“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
“Not Quite What Happened”: Sen. Joe Manchin’s Misreading Of Gun Control Politics
Senator Joe Manchin did an laudable job this year of trying to steer a bipartisan gun-control package through the Senate, despite being a Democrat representing a red state where hunting is very popular. And he may be called upon to do so again next year. But his comments about the politics of gun control yesterday on CNN’s “State of the Union” seem very wrong, and might bode poorly for the fate of gun control legislation next year:
What we found out is that people just didn’t trust government, that they were going to stop there. So they said hey Joe, we’re OK with the bill. We like the bill. The bill is not bad at all. We can live with that. But we just don’t trust government stopping and doing what we say we’re going to do.
That’s not quite what happened. Indeed, people liked the bill — very much. As proponents of the legislation often pointed out, support for universal background checks is around 90 percent and remained that high through the entire gun control debate.
It’s hard to find evidence for Manchin’s claim that the legislation failed because people didn’t “trust the government…to stop there.” An April 2013 Washington Post poll – at the height of the gun control debate — found that 55 percent of Americans thought it was possible to make new gun control laws without interfering with the rights of gun owners, with 38 percent thinking otherwise. Americans also said enacting new laws to reduce gun violence were more important than protecting the rights of gun owners, by a 52-40 margin, according to the polls.
And others, including a HuffPost/YouGov poll in September, found that 48 percent of Americans wanted gun laws that were more strict, compared with 16 percent who said less strict and 29 percent who wanted no change.
Now it’s certainly true that pro-gun groups liked to scaremonger about a “national gun registry” that would be used to take away the rights of gun-owners—but despite their best efforts, we still saw polls with broad, bipartisan support for the Manchin-Toomey legislation.
Manchin surely knows such claims are unfounded, since his own bill explicitly makes such a registry illegal, and since he regularly dismissed such concerns back in the spring. So it’s quite odd to see him retroactively validating those unfounded concerns now, and ascribing them to “most people” instead of misinformation by the gun industry and its political allies.
That’s troubling for the immediate future of gun control, because if Manchin really believes the public has spoken, that would be a much more intractable problem then simply fighting some industry misinformation and winning a couple more votes.
But this little episode also underscores a personal pet peeve: the tendency by many people, including those who work within the system and know better, to broadly and belatedly ascribe legislative outcomes as the obvious will of the voters. Gun control failed despite public support, because pro-gun groups are quite adept at lobbying (and spending money), and because many legislators feared primary challenges from pro-gun opponents. Even though it failed in Congress, it didn’t fail with the people.
Similarly, you might hear folks pontificating that the death of the public option during the debate over the Affordable Care Act shows that Americans aren’t ready for socialized health insurance—but the public option was extraordinarily popular with both conservatives and liberals, and was in fact one of the more popular parts of the bill. Our democracy doesn’t always work the way it’s supposed to, and people who work in politics would be wise to remember that when assessing what went wrong and how to move forward.
By: Greg Sargent, The Plum Line, The Washington Post; December 23, 2013
“Obscuring The Bigger Picture”: The Republican Tempest Over The Affordable Care Act Diverts Attention From Three Large Truths
Having failed to defeat the Affordable Care Act in Congress, to beat it back in the last election, to repeal it despite more than eighty votes in the House, to stop it in the federal courts, to get enough votes in the Supreme Court to overrule it, and to gut it with outright extortion (closing the government and threatening to default on the nation’s debts unless it was repealed), Republicans are now down to their last ploy.
They are hell-bent on destroying the Affordable Care Act in Americans’ minds.
A document circulating among House Republicans (reported by the New York Times) instructs them to repeat the following themes and stories continuously: “Because of Obamacare, I Lost My Insurance.” “Obamacare Increases Health Care Costs.” “The Exchanges May Not Be Secure, Putting Personal Information at Risk.”
Every Republican in Washington has been programmed to use the word “disaster” whenever mentioning the Act, always refer to it as Obamacare, and demand its repeal.
