Paul Krugman, the journalist for the New York Times wrote an op-ed column yesterday in which he featured the word kludge. I would have read the article anyway, as I always read his work. But the use of this word, which I had never seen before, made it an even more special occasion. I could smell a feature word for this blog posting, and it smelled great. He even went to the trouble of defining the word, obviously knowing that there were some of us out there who wouldn’t know what the word meant. Sensitive, I like that.
It turns out that Krugman was talking about the Affordable Care Act, commonly known these days as Obamacare. His point is that it is a program that is clumsy, but capable of being beneficial for the country. It is worth the trouble to get there.
But Krugman makes another point that is even more important. He points to Medicare, an already-existing system which works pretty well for the most part. The question is one which any number of people have asked, “Why not just institute Medicare as the Affordable Care program for the nation? It’s a single-pay program with an already-existing bureaucracy. As a Medicare recipient, I can attest to the fact that it was seamless to enter; it works just like they told me it would; and it is a respected, competent program which makes me feel as if I’m in the hands of a program that cares about me. I really like it.
Oh, I have heard the complaints of doctors and medical institutions that the reimbursements are not terribly lucrative. I suspect that’s true, compared to what a physician can receive from a private-pay patient. But that’s fixable over time. The point it that it works….and it’s not a kludge. It is smooth, for the most part, and it is worth retaining.
I suppose that at any given moment any organization can be called a kludge. The church, the justice system, the educational system, banks, the Boy Scouts of America, the automotive industry, …you name it. Anytime a large organization exists it is vulnerable to glitches which don’t meet the specific needs of a person at a particular moment. And Medicare is not immune from that.
But for the most part Medicare works. There are some who don’t want a single-pay provider, worried that the cumbersome government is incapable of functioning without messing up. The ideological cry and hue of conservatives is that government is just too big to be effective. It needs to be smaller…and programs like Medicare are vulnerable to this charge and at the top of the list of those who want to cut the size of the government. It would be a tragedy.
It is this ideological position that Krugman is identifying as the stumbling block in the health care discussions. There can always be a clash when ideology and pragmatism come up against each other.
I commend Krugman’s column to you. You’ll find it on page A25 of Monday’s New York Times.
Photo Credit: colorprintingfo
* Definition of Kludge by Paul Krugman, New York Times Op Ed Page, Oct. 28, 2013.