Stop the Metaphor Madness

There are no comparisons — Obamacare stands alone.

President Obama speaks about fiscal policy at George Washington University on April 13, 2011 in Washington, DC. President Obama laid out his plan for deficit and debt reduction.
National Journal
Major Garrett
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Major Garrett
Nov. 28, 2013, midnight

Can we, be­fore our L-Trypto­phan coma com­mences, vow to aban­don all at­tempts to fes­toon Obama­care with ri­dicu­lous his­tor­ic­al meta­phors? The damn law is big, with a reg­u­lat­ory heft now in ex­cess of 20,000 pages. But even this gov­ern­ment­al be­hemoth groans un­der the weight of meta­phor­ic­al or­na­ments both daft and dull.

Obama­care is not Kat­rina, not in fact or polit­ic­al im­pact.

Obama­care is not Ir­aq, not in its hu­man or ma­ter­i­al cost or in the reck­less mis­use of a com­mand­er in chief’s most sac­red ob­lig­a­tions of truth, judg­ment, and man­age­ment.

Obama­care is not the Bay of Pigs, not in concept, ex­e­cu­tion, or polit­ic­al ap­prais­al.

And just to be help­ful, let me cross oth­er meta­phors off the list that may tempt those wrest­ling with a new con­cep­tu­al hook to de­scribe Obama­care.

It’s not Pres­id­ent Obama’s Ir­an-Con­tra af­fair or his May­aquez or Pueblo. It’s not his Yalta or Mu­nich. It’s not his Tet, Dunkirk, or Wa­ter­loo, either. And it isn’t Obama’s Teapot Dome, Cred­it Mo­bilier, or XYZ Af­fair. And it isn’t Ther­mo­pylae, either. At least not yet — though Re­pub­lic­ans might love to play the Greeks and pos­sibly nom­in­ate Sen. Ted Cruz as their Le­oni­das.

The Af­ford­able Care Act is a sin­gu­lar cre­ation, a par­tis­an-con­struc­ted, par­tis­an-man­euvered, and par­tis­an-de­fen­ded hy­brid of gov­ern­ment co­er­cion and private-sec­tor col­lab­or­a­tion. It is not the apo­theosis of lib­er­al­ism, though it is lately mis­taken for that (a single-pay­er sys­tem would have been). There­fore, its fate can­not and will not write the fi­nal or ne­ces­sar­ily even next chapter of lib­er­al­ism or pro­gressiv­ism’s role in Amer­ic­an life. The ACA is not the Her­it­age Found­a­tion’s free-mar­ket al­tern­at­ive to Hil­lary­care it is of­ten mis­char­ac­ter­ized to be, and there­fore its com­pon­ent parts shed no light on GOP ante­cedents or al­tern­at­ives. Ante­cedents there are many, for there was a time when Re­pub­lic­ans ser­i­ously craf­ted such le­gis­lat­ive struc­tures. This they no longer do, and thus they are stuck and sty­mied with a re­pet­it­ive pro­ced­ur­al cam­paign against Obama­care that thus far has neither suc­ceeded in Con­gress nor gal­van­ized the pub­lic.

The ACA is, most of all, a mess.

And I don’t mean Health­, a sub­ject I will re­turn to mo­ment­ar­ily.

I mean the law and its con­sequences, its reg­u­la­tions and taxes, its causes and its ef­fects are messy. Win­ners and losers abound. This is true now and will be true for as long as the law re­mains. And re­main it likely will, pre­cisely be­cause of the tight and self-re­in­for­cing al­li­ance the law con­struc­ted with in­surers, hos­pit­als, and doc­tors. Amer­ic­ans who lacked in­sur­ance cov­er­age will find it through the private sec­tor on fed­er­al or state ex­changes or via Medi­caid. Amer­ic­ans who had policies on the in­di­vidu­al mar­ket will lose their old cov­er­age and pos­sibly find new and bet­ter cov­er­age or more ex­pens­ive and in­feri­or plans. Amer­ic­ans em­ployed by large cor­por­a­tions will see mod­est changes in be­ne­fit and premi­um sched­ules, and those who work for smal­ler com­pan­ies may see pre­vi­ous cov­er­age van­ish and choose new op­tions that may or may not live up to their ex­pect­a­tions. All of this will be destabil­iz­ing and gen­er­ate in dif­fer­ent re­gions and among dif­fer­ent demo­graph­ic groups anxi­ety, pos­sib­il­ity, re­lief, and rage.

In this, Obama­care will un­in­ten­tion­ally but un­mis­tak­ably re­semble the old sys­tem — where these power­ful emo­tions and wrench­ing eco­nom­ic dis­lo­ca­tions were com­mon but en­gin­eered en­tirely by the private in­sur­ance mar­ket. To cov­er those who lacked in­sur­ance, Obama de­cided to in­ter­pose the fed­er­al gov­ern­ment in this messy mar­ket, and his hy­per-simplist­ic rhet­or­ic about keep­ing in­sur­ance plans and doc­tors ex­posed his con­tempt for pub­lic dis­course and cor­roded his cred­ib­il­ity, by far the most dur­able per­son­al at­trib­ute of his pres­id­ency.

Obama’s rhet­or­ic has been his polit­ic­al un­do­ing, driv­ing his poll rat­ings to new lows and grind­ing his oth­er le­gis­lat­ive am­bi­tions to dust. Obama­care has be­come a cru­cible of ac­count­ab­il­ity and be­lievab­il­ity. With­in that con­fined space, made hot­ter and more va­por­ous by his own dis­cred­ited plat­it­udes, Obama’s abil­ity to lead, in­spire, and per­suade has suffered. But the law re­mains, and the next four months will be but the first of many mo­ments to judge its out­comes against its am­bi­tions and prom­ises.