Republican wordsmiths know they can count on Fox News and right-wing yell radio to amplify and intensify all of this in continuous loops of elaboration and outrage, repeated so often as to infect peoples’ minds like purulent pustules.
The idea is to make the Act so detestable it becomes the fearsome centerpiece of the midterm elections of 2014 — putting enough Democrats on the defensive they join in seeking its repeal or at least in amending it in ways that gut it (such as allowing insurers to sell whatever policies they want as long as they want, or delaying it further).
Admittedly, the President provided Republicans ammunition by botching the Act’s roll-out. Why wasn’t HealthCare.gov up and running smoothly October 1? Partly because the Administration didn’t anticipate that almost every Republican governor would refuse to set up a state exchange, thereby loading even more responsibility on an already over-worked and underfunded Department of Health and Human Services.
Why didn’t Obama’s advisors anticipate that some policies would be cancelled (after all, the Act sets higher standards than many policies offered) and therefore his “you can keep their old insurance” promise would become a target? Likely because they knew all policies were “grandfathered” for a year, didn’t anticipate how many insurers would cancel right away, and understood that only 5 percent of policyholders received insurance independent of an employer anyway.
But there’s really no good excuse. The White House should have anticipated the Republican attack machine.
The real problem is now. The President and other Democrats aren’t meeting the Republican barrage with three larger truths that show the pettiness of the attack:
The wreck of private insurance. Ours has been the only healthcare system in the world designed to avoid sick people. For-profit insurers have spent billions finding and marketing their policies to healthy people – young adults, people at low risk of expensive diseases, groups of professionals – while rejecting people with preexisting conditions, otherwise debilitated, or at high risk of heart disease, diabetes, and cancer. And have routinely dropped coverage of policy holders who become seriously sick or disabled. What else would you expect from corporations seeking to maximize profits?
But the social consequences have been devastating. We have ended up with the most expensive healthcare system in the world (finding and marketing to healthy people is expensive, corporate executives are expensive, profits adequate to satisfy shareholders are expensive), combined with the worst health outcomes of all rich countries — highest rates of infant mortality, shortest life spans, largest portions of populations never seeing a doctor and receiving no preventive care, most expensive uses of emergency rooms.
We could not and cannot continue with this travesty of a healthcare system.
The Affordable Care Act is a modest solution. It still relies on private insurers — merely setting minimum standards and “exchanges” where customers can compare policies, requiring insurers to take people with preexisting conditions and not abandon those who get seriously sick, and helping low-income people afford coverage.
A single-payer system would have been preferable. Most other rich countries do it this way. It could have been grafted on to Social Security and Medicare, paid for through payroll taxes, expanded to lower-income families through Medicaid. It would have been simple and efficient. (It’s no coincidence that the Act’s Medicaid expansion has been easy and rapid in states that chose to accept it.)
But Republicans were dead set against this. They wouldn’t even abide a “public option” to buy into something resembling Medicare. In the end, they wouldn’t even go along with the Affordable Care Act, which was based on Republican ideas in the first place. (From Richard Nixon’s healthcare plan through the musings of the Heritage Foundation, Republicans for years urged that everything be kept in the hands of private insurers but the government set minimum standards, create state-based insurance exchanges, and require everyone to sign up).
The moral imperative. Even a clunky compromise like the ACA between a national system of health insurance and a for-profit insurance market depends, fundamentally, on a social compact in which those who are healthier and richer are willing to help those who are sicker and poorer. Such a social compact defines a society.
The other day I heard a young man say he’d rather pay a penalty than buy health insurance under the Act because, in his words, “why should I pay for the sick and the old?” The answer is he has a responsibility to do so, as a member the same society they inhabit.
