Translation: If you live inside a fantasy box, Obamacare looks inevitable and hopeless

Translation: If you live inside a fantasy box, Obamacare looks inevitable and hopeless

[Ed. – It’s just not possible to keep going with these people’s own headlines.  They don’t even make sense anymore — or, at least, they only make sense if all your assumptions are illusory and unrealistic.  Another word for that would be “insane.”]

The system simply can’t work as intended without a strong mandate that pushes the overwhelming majority of the eligible population onto the exchanges. Some of that will happen naturally over time, as old non-exchange plans expire and their customers drift onto the exchanges. Some of that can be done by HHS unilaterally moving to tighten the screws on various special exceptions to the normal rules. But fundamentally, for the Affordable Care Act to work as a mainstream insurance option, Congress is going to need to implement stiffer penalties.

The prospects for that obviously look bleak in the short run. But the prospects for the conservative alternative of full repeal and the progressive alternative of single-payer also look bleak.

As is usually the case in American politics, the best bet is probably that we’ll simply muddle through. But in the unlikely event that a magical spirit of compromise washes over Congress, you could imagine a three-way bargain that gives multiple stakeholders things they care about. To bring the left around to vote for a stiffer mandate, you’d almost certainly need to go back to the old idea of including a public option on the exchanges to ensure consumers have choice. Then since both a stiffer mandate and a public option would tend to reduce the average premiums, you could offer conservatives mildly stingier subsidies.

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