“The First Step Of A Long Journey”: Now’s Not The Time For Liberals To Say “I Told You So” About Obamacare
It has been a rough two months for the Affordable Care Act and its defenders. Having spent years fighting ridiculous allegations about socialized medicine and “death panels,” supporters of near-universal coverage now face something different. The performance failures in the rollout of healthcare.gov have triggered cries of “I told you so!” from some liberals. This wouldn’t have happened, they say, if only Obama had supported some form of single-payer plan, such as Medicare for all. The anger over the botched rollout is understandable, but these recriminations are poorly timed—and just plain wrong.
For starters, the ACA is working reasonably well in some places—California, Connecticut, Kentucky, Washington, and the District of Columbia, for example. These under-reported success stories show that insurance exchanges can work, if properly administered. Exchanges are successfully determining applicants’ eligibility for Medicaid or private insurance, enabling consumers to choose among competing plans, and computing the tax credits to which people are entitled. The human benefits are real, from California to Breathitt County in rural Kentucky. These successes make the federal government’s dismal rollout even more embarrassing. Republicans may have done everything within their power to dynamite the ACA, but the administration fell inexcusably short in launching Obama’s domestic-policy centerpiece.
It doesn’t help that health reform is really complicated. The U.S. health-care system is far and away the most complex in the world, one that includes employer-sponsored coverage, Medicare, Medicaid, Tricare, the Indian Health Service, and small-group and individual insurance coverage—and that’s before Obamacare was implemented.
Given that complexity, some on the left say, life would be simpler if only Congress had been willing—which it was not—to scrap all current arrangements and replace them with a single, federally administered health insurance plan. Those on the right regard this complexity and say that life would be simpler if only Congress had been willing—which it was not—to scrap all current arrangements and replace them with income-related vouchers people could use to help pay for private insurance of their choice.
Those positions enjoy loud support in the blogosphere, Twitter, and cable TV, but only niche support at each end of the political spectrum. Although their ideological values could hardly be more different, these polar-opposite camps each disdain the kludgy fixes of incremental politics. And yet, incrementalism is what most Americans want. Most people are reasonably well-insured. They like their coverage, and they want it to remain affordable. They fear legislation that threatens it. Proposals, whether from the left or right, that force most people into radically different arrangements are fated to remain politically marginal in America.
That the right, which predicted Obamacare would mean the death of liberty and ruination of the U.S health care system, feels vindicated by Obamacare’s initial woes is no surprise. But the troubles with healthcare.gov have rekindled attacks from the left, too. Consider a recent essay by American Prospect co-editor Robert Kuttner, in which he writes, “The colossal mess that Obamacare has become reflects both the character of the legislation and that of the president who sponsored it.”
We understand Kuttner’s frustration. We do not share his disdain for the ACA or for Obama. The law ended a century of legislative failures in the search for universal health insurance coverage, and enacted important reforms of our healthcare delivery system. Obama bet his historic legacy on a reform that, however imperfect, brings health insurance to millions, improves its quality, and helps slow spending growth.
The real beef of those who seek a more radical rewiring of our healthcare system is not with the president. It is with the coalition of labor, healthcare, disability, and anti-poverty groups that coalesced during 2007 and 2008 around a health reform model that later became the ACA. Candidates Hillary Clinton, Obama, and John Edwards endorsed similar health plans. They all included Medicaid expansion, regulated markets (health insurance exchanges), premium subsidies, strengthened insurance regulation, and an explicit or de facto individual mandate. Many Democrats would have preferred single-payer, but the candidates and even most single-payer supporters understood that politically this just wasn’t possible.
We wish ACA had gone farther. It could have provided more generous premium assistance and cost-sharing for working families. It could have allowed people near retirement to buy into Medicare. Alas, senators such as Joe Lieberman—not Obama—scuttled these possibilities. The ACA is only the first step in a long journey of needed health reforms.
Kuttner goes on to write: “Medicare for All would be simpler to execute, easier to understand, and harder for Republicans to oppose.” Nancy Folbre, writing in The New York Times, took the same position. Kuttner and Folbre are correct that Medicare for All would be much easier to understand. Perhaps, as Obama among others has said, Medicare for All would be preferable to our current system, were we designing that system from scratch.