The Act also depends on richer people paying higher taxes to finance health insurance for lower-income people. Starting this year, a healthcare surtax of 3.8 percent is applied to capital gains and dividend income of individuals earning more than $200,000 and a nine-tenths of 1 percent healthcare tax to wages over $200,000 or couples over $250,000. Together, the two taxes will raise an estimated $317.7 billion over 10 years, according to the Joint Committee on Taxation.
Here again, the justification is plain: We are becoming a vastly unequal society in which most of the economic gains are going to the top. It’s only just that those with higher incomes bear some responsibility for maintaining the health of Americans who are less fortunate.
This is a profoundly moral argument about who we are and what we owe each other as Americans. But Democrats have failed to make it, perhaps because they’re reluctant to admit that the Act involves any redistribution at all.
Redistribution has become so unfashionable it’s easier to say everyone comes out ahead. And everyone does come out ahead in the long term: Even the best-off will gain from a healthier and more productive workforce, and will save money from preventive care that reduces the number of destitute people using emergency rooms when they become seriously ill.
But there would be no reason to reform and extend health insurance to begin with if we did not have moral obligations to one another as members of the same society.
The initial problems with the website and the President’s ill-advised remark about everyone being able to keep their old policies are real. But they’re trifling compared to the wreckage of the current system, the modest but important step toward reform embodied in the Act, and the moral imperative at the core of the Act and of our society.
The Republicans have created a tempest out of trivialities. It is incumbent on Democrats — from the President on down — to show Americans the larger picture, and do so again and again.
By: Robert Reich, The Robert Reich Blog, November 22, 2013
“Revisionist History”: Chris Christie Shows Why The GOP Is Hopeless On Health Care Reform
With the rollout of the health care exchanges created by Obamacare hitting some bumps, to put it mildly, and President Obama’s approval rating falling to new lows, it seems like now would be the perfect time for Republicans to take control of the health care issue. Yet they haven’t.
Why? To figure that out, look no further than the GOP’s darling of the moment, New Jersey Gov. Chris Christie.
Fresh off a re-election rout, plenty of conservatives are pointing to Christie as the hope for a new, modern and revitalized GOP. And at the Wall Street Journal’s CEO Council 2013 yesterday, Christie knew his cue, saying, “Obamacare is a failure, it’s always been a failure and it will not succeed. It just won’t.”
But when asked what he would replace it with, Christie first demurred, saying he didn’t have enough time to flesh out a solution, but then added:
Obamacare is wrong, it’s a failure, it’s the most extraordinary overreach of government power in the history of our country. And it’s being run by people who have never run anything. So why are we surprised it’s failing?
What do we need to replace it? We need a robust debate among both sides. Unlike last time, where the president jammed this down everybody’s throat and got not one Republican vote because he was unwilling to make any compromise, including tort reform, for god’s sake. Well, then this time we need a robust conversation between both sides where everybody brings skin to the table and everybody compromises. And if we do that we can craft a solution.
This is just red meat, not a constructive discussion of the nation’s health care problems. And it’s emblematic of the mainstream GOP’s fact-free approach to health care reform and the problems it’s having landing punches against Obamacare.
For starters, it’s simply incorrect that the Obamacare exchanges are “being run by people who have never run anything.” Secretary of Health and Human Services Kathleen Sebelius, after all, ran a state (she was the governor of Kansas, not exactly a socialist utopia), which I imagine Christie counts as executive experience. And President Obama, like it or not, has been at the helm of the world’s largest economy and military since 2009.
But far more importantly, Christie’s only solution to the health care conundrum is more “debate.” He seems to believe that health care reform would have gone just fine if mean old Obama hadn’t “jammed this down everybody’s throat” without making any compromises. That’s revisionist history, to say the least.
Back here in reality, Senate Finance Committee Chairman Max Baucus, D-Mont., spent months fruitlessly trying to get Republicans to sign onto a health care bill, which was also endlessly debated in committee, in each chamber of Congress and on the airwaves. There are a slew of provisions in the law that come from various proposals Republicans have put forth over the years, including some lifted from their Obamacare alternative, but they earned Obama not one Republican vote.
