Keep It Simple, Stupid

Policymaking may be complicated, but voters want simple things.

Photo by Cory Doctorow (CC BY-SA 2.0)

What do the people want? It’s a question that consumes everyone in politics all the time, yet one of the clearest answers is usually ignored. As we begin another round of arguing about our atrocious health care system, Democrats in particular need a reminder. This applies to a whole range of issues, not just health care, but here’s the fundamental truth:

People want simple things, and they want things to be simple.

To explain what I mean, let’s start with one Donald Trump, who is feeling pressured by the fact that health insurance premiums are rising for pretty much everyone, and especially for the tens of millions of people who receive subsidies to purchase insurance on the Affordable Care Act exchanges. Because he doesn’t actually understand how insurance works — a strange thing to say, but it’s pretty clearly the case — he blasted this out on his social media platform:

So…that means there’s no more insurance? The government gives you some money and you pay for your own checkup or knee surgery in cash? That of course is bonkers, so Trump then changed the pitch to say something slightly different but equally moronic, that the government will give everyone money and then they’ll “go out and negotiate their own health insurance,” which will make everyone “feel like entrepreneurs.”

If “negotiating your own health insurance” sounds nightmarish to you, you’re starting to get the picture. But we’re not done. Once Trump says something, no matter how stupid, everyone in the administration has to pretend it’s a real proposal and then scramble to defend it, so you get things like this:

Dr. Oz says that rather than the current exchange system, in which you choose an insurance plan, then a subsidy for your insurance goes from the government to the insurer, we could insert an extra step, in which the government writes you a check, then you write a check to the insurer, making things more complicated for no reason whatsoever. Terrific!

Nobody likes insurance companies, but in these discussions, conservatives tend to fall back on the idea that what people want is more choice. They want more options, more ways to be entrepreneurial and consumeristic when getting their health care. But the thing is: They don’t.

You know what people actually want? They want health care that’s reliable and affordable. They don’t want to spend endless hours picking from competing plans and competing providers, so they can feel like empowered consumers. They want it to be simple.

This is one of the reasons that every industrialized country in the world has a better health care system than ours. It’s not just that they’re less expensive and cover everyone. It’s also that, even though those systems work in different ways, they’re all simpler than ours is. That’s not to say they don’t have their problems, but for most people most of the time in other developed countries, it’s pretty straightforward: You have a problem, you go to the doctor, you get treated, you go home.

This is the magical future that could await us.

Unfortunately, simple isn’t always simple

This doesn’t mean that making change is easy or uncomplicated in both political and policy terms, especially when you’re dealing with a system that is already complicated. This was the dilemma that Democrats faced when they set about to create the ACA: They had to confront an impossibly complex system full of entrenched and powerful interests who would resist any meaningful change, including doctors, hospitals, pharmaceutical companies, medical device companies, and insurers. So the decision was made to co-opt them rather than fight them, and rather than a wholesale reimagining of the system, the ACA took the already complex system and layered even more complexity on top of it.

The ACA was, in short, a giant kludge, a term that gained wider use back in 2013 after political scientist Steven Teles published an influential article on our “kludgeocracy”:

The term comes out of the world of computer programming, where a kludge is an inelegant patch put in place to solve an unexpected problem and designed to be backward-compatible with the rest of an existing system. When you add up enough kludges, you get a very complicated program that has no clear organizing principle, is exceedingly difficult to understand, and is subject to crashes. Any user of Microsoft Windows will immediately grasp the concept.

“Clumsy but temporarily effective” also describes much of American public policy today. To see policy kludges in action, one need look no further than the mind-numbing complexity of the health-care system (which even Obamacare’s champions must admit has only grown more complicated under the new law, even if in their view the system is now also more just), or our byzantine system of funding higher education, or our bewildering federal-state system of governing everything from welfare to education to environmental regulation. America has chosen to govern itself through more indirect and incoherent policy mechanisms than can be found in any comparable country.

As Obama said in 2009, “If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense…The only problem is that we’re not starting from scratch.” Getting the ACA passed (without a vote to spare) was an extraordinary political accomplishment, but we’re still living with the consequence of its kludginess. Unfortunately, Democrats’ policy solutions often make things more complicated, since they tend to be both cautious and attuned to the complexity of the problems they’re trying to solve, pushing them in the direction of more and more complex policy designs that are often impossible to explain to the average person.

Republicans don’t have that problem. Notwithstanding their idiocy about forcing people to devote more time to finding health coverage, their approach to policymaking is usually much simpler. That’s partly because most of them don’t particularly care about policy, and partly because a lot of the time they just want to destroy government agencies and capabilities, and destruction is far simpler than construction. If you want, say, an agency that will police the finance industry to make sure people aren’t victimized by scams, there are a lot of questions you have to answer about monitoring, reporting, enforcement, compensation, and more. But if you want the government to stop protecting people, you can just shut down everything the agency is doing, fire everybody, and declare that it never should have existed in the first place. Simple.

Back to where we started

This relates to a larger dilemma Democrats face, that at a time of deep skepticism about established institutions, they find themselves defending those institutions, as imperfect as they may be, because the alternative of their destruction is so much worse. But that doesn’t mean progressives can’t think more about at least starting from the simple things people want, and using that to create the political support they need to get to the point where they can deal with the complexity.

Those on both the center and left ought to be able to support an agenda that begins with simple goals. The “abundance” debate, for instance, has wound up pitting the left against the center, but at its most fundamental level it starts from a place that everyone in the Democratic coalition should be able to support: We ought to build more. More housing, more public transportation, more parks, more good stuff that makes life good. Of course it gets complicated when you have to start addressing the inevitable tradeoffs, but if you don’t start in the appealing, simple place, you won’t even have the chance to get to the difficult part.

This was a key element of Zohran Mamdani’s success in New York. He started his campaign by asking people what was important to them, and the answer he got was that the city is unaffordable. That led to the main theme of his campaign: The city should be affordable for everyone. A very simple idea. He then followed that with more simple ideas. How about we make buses free? Simple. What if everyone could have child care? Simple. Make a halal plate $8 instead of $10 by fixing the food truck permit process. Simple.

Are those things going to be hard to do, because they’re actually pretty complicated? Sure. But the goals are simple and understandable. And that’s the place Democrats have to start from. They need to prepare and be ready to handle the complexity of policymaking so they don’t just fail when they actually gain power. But they have to begin by identifying the simple things people want in order to make their lives better, then show that they’ll fight for those things. At least the first step is pretty simple.

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