“Why They Are Dead, Horribly Wrong”: What Democrats Whine About When They Whine About ObamaCare
Democrats have reacted to crushing losses in November’s midterm elections in the usual manner: with a circular firing squad. And one of the targets has been the signature policy of the Obama administration, the Affordable Care Act.
Sen. Chuck Schumer of New York took the lead earlier this month, arguing that it was a mistake for Democrats to pass comprehensive health care reform. Retiring Sen. Tom Harkin (Iowa) has come to the same conclusion for different reasons.
While it’s not surprising that this argument has intensified after the midterm bloodbath, it isn’t a new one. Massachusetts congressman Barney Frank was saying the same things in 2012, and former White House Chief of Staff Rahm Emmanuel urged Obama to abandon health care reform in 2010, after the election of Scott Brown to the Senate cost Democrats their brief filibuster-proof majority.
But whether made now or at the time, whether from the left, right, or center, whether driven by policy or pragmatism, all of these arguments have one thing in common: they’re dead wrong. Horribly wrong. Wrong about the ACA, wrong about what was possible in 2010, and wrong about American political history in general.
Before analyzing each variation of the claim that Democrats were wrong to pass the ACA, it’s important to start with this: the ACA has been a remarkable policy success. It has substantially reduced the number of Americans without health insurance, and in so doing has alleviated a great deal of needless suffering, anxiety, and financial stress. It has slowed the growth in health care costs. And its medley of wonky reforms has improved health outcomes.
Furthermore, had it been allowed to work as intended, rather than having its Medicaid expansion ineptly re-written by the Supreme Court and obstructed by Republican statehouses, the scope of the achievement would be even greater.
The ACA doesn’t represent optimal health care policy by any means — to find a better one you need only throw a dart at a map of Western Europe. But it’s a success that Democrats should be very proud of, one that can stand alongside the great achievements of the New Deal and the Great Society.
Arguments that Democrats should not have done health care face a very, very high burden of proof. And they don’t even come close.
Democrats should have focused on something else.
This is a recurring theme in the anti-ACA arguments being made by Democrats. Schumer says Democrats should have focused on the “middle class” rather than health care reform, while Frank argued that the Democrats should have emphasized financial reform instead.
The main problem with these arguments is that no alternative course of action would be remotely worth trading for the ACA. As Paul Krugman points out, “focusing” on the economy in and of itself has no value, and Schumer can’t point to any concrete policy that would have passed had the Democrats not pursued comprehensive health care reform. There was not going to be a second major round of stimulus no matter what. The Obama administration didn’t do nearly enough for underwater homeowners, but this failure was independent of the ACA.
The only alternative policy course that could have arguably been preferable to the ACA would have been legislation addressing climate change. But given the Senate’s heavy tilt towards conservative fossil-fuel states, cap-and-trade legislation was always going to be stillborn. The idea that two Democratic senators from North Dakota, two Democratic senators from Montana, Mary “I’m going to my political grave defending the Keystone pipeline” Landrieu, and other relatively conservative Democrats were all going to vote for major climate change legislation is fantastical. In addition, much of what cap-and-trade would have accomplished can be addressed through regulatory action, which is not the case with health care.
Democrats should have waited for a pony.
Harkin’s argument is somewhat different — and is superficially more appealing — than Schumer’s. Instead of arguing that health care reform was a misguided priority, Harkin argues that the ACA wasn’t good enough. “We should have either done it the correct way or not done anything at all,” he asserts. Democrats should have tried for “single-payer right from the get go or at least put a public option [which] would have simplified a lot.”
This is like saying that Democrats should have gotten “two weeks at the penthouse suite at the Ritz-Carlton in San Francisco…or at least a night at the Motel 6 in Tulsa.” It misleadingly conflates two very different policies with two different political possibilities. Single-payer would certainly have been a better policy than the ACA, but it would be hard to get 20 votes for it in the Senate, let alone 60. (It’s worth noting that Sen. Bernie Sanders’ 2009 single-payer bill had a grand total of zero co-sponsors.)
The question of the public option is more complicated. There are variants of the public option — most obviously a universally available Medicare buy-in — that would have been major reforms, representing a pathway to single-payer. But that is precisely why a robust public option was as DOA in Congress as single-payer itself. The public option in the House bill — which would not have been universally available or cheaper than private alternatives — was small potatoes that would not have made the ACA simpler, more popular, or significantly more progressive. And even so, there almost certainly weren’t the votes in the Senate to pass even the neutered version of the public option.