But we aren’t. The slogan “Medicare for all” was never incorporated in a well-crafted legislative proposal. Had it been, it would have been even easier than Obamacare for Republicans to oppose. And implementation would have been formidably difficult. Had the transition to single-payer ever been specifically mapped out, it would immediately have become apparent that this process requires wholesale replacement or rewiring of employer-based coverage, major changes in the relations between states and the federal government. Hundreds of billions of dollars in transfers and new taxes would have been necessary. Enterprising constitutional conservatives surely would have identified plausible court challenges. What’s more, a phalanx of providers—hospitals, doctors, insurers, drug companies and device manufacturers—opposed single-payer proposals. Even such incremental moves as the public option evoked profound unease among insurers, community hospitals, and other key parts of the coalition that supported the ACA.
The backlash against the ACA is occurring because it disrupts coverage of several million people in the individual and small-group insurance market. Transition to single-payer would have been far messier, disrupting coverage for hundreds of millions of Americans, with a much larger and more explosive mix of winners and losers.
There was and is no alternative to the messy incremental politics that produced Obamacare. Liberals such as then–House Majority Speaker Nancy Pelosi didn’t make unpalatable compromises because they held pallid aspirations for health reform. They compromised because they knew that they could not impose their will on querulous colleagues, because they needed 60 Senate votes, because millions of Americans needed help, and because it is better to win messily than to lose gloriously.
Much now rides on the government’s ability to fix healthcare.gov. Definite progress has been made. The federal exchange will be better by year’s end, but it will be months, not a few weeks, before the website really works the way it should. The White House’s cautionary messages on enrollment efforts and its one-year delay in online small business enrollment exemplify the many challenges with getting Obamacare off the ground. So these are anxious times. If the ACA fails, hopes for universal coverage will be set back a generation. Now’s not the time for liberals supporters to turn against Obamacare, or against each other.
By: Henry Aaron and Harold Pollack, The New Republic, November 28, 2013
“The Myth Of Obamacare’s Bad Sales Job”: The Complexity Makes It Easy For Republicans To Lie To The Public
When they went forward with their plan to shut down the government in order to undo, defund, or otherwise undermine the Affordable Care Act (ACA), conservatives convinced themselves that their plan was going to work because Americans hate Obamacare. If you look at it in an extremely narrow, context-free way, that’s sort of true. If you just ask people whether they approve of the ACA, you get between 35 percent and 45 percent approval. But the closer you look, the more complicated it gets. Some people disapprove of it because they feel it didn’t go far enough; add them with those who say they approve, and you’ll get a majority. Furthermore, and most critical for what I’d like to discuss, the actual components of the law, like giving people subsidies to buy insurance, outlawing denials for pre-existing conditions, and so on, are extremely popular (the one exception is the individual mandate).
One thing’s for sure, though: You can’t say that the ACA as an abstract entity is overwhelmingly popular. That has led a lot of liberals to blame Barack Obama for doing a bad job selling the law. I must have heard or read this from a hundred liberals over the last couple of years. If only he had sold it better! Then we wouldn’t be in this mess. Sometimes, I’ve actually heard people say that he never really tried to sell it.
This argument is complete bunk. Here’s why.
1. Obama did sell it. When somebody says that Obama should have sold the ACA better, you should ask them what, specifically, they think he should have done. I can offer you a stone-cold guarantee that whatever they suggest is something that the administration and its allies did, in fact, do. Take polls to figure out what appeals would be effective? Check. Distribute talking points to their allies to get everyone repeating the same message? Check. Make one speech after another on health care? Check. Run ads touting reform? Check. They did it all. So why didn’t it work?
2. Health insurance is inherently complicated. See if you can answer these questions about your own health insurance. What’s your co-pay for office visits? What’s your deductible? What about cost-sharing for hospital admissions? Your yearly out-of-pocket maximum? Does your policy have a lifetime limit? My guess is you couldn’t answer some or all of these questions, and that only scratches the surface of the contract you signed when you got insurance. Did you read it? You probably skimmed it but didn’t bother to go through it line by line, just like you did the last time you downloaded a piece of software. Health insurance is incredibly complicated. Even people whose job it is to deal with health policy don’t always understand their own insurance.
