Krugman: Who hates Obamacare?

Ted Cruz had a teachable moment in Iowa, although he himself will learn nothing from it. A voter told Cruz the story of his brother-in-law, a barber who had never been able to afford health insurance. He finally got insurance thanks to Obamacare - and discovered that it was too late. He had terminal cancer and nothing could be done.

The voter asked how the candidate would replace the law that might have saved his brother-in-law if it had been in effect earlier. Needless to say, all he got was boilerplate about government regulations and the usual false claims that Obamacare has destroyed “millions of jobs” and caused premiums to “skyrocket.”

For the record, job growth since the Affordable Care Act went fully into effect has been the best since the 1990s, and health costs have risen much more slowly than before.

So Cruz has a truth problem. But what else can we learn from this encounter? That the Affordable Care Act is already doing enormous good. It came too late to save one man's life, but it will surely save many others. Why, then, do we hear not just conservatives but also many progressives trashing President Barack Obama's biggest policy achievement?

Part of the answer is that Bernie Sanders has chosen to make re-litigating reform, and trying for single-payer, a centerpiece of his presidential campaign. So some Sanders supporters have taken to attacking Obamacare as a failed system.

We saw something similar back in 2008, when some Obama supporters temporarily became bitter opponents of the individual mandate - the requirement that everyone buy insurance - which Hillary Clinton supported but Obama opposed. (Once in office, he in effect conceded that she had been right and included the mandate in his initiative.)

But the truth is, Sanders is just amplifying left-wing critiques of health reform that were already out there. And some of these critiques have merit. Others don't.

Let's start with the good critiques, which involve coverage and cost.

The number of uninsured Americans has dropped sharply, especially in states that have tried to make the law work. But millions are still uncovered, and in some cases high deductibles make coverage less useful than it should be.

This isn't inherent in a non-single-payer system: Other countries with Obamacare-type systems, like the Netherlands and Switzerland, do have near-universal coverage even though they rely on private insurers. But Obamacare as currently constituted doesn't seem likely to get there, perhaps because it's somewhat underfunded.

Meanwhile, although cost control is looking better than even reform advocates expected, America's health care remains much more expensive than anyone else's.

So yes, there are real issues with Obamacare. The question is how to address those issues in a politically feasible way.

But a lot of what I hear from the left is not so much a complaint about how the reform falls short as outrage that private insurers get to play any role. The idea seems to be that any role for the profit motive taints the whole effort.

That is, however, a really bad critique. Yes, Obamacare did preserve private insurance - mainly to avoid big, politically risky changes for Americans who already had good insurance but also to buy support or at least quiescence from the insurance industry. But the fact that some insurers are making money from reform (and their profits are not, by the way, all that large) isn't a reason to oppose that reform. The point is to help the uninsured, not to punish or demonize insurance companies.

And speaking of demonization: One unpleasant, ugly side of this debate has been the tendency of some Sanders supporters, and sometimes the campaign itself, to suggest that anyone raising questions about the senator's proposals must be a corrupt tool of vested interests.

Recently Kenneth Thorpe, a respected health policy expert and a longtime supporter of reform, tried to put numbers on the Sanders plan and concluded that it would cost substantially more than the campaign says. He may or may not be right, although most of the health wonks I know have reached similar conclusions.

But the campaign's policy director immediately attacked Thorpe's integrity: “It's coming from a gentleman that worked for Blue Cross Blue Shield. It's exactly what you would expect somebody who worked for BCBS to come up with.” Oh, boy.

And let's be clear: This kind of thing can do real harm. The truth is that whomever the Democrats nominate, the general election is mainly going to be a referendum on whether we preserve the real if incomplete progress we've made on health, financial reform and the environment. The last thing progressives should be doing is trash-talking that progress and impugning the motives of people who are fundamentally on their side.

Paul Krugman is a columnist for the New York Times.