Obama also ditched the public option – a government run plan in the health care exchange – as a concession, for which he got nothing in return except accusations that he was engineering a “government takeover” of health care. Oh, and Christie’s magical tort reform, the GOP silver bullet? Obama has offered it to Republicans multiple times, and in response, they did nothing. (Tort reform, in the end, would result in scant savings anyway.)
This is not to deny that Obamacare has its problems, but simply to highlight that the GOP had the opportunity to be constructive during the health care debate, and instead chose across-the-board opposition and obstruction as an explicit political strategy to bring about Obama’s “Waterloo.”
Now, years later and with Obamacare faltering, the best the GOP’s newest star can muster is to tell the same old tales in the same old way. Complicating the matter is the fact that the few ideas conservatives do have for health care reform would result in many of the same things which Republicans are now criticizing. Reforms favored by the GOP would cause people to lose their insurance plans, even if they like them. And they would cut Medicare. Gasp!
Christie either knows this and can’t say it, because he would then be vilified by the conservative base, or he is just another Republican who doesn’t understand the tradeoffs involved in reforming America’s inefficient, wasteful and oftentimes completely backward health care system. And his refusal to even try to formulate a coherent health care alternative shows why, even after 40-something repeal votes and a disastrous rollout of the exchanges, Obamacare is still very much the law of the land.
By: Pat Garofalo, U. S. News and World Report, November 19, 2013
“What Really Matters”: Don’t Knock Obamacare Until You Try It
There has been a steady drumbeat of news stories about health insurance companies informing customers that their policies will be dropped or that they will face steep rate increases due to requirements of the Affordable Care Act.
This has opened the door to fair criticisms that President Obama wrongly stated that people would be able to keep their current insurance policies if they are happy with them, as this isn’t necessarily the case. However, the real question for individuals facing rate hikes or dropped coverage is whether there are insurance options provided through the exchanges, mandated by the new law, that these people would actual prefer, thanks to some combination of lower prices and more generous benefits. Obamacare might cause some to lose their current policy, but it also might provide them with options they would prefer. That is what really matters.
People should remember that the program provides subsidies for lower income individuals and families. At least in states that have accepted the very generous federal contribution, Obamacare also expands access to Medicaid. For many people who currently lack insurance, a group of people who tend to be poorer, Obamacare insurance policies will be free or relatively cheap.
The initial implementation of Obamacare has not gone smoothly. The key problem is website difficulties faced by people who are attempting to see just how much a plan will cost them, and whose attempts to actually sign up for a policy have been thwarted. We will see if these problems are fixed in a timely fashion, and whether other serious problems crop up.
But the program, as designed, is intended to lower prices for the vast majority of people on the individual insurance market, as well as to open it up to people who previously have been denied affordable coverage because of pre-existing medical conditions. Optimistically, increased competition could even lower prices for employer-based health plans.
Admittedly, such optimistic predictions might not come to pass. Over the next several months we will get a better idea of how many people manage to enroll, whether their coverage is adequate, and whether their overall medical costs, including premiums and out of pocket costs, fall. We might ultimately declare Obamacare a failure, and if that happens we should figure out a better way to expand access to affordable health insurance and care.
Despite the rhetoric from many conservatives, Obamacare isn’t the way most self-described liberals would reform our health care system. It is needlessly complicated, not guaranteed to reduce overall medical costs significantly and its subsidies, while significant, are too stingy. People with lower middle class incomes will still likely find the premiums to be a budgetary strain. At the very least, liberals would have included a government run “public option,” a Medicare-like program that would have competed with the private insurance.
But problems aside, people who are currently navigating the private insurance market –both those without health insurance currently and those who might be receiving scary policy and price change letters from their current insurance companies — should make sure to see just what their Obamacare options are. They might be pleasantly surprised.
By: Duncan Black, USA Today, November 5, 2013
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