That means that any comprehensive reform that tried to address the pathologies of the system was going to have a hard time even explaining to people what was wrong with that system. And those pathologies are so numerous that the administration had to discuss multiple things, while the opposition only had to say that Obamacare sucks. We’ll get to that opposition in a moment, but first:
3. The Affordable Care Act was an extremely complicated bill. I discussed this in my column last week, but the ACA is a gigantic kludge, a cobbled-together jumble of features each meant to solve a practical or political problem. The administration decided that the simple thing—Medicare for all—couldn’t succeed politically. They also decided that it was vital to be able to tell people, “If you like your current insurance, you can keep it.” They also had to keep conservative Democrats on board to get above the 60 votes necessary to defeat a Republican filibuster in the Senate. They also decided to co-opt the various interest groups like insurance companies, doctors, and hospitals that benefit from the current system, which required more complexity. They also decided that every penny of it was going to be paid for, which required new taxes and spending cuts. In and of themselves each of those decisions may have been reasonable, but they added up to a complex bill that was going to be difficult to explain, no matter how good their pollsters were and how effective a speaker the President is.
4. The American public is not particularly well informed or sophisticated when it comes to understanding policy. We don’t have to go into all the details here, but anybody who sets out on a project to explain something both new and complex to a public that doesn’t understand these things very well to begin with and doesn’t much care is going to be fighting an uphill battle.
5. They were facing an extraordinarily well-financed, united opposition that would say or do pretty much anything. All that complexity made it easy to just lie to the public about what the ACA does. When people hear about some new horror the ACA allegedly includes, many are ready to believe it, since it contains so many different things they already don’t understand. So conservatives could tell them that there are death panels, or that Obamacare forces doctors to collect information on your sex life, or that the IRS is going to have your medical records, or that Congress “exempted itself from Obamacare,” or whatever else they were able to dream up.
The opposition also had the benefit of being against something, which is always easier than being for something. We’re naturally more attuned to negative information than positive information, which is why it’s so easy to use fear to create opposition to a new policy, and change is always frightening. “You’re going to love this change!” is an inherently more difficult case to make than “Be afraid!”
Furthermore, the alliance opposing the law has virtually limitless resources at its disposal. Yesterday The New York Times published a revealing story on the network of conservative funders and activists that have made it their mission to destroy the ACA, including masterminding the current shutdown. Just one Koch brothers-linked organization no one has ever heard of called Freedom Partners Chamber of Commerce distributed an incredible $200 million last year alone to various groups fighting the ACA.
Let me close this discussion with a little historical reminder. In March of 1994, when the Clinton health-care reform was being debated, The Wall Street Journal published an article about polls and focus groups it had conducted on the plan. The article was titled “Many Don’t Realize It’s the Clinton Plan They Like,” and it detailed how, while majorities of the public expressed disapproval of Bill Clinton’s health-care plan, when its features were described to them without saying whose plan it was, majorities expressed approval of it. That’s exactly the same thing we find now with the ACA. The problem wasn’t that Barack Obama didn’t try hard enough to sell it.
Fortunately, the success of the law won’t depend on whether you can get a majority of the public to tell pollsters, “I approve of Obamacare.” Once it’s fully implemented, the only thing that will matter will be whether, in all its different component parts, it works.
By: Paul Waldman, Contributing Editor, The American Prospect, October 7, 2013
“If Liberals Hate Something, It Must Be Terrific And Effective”: Those Obamacare Rape Ads Are A Scam On Conservatives
I suppose I have to talk about the creepy anti-Obamacare ads that everyone, or at least all the liberal bloggers, are talking about today.
Look, folks: this is a very obvious scam.
This is not about stopping the ACA.
This is about money.
Oh, for the donors, it’s presumably about stopping Obamacare.
But for the people putting together the ads, unless they are incredibly stupid and naive, it’s almost certainly about raising money from those donors. And, perhaps, making a name for themselves (or a bigger name — I’m not looking to see who is responsible) within the conservative movement.
These ads could not be better designed to do one thing: to get condemned by liberals. Thus impressing easily scammed conservative marks, who tend to really believe that if liberals hate something, it must be terrific and effective.