Should the Democrats have just given up then, as Harkin suggests?
No. Let’s put this in historical perspective. Harry Truman tried and failed to pass comprehensive health care reform. Lyndon Johnson, in extraordinarily favorable circumstances, failed to pass comprehensive health care reform. Ted Kennedy’s efforts under the Nixon administration failed. Bill Clinton’s efforts failed. The idea that Democrats will nationalize the health insurance industry the next chance they get is just the purest wishful thinking. And the idea that millions of people should be denied health insurance for such a long-odds gamble is not merely wrong but immoral.
Democrats would have avoided big losses in the midterms.
At the core of these arguments is the fact that the ACA is unpopular, which presumably played a major role in the Democratic Party losing big in the 2010 and 2014 midterms. This argument might be the least convincing of all.
Let’s set aside the fact that Democrats held on to the Senate in 2010 and 2012, despite the ACA’s unpopularity, as well as the presidency. The argument, at its core, is deeply problematic. It presumes that Democrats should maintain power as an end in itself. But it’s not an end in itself — the point of being elected is to do things that benefit your constituents. What’s the point of political capital if you don’t spend it?
Again, it’s worth putting things in historical perspective. The problem with waiting for the perfect, risk-free time to pass major reform legislation is that there’s never a perfect time. There have been three major periods of progressive reform legislation in Congress between the Civil War and 2008. (The fact that there have been only three should give pause to those who think that Obama, Reid, and Nancy Pelosi are worthless sellouts because they failed to completely transform the American political economy in Obama’s first two years.) In 1966, Great Society Democrats lost 47 seats in the House and three in the Senate, a preview of the crack-up of the Democratic coalition that would (with a detour created by Watergate) lead to the election of Ronald Reagan in 1980. In 1938, New Deal Democrats lost 72 seats in the House and seven in the Senate, and this tally doesn’t account for the failure of FDR’s efforts to defeat anti-New Deal Democrats in the primaries. In 1874, the Reconstruction-era Republicans lost 93 (out of 293) seats in the House and a net of seven seats in the Senate, effectively ending Reconstruction.
Does this mean that Lyndon Johnson shouldn’t have signed the Civil Rights Act? That FDR should have waited until he didn’t need Southern segregationists to pass New Deal legislation? That Republicans should have nominated Andrew Johnson rather than Ulysses S. Grant in 1868? Of course not.
The perfect response to these kind of arguments was made by Pelosi: “We come here to do a job, not keep a job. There are more than 14 million reasons why that’s wrong.” This is exactly right. The window for progressive reform in the United States is always narrow and treacherous — you get the best you can get when you have the chance. The unpopularity of the greatest progressive achievement passed by Congress in nearly five decades is unfortunate, but misguided Monday-morning quarterbacking isn’t the right response.
By: Scott Lemieux, Professor of Political Science at the College of Saint Rose in Albany, N.Y.; The Week, December 11, 2014
“A Cardinal Reality Facing The Justices”: The Supreme Court Is Now A Death Panel
Back in March 2011, when the biggest threats facing Obamacare were the Supreme Court and the 2012 elections, I argued that the demise of the Affordable Care Act would put people’s lives in immediate danger.
At the time, the law had relatively few beneficiaries—people under 26 covered by their parents’ health plans, a small population of people with pre-existing medical conditions. But some of them had already used their new coverage to finance the kinds of life-saving treatments that would leave them in need of chronic care for the rest of their lives. Take away the health law, and most of these organ transplant recipients and other patients would have become unable to afford their medications, and some of them would die.
Since then, millions of people have gained coverage under the law, and that group of chronic care patients has grown much larger. But despite the fact that the Court upheld the law, and President Obama won reelection, the ACA isn’t out of danger.
On Friday, the Supreme Court agreed to hear a case that will determine whether the federal government can continue to subsidize private ACA coverage in states that didn’t set up their own insurance exchanges.
That case is King v. Burwell, but the issue at stake has come to be defined by a comparable case called Halbig v. Burwell.
The Fourth Circuit Court of Appeals ruled against the challengers in King, but the Supreme Court agreed to grant cert to those challengers anyhow, despite the absence of a Circuit Court split. If the five conservative Supreme Court justices are so inclined, they can void ACA subsidies for millions of beneficiaries, and cripple the insurance markets in about three dozen states.
