and they chose partisanship instead.
I also note that the GOP keeps making this argument that the ACA is bad because we are paying insurance companies. As if, they aren't the biggest defenders of the insurance industry. Where would be today if we had been able to offer the "public Option" for insurance that they fought so hard against?
Americans, generally, would rather be sick and die themselves than share what little they have with others. Even if sharing meant that each of us ourselves would also be better off. This conflicts somewhat with our self-image as generous, kind, and fair-minded, so to deal with that we formulate a fantasy that other people don't deserve our help and should solve their own problems.
Had a conversation with my neighbor who owned a smallish business (30-50 employees). He was in despair about how to keep good staff but they were always trying to find jobs with decent health insurance; he couldn't afford to compete with what larger competitors could offer. He was very angry about this. When I asked, what if the field were levelled and we had universal coverage through taxes, and you didn't have to worry about that, wouldn't that solve the problem? Every company, large and small, would be on the same playing field in that regard.
He looked at me like I was a Martian and said, yeah, but that would mean I'd be paying for other people's health care that didn't even work for me. And are lazy bums on welfare. Why would people go to work at all if everything were given them for free?
I responded, you'd be paying a share of other workers' health care, but everyone else would also be paying a share of your workers' health care. Yeah, he said, but I shouldn't have to pay for other people's benefits in the first place.
In other words: yes, he would like a level playing field, but a field of desolation, where everybody is even because nobody has anything.
Insanity. We can't have universal health coverage because we need workers to want to work in order to get health coverage. But we can't give them health coverage at work because we little guys can't afford to offer health care coverage to attract good staff.
America will never get to a decent health care regime until enough of the populari are so desperate they'll care more about their own dire condition than they hate and resent the idea of other people having benefits. What America probably never will overcome is the idea that "fair" means "every man for himself, and God against all -- except of course for me."
There is an especially sad irony to this topic as it pertains to small business people and independent trade people. Often politically oriented against the types of health care that work in the rest of the world, this often means that they are least able to afford insurance.
This is the heart and soul of the problem. Folks no longer see the value of sharing solutions, they see taxes uses to pay for what people need as benefitting the lazy scum. The New Deal taught the lesson of shared problems and solutions. Conservatives worked hard in the decades since to make people hate government and hate helping others.
The reason we have the current health care situation in the united states, and I can't stress this enough, is because the people who oppose any type of universal health care are simply put, selfish F*CKING PR*CKS. They cannot stand the idea that a person who doesn't make a lot of money could get the same quality health care as a rich person or just with a better job. They'll give the bogus arguments about how if you don't pay enough, you don't have skin in the game or that it's unfair since they pay more in taxes. These are the same people that say a woman should be forced to carry a pregnancy to term. But as soon as that child is born, they say you're on your own ( oh, by the way, here is the twenty thousand dollar bill from the hospital)
Single-payer proponents in the U.S. need to start with better messaging. I submit that “healthcare is a right” doesn’t speak to a cohort of Americans on the right. It’s similar to the cohort that doesn’t want to tax billionaires because they know in their heart of hearts that one day they themselves will be one. Just like they know they’re never going to get sick and healthcare is somebody else’s problem. (Go American individualism!)
Instead of saying “healthcare is a right”, maybe just say “healthcare isn’t something some suits should be getting obscenely rich off of”, and go from there to start to remove private insurers and/or their profit motives from the system.
Health care is a business, a service business at that. Nothing will change as long as we pay health service providers salaries disproportionate to other professionals. It might start by subsidizing more schooling,, and it may also require some tort and liability reform. Good luck.
And perhaps single-payer proponents also need to start with a broader understanding of the multiple forms of insurance across the globe, and not assume that single-payer is the most likely path to universal coverage in the USA.
Poor Dean Baker. Putting up the good fight against the propaganda, but I'm not sure he's doing too well.
I just caught this, from today, on my facebook feed, Dean Baker saying the ACA didn’t raise healthcare costs, (which is correct to the best of my knowledge):
https://www.facebook.com/reel/1937045766907346
But, look at the comments! (Don’t forget to click “all comments” to avoid facebook’s auto-anger-inflamation algorithm.)
