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Paul Krugman - How progressives won the health care argument

On Monday Donald Trump came out with another big lie, claiming to be “the person who saved pre-existing conditions.” And progressives should celebrate.

I mean, it’s not a good thing that we have a president who lies about everything, all the time. And as I wrote in today’s column, he and his party are still trying to destroy Obamacare, and will probably succeed if he’s re-elected.

But notice the nature of this lie. Although Trump is actually the enemy of Americans with pre-existing conditions, he feels the need to pretend that he’s their friend. What that means is that progressives, who insisted that nobody should be denied affordable coverage because of their medical history, have won the argument.

Now, you can win an argument and still be defeated by a combination of dishonesty and brute force, and that’s a real possibility for health care. But things have definitely changed.

Back when the A.C.A. was being debated, the right denounced the entire idea of getting the government involved in regulating and subsidizing private insurance. They did so even though the principal form of private insurance we have, employer-based coverage, is heavily subsidized through the tax code — employer-paid premiums aren’t taxable income — and heavily regulated, because to get that tax-free status employers have to obey rules, including not discriminating against employees with pre-existing conditions.

And these subsidies and rules are why employer-based coverage works, to the extent it does. But conservatives claimed that terrible things would happen if you tried to extend comparable subsidies and regulation to Americans with less generous employers.

As it turned out, however, none of those terrible things happened. Remember how Obamacare was supposed to be a huge job destroyer? In 2011 the Republican House passed a bill titled “Repealing the job-killing health care law act.” Well, here we are with the A.C.A. still in place and 3.5 percent unemployment.

And remember how it was going to explode the deficit? Actually, the parts of federal spending affected by the A.C.A. rose only around 0.7 percent of G.D.P., around 40 percent of the revenue loss from the 2017 tax cut.

And, of course, around 20 million people gained health coverage. For many with pre-existing conditions, health reform was literally a lifesaver.

Now, Obamacare didn’t take us all the way to universal coverage. And some progressives trash the act. Cenk Uygur, a media personality now running for Congress (briefly endorsed by Bernie Sanders), recently declared that “Nancy Pelosi took bribes from insurance companies and 45,000 people died” — because, he apparently believes, she could have passed Medicare for All in 2010 if she wanted to.

The reality, as anyone who followed the events in real time knows, was that Obamacare was the most that could have been achieved in that political environment. In fact, it barely made it through. The point, however, is that the law’s success — and it has been a success, even if both the right and some on the left refuse to admit it — has itself changed the political environment, to the point where even Donald Trump feels the need to lie and pretend that he supports the Affordable Care Act’s key provisions.

I still don’t think Democrats can get to Medicare for All in the next few years, but if they win they’re in a good position to improve substantially on Obamacare — because, as I said, they have decisively won the argument.