Some of those beneficiaries will be the kinds of transplant recipients and other patients I wrote about three and a half years ago. Except today there are many more of them. Several of these patients explained the risk to their lives in an amicus brief, urging a different circuit court to reject the challenge to the subsidies, and thus to the viability of the insurance markets their lives depend on.
“Without insurance, Jennifer [Causor’s] treatments would be completely unaffordable. Her transplant cost nearly $280,000. She takes three anti-rejection drugs, one of which has a sticker price of $2,400 per month…. Should she become uninsured, Jennifer would face bankruptcy and even death.”
You can read the whole brief below. Conservatives are brimming with excitement over the Court’s decision to hear the challenge. Should the five conservatives rule that the text of the law doesn’t provide for federal subsidies in states that didn’t set up their own exchanges, they’ll place the onus on Congress or state governments to address the consequences for constituents who lose their benefits. The contested text could be fixed with a comically simple technical corrections bill, which Democrats would happily support. If Republicans were to sit on their hands, or use the ensuing chaos as leverage to extract unrelated concessions, it will cost people their lives. That is a cardinal reality facing justices, and the people soliciting their conservative activism.
There’s an ironic post-script to this article. The Supreme Court is likely to resolve this case with a 5-4 decision, one way or another. Either a single conservative will side with the Court’s four liberals as in 2012, and leave the law unscathed, or the five conservatives will align to void the subsidies.
Under the circumstances, supporters of the law might be nervous about the potential loss of a liberal justice. Ruth Bader Ginsburg’s health and advanced age make many liberals very uneasy, especially now that Obama’s ability to fill Supreme Court vacancies has come into doubt. But for the purposes of King, this issue is immaterial.
If Ginsburg’s seat were to become vacant, then the fate of the law would remain in the hands of a conservative swing justice. A 4-4 split effectively upholds the lower court’s ruling—and since the Fourth Circuit upheld the subsidies, the subsidies would stand. If the Fourth Circuit had ruled the other way, her health would be much more material.
When I mentioned this admittedly morbid but nevertheless important curiosity on Twitter, a large number of dimwitted (or in some cases persistently dishonest) conservatives flooded my mentions column in outrage. Most of them missed the meaning altogether, and accused me of wishing death upon a conservative Supreme Court justice. But even the ones who didn’t managed to contain their enthusiasm over the possibility of millions of people losing insurance for a moment, to reprimand me for being so cavalier about people’s lives.
By: Brian Beutler, The New Republic, November 7, 2014
“Obamacare Is Here To Stay”: Kentucky Is Emblematic Of The States That Have Received Substantial Assists From Obamacare
You’ve heard of Obamacare, right?
It’s that disastrous, costly and intrusive policy that President Obama and his fellow Democrats rammed down the throats of Congress back in 2010 — a failed plan that conservative Republicans have pledged to “repeal and replace.” According to its critics, it is un-American; it destroys the health care system; it burdens businesses; it hollows out Medicare. Right?
Ah, wrong. Despite what you may have heard and despite the caprice of electoral campaigns, the changes wrought by the Affordable Care Act are here to stay. That’s because it accomplishes much of what it set out to do — and its beneficiaries mostly like it.
Don’t expect Republicans to try to turn back the clock. Oh, some of them will continue to bash Obamacare and to blame it for any negative effects on the country’s dysfunctional health care “system” — including rising costs. And some will even go so far as to continue to insist that it ought to be repealed.
Take Senate Minority Leader Mitch McConnell, who expects to lead the upper chamber if Republicans claim a majority. In a debate last month with his Democratic rival, Alison Grimes, McConnell suggested that he would repeal the Affordable Care Act but leave in place Kentucky’s popular state exchange program.
“… The best interest of the country would be achieved by pulling out Obamacare, root and branch,” he said. “Now, with regard to Kynect, it’s a state exchange. They can continue it if they’d like to.”
McConnell’s pronouncement was a tour de force of dissembling, a virtuoso performance of fabrications and disinformation. The Washington Post’s fact checker awarded him three Pinocchios.
That’s because the state’s health care exchange, Kynect, is a part of Obamacare, made possible by the 2010 law. If Obamacare is ripped out “root and branch,” the state exchanges could not continue to exist. (The GOP has continually pledged to find a mechanism to replace Obamacare, but its warring factions have failed to agree on any plan that would leave state exchanges in place.)