We’re not doing too well, unfortunately, at least in the subset of people who chose to comment.
We do have to bear in mind that many, possibly almost all comments, may from paid Republican disinformers! (Or disinformer-bots.)
My favorite false economics misinderstanding comment appears (for which the person commenting feels so clever):
“If it was AFORDABLE it wouldn't need subsidies”
Similarly:
“If cost have decreased why do we need a tax credit? How does the credit cut cost out of the ACA?”
and
“BULLS**T... If the object of the "Affordable Care Act" was to make insurance "Affordable" why are democrats demanding hundreds of billions of dollars in subsides for the same overpriced plans people couldn't afford in the first place, 15 years later? …”
In fact, if you run through the comments, you get a whole load of stuff that’s easy to quickly refute if you know the ACA and have your head around the health insurance system and its mechanisms. But, I think that includes me, but I do not think it includes that high a proportion of the people.
With propaganda mechanisms being what they are, and the analytical thinking of so many being poor, it seems to be a losing battle! (As I’ve commented on at least one recent Dean Baker somewhere.)
—
Related, on false accusations against the ACA by Republicans, I call attention to, that I’ve pointed out here in comments, and elsewhere on substack, and even now in comments in the NY Times, such as:
https://www.nytimes.com/interactive/2025/12/30/upshot/year-in-review.html#permid=147642810 (and replies to myself to tack on references)
that a graphic used by Thune (speech) and Mike Johnson (tweet) both, recently, to claim a cost problem with the ACA, is likely wildly deceptive or grossly in error (up to I request a double check to avoid impugning the already-elsewhere-impugned for different reasons Paragon Health Institute, which produced the graphic.
I’ve also posted versions of the issue recently on Dean Baker and Jared Bernstein’s comment section, and factcheck. Also Jonathan Cohn and Krugman. A decent version of that is, on factcheck:
https://factcheckorg.substack.com/p/the-whoppers-of-2025/comment/189164712
with my full latest attempted analysis and correction of the graphic here:
https://normspier828307.substack.com/p/senate-republican-leader-john-thune
(with some explanation of the cost-sharing-reduction finance changing that is necessary to fully understand the problem, if you don’t already know the detail, here:
https://normspier828307.substack.com/p/cost-sharing-reductions-silver-loading )
Hopefully, if it will be useful, one of my comments has caught a high-level Democrat eye, or a high-level Democrat eye has already, independently, caught the problem with the Paragon graphic.
We also lived in Japan for a number of years, although not under the Japanese health care system. We did visit a local clinic several times, and never filed an insurance claim because the bill was so reasonable it didn't seem worth the paperwork. We always found the care to be readily available and highly professional.
It is scandalous that the US, which seems to consider itself the world leader in everything, has been unable or unwilling to provide cost effective health insurance to all.
Good article - and I am glad someone is reflecting on how our health care "system" compares to other, more intentional systems in other countries. I read T. R. Reid's "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care" years ago, and it still forms the core of my understanding of how there are so many ways to get proper universal health care, and how to view our own chaotic systems. Glad to have the pointer to your Taiwan article as well, I missed that earlier.
Are health insurance companies in Japan for profit companies or non profit? Putting shareholder dividends over patient care is a big problem in the US. I remember seeing a Frontline piece years ago about the universal healthcare plans in 5 capitalist democracies. The minister of health in Switzerland noted that their plan is similar to ours except that insurance companies are required by law to be non profit because profit causes a conflict of interest. Seems like that would be a good place to start for us. We shouldn't be talking about markets and consumers when discussing healthcare.
Working as an inpatient oncology nurse I have seen so many truly horrifying circumstances created by the fragmented and exploitive system we have in the US. So many people are convinced they have great healthcare until they need it. The patients that most often receive the care they need in a timely manner are on Medicare. For everyone else, roll the dice.
