Did Lenin Actually Ever Say: “The Worse, the Better”?

The answer to Nicholas Bagley’s questions is: The idea is that the worse you can make things under ObamaCare, the more likely there is to be constructive change because only an intolerable status quo can generate pressures to overcome inertia.

This is usually called a “Leninist argument”. But did Lenin ever actually say it? The only person I can find actually saying it is Plekhanov?

Nicholas Bagley: Why are conservatives so happy about the exchange litigation?: “What would be the payoff of invalidating the IRS rule allowing people on federally facilitated exchanges to get tax credits?… The exchange litigation isn’t a game: in the unlikely event that it succeeds, millions of middle-class Americans would lose their health insurance and millions more would have to pay a lot more for it. Even if you hate the ACA, how exactly is that a good thing?…

The hope seems to be that it might lead to the unraveling of the ACA—that it could, as George Will put it in a recent column, “blow [the ACA] to smithereens.” But the ACA isn’t as fragile as its opponents think it is. Consider the Medicaid expansion. Although it was expected to take hold nationwide, that expectation was dashed when the Supreme Court made it easier for the states to refuse to expand their Medicaid programs. As a result, the ACA now applies differentially across the states—the poor in California are covered, for example, and the poor in Texas aren’t. The exchange litigation, if successful, would result in a similar patchwork. But if disparate Medicaid coverage hasn’t unraveled the Act, why should the disparate availability of tax credits?

I also don’t get how the litigation would help the states that have refused to set up exchanges…. I suppose it’d be possible to construct the argument that the states would be better off if some of their employers weren’t subject to the mandate penalty. I doubt, however, that the benefits of a mildly more auspicious business climate would outweigh the costs of depriving people of the (quite large) tax credits they could otherwise have received through the exchanges. Maybe the hope, though, is that eliminating tax credits to federally facilitated exchanges would give the Republicans some leverage in negotiating changes…. But only up to a point. Without tax credits, the states would come under immense pressure to establish their own exchanges….

In the meantime, what’s certain is that the litigation, if successful, would do a lot of damage. Given the slim likelihood that the lawsuits will accomplish much, I wonder if the challengers have given enough thought to the people—real people, with real health problems, and a real need for insurance—who could be caught in the crossfire.