Here’s the rub: Kynect is very popular with Kentucky’s residents, many of whom are enjoying health insurance for the first time in their lives. They have been primed by Republican politicians to hate the president and any policy he endorses — including his signature health care plan — but they don’t want to give up Obamacare’s benefits.
Kentucky is emblematic of the states that have received substantial assists from Obamacare. It is largely rural and is among the poorest states. It has also long ranked near the bottom in several health indicators, including obesity and smoking rates and cancer deaths. Obamacare has been a boon for its residents, cutting the rate of uninsured in half.
According to The New York Times, people who live in rural areas are among the biggest winners from the Affordable Care Act. Other groups who have reaped substantial benefits are blacks, Latinos, women and younger Americans between 18 and 34.
Here’s another reason that Obamacare is here to stay: Its expansion of Medicaid is a boon to the states that have taken advantage of it. After the Supreme Court ruled that Medicaid expansion was optional, most Republican governors vowed to resist it — even though the federal government will pay 100 percent of the cost for the first three years and 90 percent thereafter.
But some of those GOP governors are now having second thoughts as rural hospitals are forced to close down for lack of funds and poor people are sidelined by preventable illnesses. Several GOP governors have already expanded Medicaid — which provides health insurance for the poor — and others are considering doing so.
Last month, Ohio’s Republican governor, John Kasich, advised his GOP colleagues to stop fighting the Medicaid expansion. The opposition, he said, “was really either political or ideological. I don’t think that holds water against real flesh and blood, and real improvements in people’s lives.”
Some Republicans have trouble admitting that on the campaign trail, but they all know it’s true.
By: Cynthia Tucker, The National Memo, November 1, 2014
“Real Improvements In People’s Lives”: John Kasich’s Unforgivable Truth About Obamacare
When we Washington types sit around and handicap the GOP field for 2016, we tend to talk about the known quantities, the people prancing around before us on a daily basis thrusting their elbows in one another’s general direction, your Pauls and Cruzes and Perrys and so on. Then Bush and Christie are mentioned. Eventually, though, some clever person shyly pipes up: “You know, keep one eye on John Kasich.”
And everyone thinks, “Yes, that’s smart.” Because Kasich is the governor of the echt-purple state, Ohio. Because he’s popular, and he’s cruising to reelection. Because his association with some of the party’s batshittier positions is remote. Because governors are usually better candidates than senators anyway.
Always has made a lot of sense to me. But yesterday, the case for Kasich got harder by dint of the governor’s electorally unfathomable and instantly controversial remarks about Obamacare. Campaigning Monday, Kasich told the Associated Press that a full repeal of the hated law is “not gonna happen.” And then he said this: “The opposition to it was really either political or ideological. I don’t think that holds water against real flesh and blood, and real improvements in people’s lives.”
A Republican governor with presidential aspirations acknowledging that Obamacare is improving people’s lives is akin to…well, for starters, a Democratic governor with presidential aspirations saying the Iraq War was a dandy idea. An astonishing statement. His press aides quickly scrambled to explain that Kasich still wants to repeal and replace the law and emphasized that they were seeking some kind of correction from the AP, allegedly on the grounds that the “it” in Kasich’s quote might have meant only the Medicaid expansion, not the entire Obamacare law. [Update: Yes, it would appear that the “it” was just the Medicaid expansion, and the AP has now changed their report to reflect this. Kasich’s press aide Rob Nichols called me Tuesday morning to say: “Absolutely no news was broken yesterday.”]
Be that as it may, stuffing this cat back in this bag probably can’t be done. The quote is out there now. Flesh and blood improvements in people’s lives! Via Barack Obama.
Intense partisans on both sides make up their minds about politicians less on intellectual or policy-substantive bases than on what we in the pundit trade call “affective” ones—having to do with their emotional responses, how a candidate or a situation makes them feel. It’s true as I say on both sides, but it’s much truer on the right these days than on the left, because the right-wing base has real power over Republican politicians, whereas the left base doesn’t have remotely that kind of power to frighten Democratic pols. If a Democrat angers the left, he or she will likely survive it except over one or two issues (the aforementioned Iraq War), and indeed is likelier than not to end up prospering from having done so (the Sister Souljah paradigm).
If a Republican enrages the right, though, he’s cooked. And it can be the smallest and most symbolic thing. Charlie Crist got thrown out of the party for one hug, after all. Mitt Romney was never the base’s favorite, of course, and neither was John McCain. But you’ll notice that when each was the party’s nominee, neither whispered a syllable that would risk offending the base. McCain elevated Sarah Palin. Romney finally adopted some slightly more centrist-seeming positions during the first debate, but he was extremely clever about that, because in doing so, he confounded the media, which were aghast at his sudden reversals of position. So in other words, the base forgave him for the crime of moving to the center because he did it in a way that made the media mad, which pleased the base voters more than his shifts displeased them.