My husband collapsed in front of a convention center in Yokohama. ( severe aortic stenosis). He was taken to the hospital er. He was accompanied by an English speaking doctor who helped with translation. My husband had lab work, xrays, Ctscan of his head ( rule out brain bleed, concussion), ekg, echocardiogram, cardiology consult. He was told to fly back to the states and have that valve replaced. When I went to check him out, they gave me a card like a parking ticket. This card had all the fees for his stay in the er, ambulance ride, tests etc. The doctor who accompanied him to the hospital, helped me with the billing procedure. He kept on apologizing that it would be so expensive, because we weren’t on their universal coverage plan and would have to pay out of pocket. I put the card into a machine, ( it was like a parking kiosk you see in garages across the USA.). I thought we would be paying thousands of dollars. As the yen totalled up, it looked like a lot of money. The whole visit came to $467 US dollars. Paid by credit card. If I went to the er with a strep throat in the US it would have been much more than that. We weren’t very pleased with the medical care he got.
My wife is Canadian. She is covered under Canada Health plus a supplementary personal insurance.
She and her family have had a number of medical issues since I got to know her and married her. Sports-related injuries (family is rather active), age-related things.
Sometimes they had to wait for specialized treatment, but they got the treatment and things were fixed--if not as quickly as one might want. Cost? $0 oop.
Stepson, shoulder repair, free.
Grandson, knee repair after snowmobile accident, free.
Wife, ovaries removed (potential cancer), free. She also is part of a regular screening program for that (fre).
My wife just had cataract surgery on both eyes, by one of the leading people in Canada doing it. Turned out wonderfully. Got is done in less than a month from deciding to do it. THAT she did pay for through her supplementary insurance/pocket--basically in order to have it done quickly and have both eyes done at once. Cost about $10 k Canadian--which to my mind was pretty cheap. Cost through Canada health would have been $0, but with a year wait and only one eye.
It cost us more to have surgery done on the cat this summer. LOL.
Medical rationing is a fact of life. Sometimes the waiting is simply a time factor (availability). In the US, it is often rationed by the cost--and the effect it will have on your insurance company's bottom line.
I have psoriasis and psoriatic arthritis. There is a drug treatment for that. It costs about $26,000 a dose (when I searched up the actual cost). I have this extended fight with my insurance company every year getting this approved, which means that I miss one or more doses of medication and I relapse.
Awesome.
Our system has some similarities to Japan's, and is partly the result of historical conditions, such as employer-based healthcare and labor union perks. Given this complexity, why not start with mamageable changes: restore funding for Medicaid; create a public option for the ACA; slowly lower the age limit for Medicare; change re-imbursement for HMOs so that the government doesn't pay more than for standard Medicare.
The Affordable Care Act was hardly flawless, but it looked good in comparison to the GOP's alternative. What was the GOP's alternative? (Insert several blank lines here.)
Since Trump's "Big Beautiful Health Care Plan" in 2017 (Apologies for the satirical reference), the GOP health plan has consisted of several "concepts," a few references to non-existent working groups, and a whole lot of flat-out lies about its imminent activation. Check the Wikipedia entry for "vaporware."
A bit off topic, but I still enjoy the answers given in surveys during the first few months of the ACA. Quite a few approved of the ACA, but disliked Obamacare.
""This is frequently the way health care systems develop—in stages, and by building upon whatever pieces are already in place. It’s also why universal coverage takes more forms than commonly understood or discussed in American politics.""
Perhaps my favorite aha moment within this article. Thank you!
the bottom line in the US Congress is
they are not a part of the healthcare program.
Considering that the Republican created health care plan became the ACA, they'll never come up with an alternative. The Heritage Foundation's alternative to the "socialist" plan they expected Hillary Clinton to come up with ultimately became the ACA, with a boost from Massachusetts where Mitt Romney adopted it and made it work there. Had they claimed it when Obama proposed it, rather than making it worse in the name of bipartisanship then still not voting for it, it might have been better from the beginning. Rather, they decided that they would dub it "Obamacare", trying to make that a four letter word. Now they've got nothing, but feel compelled to tear down the ACA, just because it is fully associated with Democrats. Instead of serving their constituents by claiming it was their concept, then working to make it better, they decided to side with the insurance companies trying to save their gross gouging of the system. They had their shot to get credit and they chose partisanship instead.
