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Comment by mysterypie | Hacker News Reader

I didn't quite understand what he was saying about President Obama's thinking, so here's the full quote from Obama:

"Everybody who supports single-payer health care says, ‘Look at all this money we would be saving from insurance and paperwork.’ That represents one million, two million, three million jobs [filled by] people who are working at Blue Cross Blue Shield or Kaiser or other places. What are we doing with them? Where are we employing them?"

So it seems that Obama didn't pursue a single-payer system because keeping 2-3 million "bullshit" jobs was more important than efficiency in the health care system, or at least it was part of his reasoning.

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Joe Leiberman would not have voted for single payer. He opposed moving Medicare eligibility to 55 and over so that had to be taken out of ACA. He (or any single Democrat) was the margin for passing the bill in the Senate with 60 votes to avoid the GOP killing the bill in the Senate.

Also, if I remember correctly, the ACA is similar to but not identical to a GOP plan from the 90's and the state plan adopted when Mitt Romney was governor of Massachusetts in the way you describe - continuing to use existing insurance companies.

Yes, obamacare is trivially different from romneycare. It's villified for political reasons by the right but it's what their mutual benefactors wanted. (Continued inefficiency and profitability; upward wealth redistribution)

Just to underscore this, Lieberman represented Connecticut, which is home to some of the biggest insurance companies in the United States. Lieberman killed the public option in the ACA.

https://www.publicintegrity.org/2015/02/16/16766/elimination...

Lieberman was (and is) certainly bought and sold by the insurance companies, but the lion's share of the blame for not having single payer - let alone a public option - lies squarely on Obama's shoulders. Obama's man in the Senate, Max Baucus, at Obama's direction, barred all single-payer and public option advocates from the conference rooms and negotiating table from the very beginning. Nancy Pelosi and Obama cajoled Dennis Kucinich into supporting the ACA in exchange for a promise that they would bring his single-payer bill to the floor for a vote, to at least put Congressman on the record. Obama brought Kucinich on Air Force one to make this promise. They lied. Kucinich never got his vote - Pelosi and Obama never allowed single payer to surface at all.

Lieberman is certainly worth of endless condementation, but trying to pretend Obama didn't do everything he could to kill single-payer and a public option in order to implement Romneycare is just wrong.

At a political level, the entire approach of "get to 60 votes then punch it through!" is all wrong. This sort of change in the social contract of 300 million-plus people requires more consensus and a more gradual change than that sort of move can provide.

The political situation and polarization of the country certainly got a lot worse when the ACA was passed and that is arguably the biggest political problem the U.S. has had since, affecting basically every policy decision the U.S. makes.

To bring it back to jobs without purpose, not wanting to quickly rearrange an entire sector of the economy is a completely cogent reason to oppose a change you would otherwise vote for if it were applied differently.

Isn't the 60 votes thing is more a reaction to the Gringich stated policy of obstruction before cooperation style politics - before that Democrats and GOP crossed party lines more often to pass legislation and did not vote in lock step, I definitely recall Reagan/Tip O'Neill worked together across party lines to pass legislation most recently. Also, because of the 1980's Byrd Rule that requires 60 votes on avoiding the filibuster in the Senate on bills that affect the budget in certain ways after reconciliation - it sometimes lets bills only need 50 like the GOP was trying for with their ACA rollback last session.

Now it seems rare, the Maginsky Act sanctions and the Iraq War powers are the only consensus votes that come to mind.

A lot of the animosity goes much further back than Gingrich. There were burned bridges during the Bork and Thomas hearings, for instance.

Interestingly enough the house single-payer bill H.R. 676 [1] (and supposedly the Senate bill S. 1804, although I couldn't find any specific language on it) has provisions for "retraining, job placement and employment transition" to account for any "jobs eliminated due to reduced clerical and administrative work".

[1] https://www.congress.gov/bill/115th-congress/house-bill/676

It just sounds like a realpolitik explanation that a bill that would cause that level of job loss should have a solution for the affected employees.

That is assuming it will cause job loss of any appreciable amount. A backup plan is good to have and propose.

My personal take is that a bunch of these pointless jobs would get shoved into government sector.

It's probably best to whittle away at that rather than unemploy 3m people in one go. Better for them to find another place in the economy slowly. At least, that's how I read it.

If anything, ACA seems to increase their number, not decrease it.

I don’t think any sane man would be dumb enough to pass a bill that would make millions unemployed.

Not overnight anyway. Remember that the bill was passed during the recovery period from a recession.

So much this. Everyone wants to fix things by just changing X without taking the time to see the effects that will cascade. There are a lot of worthless jobs in all these systems and those people buy houses and cars which employs other people who buy clothes and food which employs people who buy health insurance. We can make health care better and cheaper but it requires will we don't have. These same people can now be employed in jobs we really need like elder care, etc. But everyone would rather keep their $80K office job where they spend half the day on their phone and fb.

The dark side of me would axe everyone and it would be a bit of cosmic justice. The current healthcare philosophy in America is sprinkled with social darwinism in that you are 'free' to choose what's best for you and if you can't afford it, fuck you, it's your fault, you haven't worked hard enough.