So, back to Kasich. It was one thing to take the Medicaid money. He was one of nine Republican governors to do so, so he had company there. But there’s a right way and wrong way for a Republican governor to accept the Medicaid money. You take the Medicaid money by still complaining about the law and denouncing it, lying that your hands were tied or something like that. You don’t take it by saying it’s actually good.
But Kasich on this point was already in trouble with conservatives, because he took the money a year ago in what conservatives in the Buckeye State thought was a really shifty way. He went around the GOP-controlled state legislature, which opposed the expansion, and won a 5-2 vote on a state Controlling Board whose authority even to make such a decision was questioned at the time by conservatives. Kasich had, in the run-up to the vote, traveled the state campaigning to accept the money, even occasionally making (are you sitting down?) moral arguments in favor of helping the poor.
So all that was known. But none of it was a sound-bite like this. The obvious implication here for 2016 is that, as president, he would not seek to repeal the law, even though he still insists otherwise. So picture the GOP candidate debates of late 2015. They will be asked if they’re going to repeal all of Obamacare. Yes, the rest will thunder! But Kasich will perform some meek tap dance about repeal and replace, leaving the good parts. Good parts?! To GOP primary voters?
Well, he’ll certainly stand out from the field. And who knows. Maybe the 2016 GOP will decide that this sin is forgivable. The urge to beat Hillary Clinton will be fierce, and if the polls say Kasich can do it, then maybe voters will cut him the necessary slack. But that would be a very different electorate from the one we’ve known. My thought for now: Move that eye you were keeping on Kasich over to Indiana’s Mike Pence.
By: Michael Tomasky, The Daily Beast, October 21, 2014
“Who Knew?”: Obamacare Is Such A Disaster That Even More Insurers Want To Be Part Of It
There are still plenty of days when Obamacare looks bad. Tuesday wasn’t one of them.
The Department of Health and Human Services announced that more insurers were joining the Affordable Care Act’s new marketplaces—you know, the places where people can buy coverage on their own and, depending on their incomes, qualify for subsidies. How many more insurers are participating? Quite a few, it turns out. According to HHS, the net increase is more than 25 percent. That should translate to more options for people buying coverage. The increased competition should also help keep premiums relatively low.
The data is preliminary, based on 44 states for which HHS had information. And of course the sheer number of insurers offering coverage is just one sign of how the law is doing. If you’re actually buying insurance, you don’t simply want choices. You want good choices. You want to know that the insurance will give you access to doctors and hospitals when you need them. You want to know that the coverage pays your bills adequately. And so on.
Still, Obamacare critics hadn’t predicted the markets would evolve this way. On the contrary, they expected that young and healthy people would stay far away from the new marketplaces, because the new coverage would be pricier than what they were paying before. Without enough business, the argument went, insurers would get skittish and withdraw. At best, the marketplaces would all become oligopolies and monopolies, with just a handful of insurers continuing to sell policies. At worst, the whole scheme would fall apart. That quite obviously isn’t happening.
Trouble could still arise. By design, Obamacare includes a series of provisions designed to insulate insurers from major losses in the first three years. I usually describe them as “shock absorbers.” Many other policy wonks refer to them as the three Rs, for reinsurance, risk corridors, and risk adjustment. Two of the three, risk corridors and reinsurance, are temporary measures set to expire in 2016. More knowledgeable critics of the law, like Bob Laszewski and Megan McArdle, have warned that more insurers could abandon the market or at least jack up their premiums once those measures expire.
I can’t tell you with certainty whether they are right or wrong. Always in motion is the future, as a famous prophet once said. But keep in mind that gloomy, even dire, predictions about Obamacare’s marketplaces are nothing new. One of my favorites was an op-ed that ran in the Wall Street Journal at the end of last year. The author was John Cochrane, a professor of finance at the University of Chicago. The headline was “What to Do When Obamacare Unravels”—not “if,” mind you, but “when.”
At the time, with unexpected plan cancellations and the website problems very much on people’s minds, betting against the program working probably seemed like a good idea. Who wants to make that kind of bet now?
By: Jonathan Cohn, The New Republic, September 24, 2014
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