I also note that the GOP keeps making this argument that the ACA is bad because we are paying insurance companies. As if, they aren't the biggest defenders of the insurance industry. Where would be today if we had been able to offer the "public Option" for insurance that they fought so hard against?
Why are we stupid?
Americans, generally, would rather be sick and die themselves than share what little they have with others. Even if sharing meant that each of us ourselves would also be better off. This conflicts somewhat with our self-image as generous, kind, and fair-minded, so to deal with that we formulate a fantasy that other people don't deserve our help and should solve their own problems.
Had a conversation with my neighbor who owned a smallish business (30-50 employees). He was in despair about how to keep good staff but they were always trying to find jobs with decent health insurance; he couldn't afford to compete with what larger competitors could offer. He was very angry about this. When I asked, what if the field were levelled and we had universal coverage through taxes, and you didn't have to worry about that, wouldn't that solve the problem? Every company, large and small, would be on the same playing field in that regard.
He looked at me like I was a Martian and said, yeah, but that would mean I'd be paying for other people's health care that didn't even work for me. And are lazy bums on welfare. Why would people go to work at all if everything were given them for free?
I responded, you'd be paying a share of other workers' health care, but everyone else would also be paying a share of your workers' health care. Yeah, he said, but I shouldn't have to pay for other people's benefits in the first place.
In other words: yes, he would like a level playing field, but a field of desolation, where everybody is even because nobody has anything.
Insanity. We can't have universal health coverage because we need workers to want to work in order to get health coverage. But we can't give them health coverage at work because we little guys can't afford to offer health care coverage to attract good staff.
America will never get to a decent health care regime until enough of the populari are so desperate they'll care more about their own dire condition than they hate and resent the idea of other people having benefits. What America probably never will overcome is the idea that "fair" means "every man for himself, and God against all -- except of course for me."
I noticed a big difference in attitude after George w Bush. We have become an on your own society. I got mine, I'm not paying for yours.
There is an especially sad irony to this topic as it pertains to small business people and independent trade people. Often politically oriented against the types of health care that work in the rest of the world, this often means that they are least able to afford insurance.
This is the heart and soul of the problem. Folks no longer see the value of sharing solutions, they see taxes uses to pay for what people need as benefitting the lazy scum. The New Deal taught the lesson of shared problems and solutions. Conservatives worked hard in the decades since to make people hate government and hate helping others.
The reason we have the current health care situation in the united states, and I can't stress this enough, is because the people who oppose any type of universal health care are simply put, selfish F*CKING PR*CKS. They cannot stand the idea that a person who doesn't make a lot of money could get the same quality health care as a rich person or just with a better job. They'll give the bogus arguments about how if you don't pay enough, you don't have skin in the game or that it's unfair since they pay more in taxes. These are the same people that say a woman should be forced to carry a pregnancy to term. But as soon as that child is born, they say you're on your own ( oh, by the way, here is the twenty thousand dollar bill from the hospital)
Single-payer proponents in the U.S. need to start with better messaging. I submit that “healthcare is a right” doesn’t speak to a cohort of Americans on the right. It’s similar to the cohort that doesn’t want to tax billionaires because they know in their heart of hearts that one day they themselves will be one. Just like they know they’re never going to get sick and healthcare is somebody else’s problem. (Go American individualism!)
Instead of saying “healthcare is a right”, maybe just say “healthcare isn’t something some suits should be getting obscenely rich off of”, and go from there to start to remove private insurers and/or their profit motives from the system.
Health care is a business, a service business at that. Nothing will change as long as we pay health service providers salaries disproportionate to other professionals. It might start by subsidizing more schooling,, and it may also require some tort and liability reform. Good luck.
And perhaps single-payer proponents also need to start with a broader understanding of the multiple forms of insurance across the globe, and not assume that single-payer is the most likely path to universal coverage in the USA.