In his latest column for the New York Times, celebrated economist and best-selling author Paul Krugman argues that Obamacare, while better than nothing, "is an immense kludge," which he defines as "a clumsy, ugly structure that more or less deals with a problem, but in an inefficient way." The irony? For all the GOP's criticisms of Obamacare for being unwieldy and overcomplicated, the party's proposed "reforms" to the comparatively streamlined Medicare would make the popular single-payer program, according to Krugman, more like Obamacare — not less.
After crediting the insurance industry and a public unwilling to part with employer-provided insurance as the two main impediments to simply expanding Medicare to all Americans, Krugman writes that Obamacare was "probably all we could get" from today's political system. "The thing is," Krugman continues, "such better-than-nothing-but-pretty-bad solutions have become the norm in American governance." He cites Steven Teles of Johns Hopkins, who in a recent essay called the U.S. a "kludgeocracy," and blames anti-government ideology for resulting in so many kludges.
The best example of this anti-government ideology resulting in ugly policy, Krugman claims, can be found in Republican calls to "reform" Medicare. "Republicans still dream of dismantling Medicare as we know it," Krugman writes, "instead giving seniors vouchers to buy private insurance." Coupled with means testing, turning Medicare into a voucher system would, in effect, "convert Medicare into Obamacare" by taking what was a simple, single-payer model and turning it into one based around a government-subsidized marketplace.
Krugman goes on to credit the GOP's anti-government ideology for leading them to this strange conclusion. "[T]he assault on Medicare," he claims, "is really about an ideology that is fundamentally hostile to the notion of the government helping people, and tries to make whatever help is given as limited and indirect as possible, restricting its scope and running it through private corporations." Ultimately, Krugman writes, a society beholden to anti-government dogma will have a bad government. Until this reflexive hatred of government is tackled, in other words, expect more kludges.