Tuesday, March 28, 2017

“I Thought They Said Obamacare Was Evil”

Affirmation for the Affordable Care Act from an Unexpected Source

Republicans, predictably, have failed abysmally in their efforts to repeal and replace the Affordable Care Act, or Obamacare, and the usual media hand-wringing can be expected to go on for at least a few more days. The New York Times covers both the public and private sides of the inevitable blame game, Reuters focuses on the Great Dealmaker’s inability to close his first big deal as president, and the Guardian actually finds a possible bright side for the president at the other end of all this. But the media report I found most interesting was this Anderson Cooper interview with Ohio Governor and former presidential candidate John Kasich, which appeared a few days before the failure of the repeal effort.

Fast-forward to 3:50 in the video to hear Kasich say this:
“If Republicans jam this through…we will be right back where we were…before we started with Obamacare.”
Now, Kasich certainly engages, throughout this interview, in the wild intellectual gymnastics all Republicans engage in when criticizing the ACA. But in the end, here is a prominent Republican leader, a governor of a swing state, saying out loud that in the days before Obamacare, the country was worse off. That is, Obamacare has actually made things better for Americans.

This is just one Republican, perhaps unwittingly, making this statement out loud on national television, but the reality is, the entire American Health Care Act debacle perpetrated by the president, Speaker of the House Paul Ryan, and all of their fellow Republicans, whether it be the governors, the Freedom Caucus, or the Tuesday Group, has, more than anything else, served to solidly affirm the importance of the Obamacare law and the sweat, toil, and political mastery that were required to get it enacted in the first place. Here are three reasons why:
  1. Obamacare is a compromise. Despite the false narrative long pushed by Republicans that Obamacare was a shady deal negotiated in secret in back rooms, it was in fact a huge compromise. As moderate conservative thinker David Frum explains in a recent piece in the Atlantic, Obamacare constituted the “adoption of  ideas developed at the Heritage Foundation in the early 1990s and then enacted into state law in Massachusetts by Governor Mitt Romney.” Recall that President Obama and Democrats didn’t have to do this. They had the votes to pass a single-payer system of the kind Bernie Sanders still advocates, which would have been truer to liberal principles and in the end, I believe, much less expensive. But they knew there would be a huge political backlash, and that Republicans would be able to repeal and replace a single-payer law, probably with something that looked a lot like Obamacare, so they compromised.

  2. Obamacare is a success. An analysis by Margot Sanger-Katz in a February piece in the New York Times clearly details the fact that, despite mixed results overall for the ACA, it has had some remarkable successes that would have been unthinkable before Barack Obama became president. Millions of Americans now have health care coverage and are now more financially secure, health insurance overall is now more comprehensive, and both income inequality and the federal budget deficit have been reduced. And one must always remember that these successes occurred despite a constant drumbeat of invective, hyperbole, and irrational resistance to the law by Republicans nationwide. Tweaks are certainly needed to address weaknesses, but total repeal is no longer even important to most Americans, and that’s because the law has delivered on its most important promises.
  3. Obamacare has reframed the debate. As Sanger-Katz points out, “The Affordable Care Act has shifted the nation’s baseline expectations for how health care should work. Its successes have pushed Republican politicians, like Mr. Trump, into making expansive promises to provide insurance to all Americans.” And it’s not just government accountability that is discussed differently now; it’s health insurance and health provider services as well. As Sanger-Katz writes, “[Obamacare’s] failures have become focal points, too, leading to calls for lower insurance deductibles and for more choices in doctors and hospitals.” 

All of this indirectly led the president and Congressional Republicans to do something very strange over the past few weeks: after seven years of pledging to cheering crowds that they would totally repeal Obamacare immediately after taking power, they instead entered into a debate about how to modify the law: which provisions to keep and which to cast away, and what timing would be most advantageous politically. This tacit admission seems to have gone unnoticed, but that’s just what it was: a tacit admission that Obamacare had improved the lives of so many Americans, many of them Republicans, that it simply could not be repealed without massive political ramifications.

It’s hard to imagine in this weird aftermath of a bizarre, three-week Republican fire drill that the Obamacare law was debated in Congress for the better part of a year, that Republicans proposed dozens of amendments, many of which were accepted, and that many Democrats voted for the law despite serious misgivings. Even Sen. Tom Cotton of Arkansas, one of the more conservative Republicans in the Senate, has now admitted that the Democrats followed a more deliberative process in 2009 than the Republicans have with the AHCA. That’s called compromise, and it’s the necessary evil at the core of democratic governance.

As history judges this turbulent period in American politics, it could well be that Obamacare, whatever Republicans do in the coming months to try and push it over the cliff, just might go down as the last great legislative achievement of this democracy for a very long time.