This campaign is not designed to convince young people to “opt out” of Obamacare. It’s part of a “campus tour” supposedly designed to convince those young people to go without insurance, but that’s transparently a fraud; traditional-aged college students, the ones who are supposedly being targeted, aren’t really the customers that matter (it’s their older brothers and sisters…yes, some traditional-age college students may purchase their own insurance under ACA, more than was the case before, but it must be a fairly small group).
No, there are real efforts to undermine the law — harassing the “navigators,” pressuring the NFL and others not to publicize it, and more — but this campaign isn’t one of them.
Will it have any effect on actual consumer behavior? I doubt it. But it is worth noting that if it does “work” at all, it’s going to work on the people who respond best to the affect evoked by the ads: in other words, people already primed and ready to hate Obama(care), people already primed and ready to hate the government of the United States, people primed and ready to suspect the very worst of the program. And do note: the way it “works” is by convincing them to go without health insurance.
So basically: if you’re a rich conservative who isn’t very smart about how you give your money, this ad is designed to pick your pocket. If you’re a non-rich conservative, you might get duped into some foolish behavior, but that’s just acceptable collateral damage. For everyone else, it’s an occasion for (to be fair, entirely justified) outrage, I suppose, but basically it’ll come and go without any real effects.
Hey, I know: we’re not supposed to question motives. I believe that. So I’ll say again: it’s possible that these ads are not a scam, but a real political campaign undertaken by seriously naive and stupid operatives. Just as it’s possible that the people doing the “defund” campaign sincerely believe that a government shutdown threat would achieve that, as opposed (as Jamelle Bouie and others pointed out) just finding it an effective money-raising tool). I have to admit, however: that’s not what I think is going on.
By: Jonathan Bernstein, Washington Monthly, Ten Miles Square, September 20, 2013
“When Liberals Enable Tyrants”: Can A Liberal Oppose Tyranny And Support Military Intervention At The Same Time?
What is liberalism supposed to be about on the world stage? What values and goals do American liberals wish to promote around the world? I’m pretty certain most would say free democratic societies; full political rights for ethnic minorities; equal rights for women and, with any luck, gay people; a free press; an independent judiciary; and so forth. And, where those cannot be achieved, at least a base-level opposition to tyranny, reaction, religious fundamentalism, and so on.
Most would name these things. But, I have to say, most rank-and-file liberals don’t seem to me to be very passionate about them. What most liberals are passionate about is one thing: opposition to U.S. militarism. That’s what really roils the loins. Ever since Vietnam, there’s been this template, this governing notion that every military action the United States undertakes is by definition both immoral and bound inevitably to lead to a quagmire; that the U.S. military can do only bad in the world. Lord knows, there’s plenty of evidence to back up the claim, and a posture of deep skepticism about all military plans and promises is the only serious posture (abandoned by most of the “serious” people back in 2003).
I’ve described here two impulses: the desire to do good in the world, or at least to prevent the bad; and opposition to American force. Often these desires can exist in harmony. But what if they conflict? Why is opposition to any projection of force always the deciding factor? At times it can lead people into some very illiberal little corners.
I say this is one of those times. Taking no action now, after what Assad did, strengthens the hand of murderers, theocrats, and some of the most illiberal people on the planet. Yes, I have concerns about what might happen. You’ve read many columns, I’m sure, and heard many Democratic members of Congress on cable television talking about the potential catastrophic effects of a strike. I don’t deny them. I worry about them daily.
But I bet you haven’t heard many people talk about the potential harmful effects in the region of not striking the Assad regime. Yes, you probably saw Lindsey Graham and John McCain talk about how Iran would be emboldened in its nuclear ambitions, but that’s not even the half of it. Here are six consequences of not launching a strike against Syria, all of which could harm small-d democratic hopes in the region and, indeed, potentially increase the carnage.
(1) An Emboldened Assad
If the U.S. doesn’t strike, Assad would be emboldened to intensify the fighting in rebel-held areas. Rebel groups of different kinds hold a large number of cities and towns, as this map will show you. What if, concluding that the war-weary West doesn’t really care what he does and isn’t going to lift a finger to stop him, Assad (with Iran’s help) launches savage campaigns in these areas?