In­stant ana­lys­is of the polit­ic­al im­port of Obama’s cur­rent mal­aise misses the arc of the story and the law. Obama­care’s im­ple­ment­a­tion is not a wa­ter­shed, turn­stile, or hinge of his­tory. It is an on­go­ing saga. It’s not a three-act play, but a gov­ern­ment­al seri­al that will run con­tinu­ously, pro­duct­ively, de­struct­ively, and mono­ton­ously for the re­mainder of the Obama pres­id­ency and, quite prob­ably, through the pres­id­ency of his suc­cessor.

Amid the tangled snare of win­ners and losers will joust Re­pub­lic­an op­pon­ents and Demo­crat­ic de­fend­ers. And make no mis­take, for Demo­crats there is no oth­er prac­tic­al place to stand but in de­fense of Obama­care. Re­pub­lic­ans and dis­en­chanted in­de­pend­ents will give no cred­it, and party loy­al­ists will sav­age the squeam­ish.

The first test comes next week with the rol­lout of the post-op Health­ So fear­ful that it will crash un­der heavy use, the White House on Monday asked its health care al­lies (En­roll Amer­ica, Fam­il­ies USA, and many big uni­ons) not to launch a second en­roll­ment cam­paign. Hardly en­cour­aging. Even so, White House ad­visers in­sist that the site will be able to — mostly — ac­com­mod­ate 50,000 sim­ul­tan­eous users, and that means up­ward of 800,000 cus­tom­ers per day. Dur­ing peak us­age, mean­ing any­thing above 50,000 con­sumers, delays are pre­dicted. But in­stead of get­ting er­ror mes­sages, stalled users will re­ceive an email in­struct­ing them when they can sign in later and be at the front of the line. Should do won­ders for the Late Show rat­ings. As for er­ror rates, they’ve fallen from 8 per­cent fre­quency three weeks ago to less than 1 per­cent (nearly as good as the Top Ten list).

The next test comes in mid-Decem­ber, when the White House ex­pects a surge in en­roll­ment as con­sumers at­tempt to pur­chase in­sur­ance that will be­gin Jan. 1. Be­fore the six-month en­roll­ment peri­od ends, the ad­min­is­tra­tion an­ti­cip­ates two sig­ni­fic­ant bulges in en­roll­ment — one for the first cov­er­age win­dow (to ob­tain cov­er­age by Jan. 1) and one for the fi­nal en­roll­ment dead­line of March 31. How the web­site and in­surers handle the first surge in mid-Decem­ber will ex­plain a lot about the web­site’s triage and the ef­fic­acy of the in­sur­ance pri­cing and se­lec­tion mod­els. The White House also ex­pects en­roll­ment to taper off after Dec. 23 (the new en­roll­ment dead­line for Jan. 1 cov­er­age) be­fore it reaches a max­im­um peak from mid-Feb­ru­ary to the fi­nal cutoff date of March 31. For his­tor­ic­al and com­par­at­ive pur­poses, in the first two months of Mas­sachu­setts’ health care law, 17 per­cent of en­rollees were 18 to 34; in the fi­nal two months of the 11-month en­roll­ment peri­od in Mas­sachu­setts, 39 per­cent of en­rollees were 18 to 34. The ad­min­is­tra­tion ex­pects this pat­tern to re­peat it­self un­der the ACA, though on the short­er, six-month timeline. Also in Decem­ber, in­sur­ance com­pan­ies will ramp up dir­ect en­roll­ment out­reach to fu­ture con­sumers — of­fer­ing them plans and then con­nect­ing to the state or fed­er­al web­site for as­sist­ance with sub­sidies for premi­ums and cov­er­age offered. Decem­ber will be an acid test for Health­ 2.0 and the new, ad hoc re­cruit­ment of en­rollees by in­sur­ance com­pan­ies. The ver­dicts, while not con­clus­ive, will be in­struct­ive.

All this will serve as the back­drop for Obama’s State of the Uni­on ad­dress, which will un­ques­tion­ably be the State of Obama­care ad­dress. Land­ing between the ex­pec­ted con­clu­sion of budget/se­quester talks on Jan. 15 and a debt-ceil­ing ex­ten­sion on Feb. 15, the State of the Uni­on (Obama­care) ad­dress will be Obama’s next best chance to — in White House jar­gon — pivot, re­set, or reach an in­flec­tion point on the ACA as a mat­ter of law, im­ple­ment­a­tion, and polit­ics. Obama­care will be able, the White House hopes, to ad­mit past mis­takes, er­rors of man­age­ment, and leaky health care prom­ises but spin the lar­ger de­bate for­ward with tales of web­site re­demp­tion, en­roll­ment surges, and sat­is­fied con­sumers with new­found cov­er­age and con­tent­ment.

As I said, Obama­care is a saga and a mess, sin­gu­larly so. It needs no meta­phor­ic­al em­broid­ery.

As Mi­chael, played by Robert DeNiro, fam­ously said in The Deer Hunter: “See this. This is this. This ain’t something else. This is this. From now on, you’re on your own.” 

Obama­care is Obama­care. It ain’t something else. For Obama, the next two months will go some dis­tance in de­term­in­ing if he is also on his own.

The au­thor is Na­tion­al Journ­al Cor­res­pond­ent-at-Large and Chief White House Cor­res­pond­ent for CBS News. He is also a dis­tin­guished fel­low at the George Wash­ing­ton Uni­versity School of Me­dia and Pub­lic Af­fairs.

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