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I think people had rose colored glasses about Obama because he was, by far, the most charismatic President we've had in modern times. His speeches still give me

I think people had rose colored glasses about Obama because he was, by far, the most charismatic President we've had in modern times. His speeches still give me goose bumps, even when I disagree with what he's saying! That man has the gift of gab. Him also being intelligent further, sadly, makes him an outlier in modern times. But many of the things he did were dubious and ACA is a perfect example of this. It's little more than an subsidy for private insurance companies whose profits dramatically increased relatively shortly after adapting to it. Universal healthcare doesn't have to be adversarial towards private insurance, but it should not directly drive increases in profits because, especially once its mandated + subsidized, profits need to be controlled as the government is effectively guaranteeing them. Medical loss ratios (insurers must pay a minimum percent of premium revenue on medical costs) are obviously insufficient since they do nothing to motivate lower costs. On the contrary, it directly incentivizes maximizing costs which is exactly what's happened. For one specific datum medicare administrative costs are around 2% - private insurance administrative costs start around 12%. --- Basically there is no way this was even remotely close to the most socially motivated (I don't see radical as a desirable adjective) package he could get have gotten passed. And now with the country so divided, it's unlikely we'll be getting anything better anytime in the foreseeable future, because whichever side tries to pass it will simply be opposed by the other, regardless of merit. Hopefully Mamdani isn't a complete failure, because more parties in power is perhaps one way to break the divides in society.

macNchz 1y ago
The ACA was, I believe, a highly intentional better-done-than-perfect effort, fully cognizant of the historical cycles of political will around major healthcare policy in America. If you review in depth the efforts in the 90s under Clinton, and earlier under Johnson, I think the approach was well considered. A more ambitious policy proposal ending in failure very well may have have put the topic to bed for another twenty years. The loss of the “public option” did sting, though.
- TheCoelacanth 1y ago
  Yes, and many states blocking the Medicaid expansion also hurt it.
- danaris 1y ago
  It is that, but it also could have been much better than it was if the Democrats had not made so many concessions trying to win Republican votes, before finally giving up and pushing it through without bipartisan support.
JumpCrisscross 1y ago
> there is no way this was even remotely close to the most socially motivated (I don't see radical as a desirable adjective) package he could get have gotten passed What are you basing this on? Again, Pelosi lost her House because of ACA. Republicans shut down the government multiple times trying to repeal it. They narrowly missed, but because the compromise was powerful. Had Pelosi and Obama pushed harder on ACA, chances are high it would have never passed. I’m not saying it was perfectly calibrated. But the problems you’re mentioning would have meant battling entire new categories of powerful interest groups. That's what, in part, sank HillaryCare.
mmooss 1y ago
> Obama ... was, by far, the most charismatic President we've had in modern times Watching old Obama speeches, I find him mostly run-of-the-mill. Trump, whether or not you like him, is far more charismatic - his success is built on his charisma. Also, look up Bill Clinton or Ronald Reagan speeches, by maybe that isn't what you mean by 'modern times'.
- abenga 1y ago
  > his success is built on his charisma. Print out one of his speeches and read them. His success is built on backlash against the shock of seeing a black president.
  - ben_w 1y ago
    I don't like Trump, and I rank his emission of word-shaped noises somewhere between picking random items from autocomplete suggestions, and my pre-ChatGPT experiments with GPT-3 models. Charisma is a different axis to all of that. A lot of people, for reasons I cannot even empathise with, demonstrably like him. One could even describe their response as "idolising" him. (Where does one draw the line between "a cult of personality" and "apotheosis" anyway?)
    - deleted 1y ago
      [deleted]
    - isleyaardvark 1y ago
      His success is built on racism. As effective as they can be, people don't generally describe the person who whips up a violent mob as charismatic.
      - ben_w 1y ago
        They have called it that since the word was coined in the original ancient Greek, and the skill itself seen as a divine gift: https://en.wikipedia.org/wiki/Demagogue https://en.wikipedia.org/wiki/Demagogue, https://en.wikipedia.org/wiki/Charisma https://en.wikipedia.org/wiki/Charisma It's part of why the ancient Greeks thought government came in cycles, with democracy being only a transitory state.

macNchz 1y ago

The ACA was, I believe, a highly intentional better-done-than-perfect effort, fully cognizant of the historical cycles of political will around major healthcare policy in America. If you review in depth the efforts in the 90s under Clinton, and earlier under Johnson, I think the approach was well considered. A more ambitious policy proposal ending in failure very well may have have put the topic to bed for another twenty years. The loss of the “public option” did sting, though.

TheCoelacanth 1y ago
Yes, and many states blocking the Medicaid expansion also hurt it.
danaris 1y ago
It is that, but it also could have been much better than it was if the Democrats had not made so many concessions trying to win Republican votes, before finally giving up and pushing it through without bipartisan support.

JumpCrisscross 1y ago

> there is no way this was even remotely close to the most socially motivated (I don't see radical as a desirable adjective) package he could get have gotten passed What are you basing this on? Again, Pelosi lost her House because of ACA. Republicans shut down the government multiple times trying to repeal it. They narrowly missed, but because the compromise was powerful. Had Pelosi and Obama pushed harder on ACA, chances are high it would have never passed. I’m not saying it was perfectly calibrated. But the problems you’re mentioning would have meant battling entire new categories of powerful interest groups. That's what, in part, sank HillaryCare.

mmooss 1y ago

> Obama ... was, by far, the most charismatic President we've had in modern times Watching old Obama speeches, I find him mostly run-of-the-mill. Trump, whether or not you like him, is far more charismatic - his success is built on his charisma. Also, look up Bill Clinton or Ronald Reagan speeches, by maybe that isn't what you mean by 'modern times'.

abenga 1y ago
> his success is built on his charisma. Print out one of his speeches and read them. His success is built on backlash against the shock of seeing a black president.
- ben_w 1y ago
  I don't like Trump, and I rank his emission of word-shaped noises somewhere between picking random items from autocomplete suggestions, and my pre-ChatGPT experiments with GPT-3 models. Charisma is a different axis to all of that. A lot of people, for reasons I cannot even empathise with, demonstrably like him. One could even describe their response as "idolising" him. (Where does one draw the line between "a cult of personality" and "apotheosis" anyway?)
  - deleted 1y ago
    [deleted]
  - isleyaardvark 1y ago
    His success is built on racism. As effective as they can be, people don't generally describe the person who whips up a violent mob as charismatic.
    - ben_w 1y ago
      They have called it that since the word was coined in the original ancient Greek, and the skill itself seen as a divine gift: https://en.wikipedia.org/wiki/Demagogue https://en.wikipedia.org/wiki/Demagogue, https://en.wikipedia.org/wiki/Charisma https://en.wikipedia.org/wiki/Charisma It's part of why the ancient Greeks thought government came in cycles, with democracy being only a transitory state.