No strike is a green light for Assad to take over all the liberated areas by any means necessary, maybe including, again, chemical weapons. The CWs weren’t used last month just because he’s a big meanie. They were used to ferret rebel fighters out of their strongholds. Why wouldn’t he do it again if no one does a thing to stop him? And again?
(2) More Radicalized Rebels
Also within Syria itself, it’s possible that a failure to strike will radicalize more rebels and turn more of them against the United States and send them into the waiting arms of ISIS and al-Nusra, the al Qaeda affiliates. It certainly seems safe to say that the “good” elements of the anti-regime forces, the people looking to the West for help, would be the losers if we don’t strike. Both the regime and the rebel Islamists have been killing members of the better rebel factions, and both groups would get the message from no U.S. strike that those factions have no protector.
(3) A Win for Hezbollah
Hezbollah, Assad’s ally and Iran’s terrorist proxy army, could more easily take over in Lebanon if the U.S. holds back. Right now in Lebanon, there is no government. I don’t want to drag you too deeply into Lebanese politics, but Hezbollah wants one of two things: either to be in the government, or at least to have what is called the “obstructing third” privilege that permitted it in the last government to block anything the government wants to do. On the other side are pro-Western politicians who have sought to reduce Hezbollah’s influence. No strike would only embolden Hezbollah, which could then decide on key military and security appointments in the next government.
(4) A Strengthened Iran in Iraq
Why? Because of the ongoing competition between Iran and Saudi Arabia for Iraqi influence, no strike would probably make Prime Minister Nuri al-Maliki tilt more toward Iran (Saudi Arabia supports a U.S. strike, albeit not quite openly). Lately, according to Ken Pollack, Washington and Tehran have been in a kind of unexpected entente in Iraq. And Tehran probably has enough on its plate in Syria to prevent it from starting to make power moves in Iraq. But it’s possible, if the U.S. stands down over Syria, that Iran could start doing just that in Iraq, even as the country seems to be sliding back into civil war.
(5) A Blow to Israel
And there’s Israel to think about it. If Nos. 2 and 3 above come to pass—a strengthened al Qaeda and Hezbollah—well, that can’t be very good news for Israel. There are now “resistance brigades” affiliated with the Syrian regime operating in the long-disputed Golan. These brigades, too, will take note if the United States does nothing here.
(6) A Nuclear-Trigger-Happy Iran
There is, yes, the ultimate question of Iran’s nuclear ambitions. I think it’s hard to argue that a U.S. strike would delay those ambitions. But it is not hard to argue the opposite—that the lack of American action against Syria would make Tehran feel that much freer to proceed with that much more impunity.
Looking back over my list, who could benefit from the U.S. not taking action here? Assad, the dictator with the blood of 100,000 on his hands. Iran, one of the world’s most reactionary regimes. Hezbollah, a terrorist force that crushes the democratic aspirations of the Lebanese people. And al Qaeda, the extremist fanatics behind 9/11. Are those the kinds of people liberals want to help? I’m sure liberal members of Congress who’ve announced they’re voting no—Raúl Grijalva, Alan Grayson, Charlie Rangel, Barbara Lee, and about 17 others—have spent a heck of a lot of time thinking about what could go wrong if we do strike. I bet they haven’t given a moment’s thought to what could go wrong if we don’t.
I say that’s worth thinking about. Also worth thinking about is the fact that many liberal-minded people from the region, and certainly many or virtually all of the nonextremist rebels, want the United States to act. From their point of view, without the United States’ engagement, the region is buried in slaughter, theocracy, and darkness. I would expect American liberals at least to stop and think about that.
Again, no one is talking about 130,000 ground troops. That was a qualitatively different thing, and I opposed it from the start. Yes, an American attack might escalate matters. But it also might not. We got in and out of Libya. It’s not clear what that one accomplished yet, although we did presumably prevent a slaughter of many thousands in Benghazi. It is clear what we accomplished in Kosovo, where another murderer was removed from office and hauled to the Hague (without one American life lost). So it doesn’t always end badly. And it isn’t always immoral. This is one of those cases where, if the scale of the action is appropriate and if it works, a military incursion can actually serve liberal ends. No, that’s not for sure. But it is for sure that doing nothing helps the reactionaries.
By: Michael Tomasky, The Daily Beast, September 6, 2013