So I would gladly layoff most healthcare administrators and have them figure out what to do, by themselves. It's their fault and their fault only if they can't. “That’s what freedom is all about: taking your own risks.”[1]

Fuck them, this is America, you 'own' your career. I mean, this is the universe I'm currently working in, why shouldn't they be subjected to the same thing? Especially when they chose to work in a parasitic system? If my skills lag behind, I'm unhirable in my industry. Coupled with my increasing age, IT'S ALL MY FAULT AND MY FAULT ONLY if I get fired/laid off and end up with no healthcare.

[1] https://www.nytimes.com/2011/09/16/opinion/krugman-free-to-d...

Yeah, but those are good questions he's asking. What are we doing with them? If it weren't for Lieberman, maybe we'd have been forced to figure that out.

No, that's not a good question, it's political pandering to special interests. It's wrong in it's superficial representation and it's done for very wrong reasons.

A significant reduction in overhead would free significant funds into the hands of the consumers, who would employ them to improve their lives, generating economic growth and demand in other economic areas that would pick up the slack. Granted, it's not comfortable for the workers made redundant, hence the tendency to band together as a special interest group and put political pressure to keep things inefficient (that's all assuming single payer is indeed an efficiency improvement, an entirely separate discussion).

What I'm saying is that he's asking the questions rhetorically like this only because it was already known to be impossible to get to single payer because of Lieberman.

If the facts on the ground were that it was actually possible to get single payer passed, I think those questions would have been easily answerable. It just wasn't tactically necessary to answer them in the context of what was achievable because of one horrendous (sorry Lieberman, but you really blew it) person.

The statement was clearly entirely political, of course.

For the workers made redundant, a good answer to "what will happen to them" is some transitional support to help them re-train (whether through universities or vocational training) for other jobs, and maybe some assistance figuring out what new path to pick and how to get new jobs in the end.

"What will happen to them" doesn't have to mean preserving a broken system, it just has to mean caring humanely for those affected.

West Virginians vehemently disagree with you, it seems. https://www.reuters.com/article/us-trump-effect-coal-retrain...

According to that article, they disagree with this idea as applied to an industry (coal) that has long been a key part of West Virginia's cultural and political identity.

Also according to that article, former coal miners are more open to retraining where other industries have jobs readily available and/or where coal has no credible chance of comeback in that area.

None of that contradicts my suggestion as applied to the health insurance industry, which isn't really part of any cultural identity, and which would clearly not be about to rebound quickly in a single-payer world.

Retraining could even be pretty quick if they retrained to other forms of insurance, especially life insurance (which still cares about individual health) but there are many other kinds too.

What makes you think the other insurance markets can absorb anywhere near that number of workers, without collapsing wages and causing even more misery?

I don't, but they can be among a menu of several destinations for them. Certainly not the only destinations.

Destigmatise and expand welfare. That's exactly what it's there for, so you don't have swathes of people doing jack shit for 8 hours a day and helping no-one. If even 10% of those displaced by getting rid of bullshit jobs go on to do something productive, it's an enormous win for the economy.

Wellfare dependency bas negative, debilitating effects that can last generations once it take hold. Just like poverty.

On the face of it, the idea that it's somehow worse to be given food than to starve is kindof ridiculous.

I mean, sure, it's easy to setup negative incentives if you setup a welfare system and you aren't paying attention, but that's really a different sort of issue... and one that can be solved by looking at those negative incentives. (the earned income tax credit is a good place to start if you want to look at real-world attempts to amelerate the negative incentives that come with "you lose all benefits if you earn more than X dollars" style need-based plans. I'm just bringing it up because it's a real-world attempt to solve that problem and because there is real-world research on it.)

An imaginary way to deal with those negative incentives is Milton Friedman's "negative income tax" or even the 'basic income' people are on about.

But point being, the negative incentives are a thing that you have to watch for with welfare programs... but they don't negate the good done by, you know, allowing poor children to access medical care, food and education.

On the face of it, the idea that it's somehow worse to be given food than to starve is kindof ridiculous.

The discussion here was between welfare and bullshit jobs, not welfare or starving.

The problem with those jobs is that people capable of doing them are already employed. Welfare is still needed for those who can't.

The pointless job sucks out many hours of productive hobbies and caretaking, space to think, innovate and organise.

This might be the desired effect - one of the means to control the population.

The counter-argument is that these jobs are sucking out many hours of taking drugs (incl. alcohol), watching TV and falling into depression, since many can't really handle being idle.

I tend to be more optimistic and think that the problems arise by our current model of unemployment rather than the idleness by itself, but I can't pretend I know the answer.

What is the ultimate, fundamental and irreducible, difference between welfare and government provided services? Like the military, or like pensions? Or, in the UK, like the NHS?

Is it 1 million or 3 million? Because not knowing the difference of 2 million people isn’t a sound, quantitative basis for making policy. What if the impact on jobs was 0? Or -1m, i.e. a million jobs added?

Nobody probably knows how many private providers would remain, and how much they would shrink (yes, single-payer countries usually still have private insurance providers, clinics, hospitals, etc). Pretending you can know a precise answer is worse than admitting you just know there would be a negative effect in that job market.

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