Obama’s ‘Crisis of Confidence’

When it comes to his signature health care law, the president’s margin for error is shrinking.

WASHINGTON, DC - OCTOBER 04: U.S. Senator Barbara Mikulski (D-MD) speaks as local resident Anna Heard and her two-year-old son Kai, who was born with serious medical ailments and benefitted from clinical trial procedures, look on during a news conference October 4, 2013 on Capitol Hill in Washington, DC. Senate Democrats were joined by patients and doctors to highlight public health impact of the government shutdown. 
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Major Garrett
Nov. 5, 2013, 4:45 p.m.

When Sen. Bar­bara Mikul­ski speaks, Pres­id­ent Obama ought to listen.


Mikul­ski, after all, was a so­cial work­er be­fore Obama was 5 and a suc­cess­ful com­munity or­gan­izer be­fore he was 10. She led a cam­paign to stop a pro­posed 16-lane high­way from plow­ing through her nat­ive High­landtown neigh­bor­hood in East Bal­timore. She was elec­ted to the City Coun­cil in 1971, the U.S. House in 1976, and the Sen­ate in 1986. Mikul­ski is the dean of the Sen­ate wo­men, and she sports a ca­reer vot­ing re­cord of 93.3 with Amer­ic­ans for Demo­crat­ic Ac­tion. She pas­sion­ately sup­ports Obama­care.

Be­fore ques­tion­ing Mar­ilyn Taven­ner, the head of the Cen­ters for Medi­care and Medi­caid Ser­vices, at a con­gres­sion­al hear­ing Tues­day, Mikul­ski said something that ought to make Obama’s blood run cold.

“The launch­ing of the Af­ford­able Care Act has been more than bumpy,” Mikul­ski said. “I be­lieve there’s been a crisis of con­fid­ence cre­ated in the dys­func­tion­al nature of the web­site, the can­celing of policies, and stick­er shock from some people. We read in The Bal­timore Sun this morn­ing that 73,000 Marylanders’ policies will be can­celed. So there has been fear, doubt, and a crisis of con­fid­ence.”

“Crisis of con­fid­ence.” The last time that phrase was mem­or­ably uttered was in 1979. It did not turn out well for Pres­id­ent Carter.

Mikul­ski’s wor­ries are pro­found and cut to the heart of the law’s un­steady im­ple­ment­a­tion.

“What I worry about is that there’s such a crisis of con­fid­ence, people won’t en­roll. And the very people we need to en­roll, par­tic­u­larly our young people, to make this whole sys­tem work, won’t hap­pen.”

A more dev­ast­at­ing as­sess­ment of the law’s woes and the long-term con­sequences of the “fear” and “doubt” sur­round­ing policy can­cel­la­tions, a still-troubled web­site, and Obama’s own cred­ib­il­ity gap could not have been uttered.

As any­one in polit­ics will tell you, noth­ing wounds deep­er in times of woe than truth told by a friend. It cuts in private. In pub­lic, it leaves a bleed­ing gash.

“The pres­id­ent shares Sen­at­or Mikul­ski’s frus­tra­tion with the prob­lems that we have seen,” White House press sec­ret­ary Jay Car­ney said.

When I asked if Mikul­ski’s rhet­or­ic was un­duly alarm­ist, Car­ney said it was not. There you have it: White House con­firm­a­tion that its sig­na­ture le­gis­lat­ive achieve­ment now suf­fers from a crisis of con­fid­ence.

Time for triage. Not for Health­care.gov but for the fun­da­ment­als of the law Mikul­ski iden­ti­fied. If young people don’t sign up, the sys­tem crashes. Hit­ting Ctrl+Alt+De­lete won’t fix it.

Young and healthy Amer­ic­ans (so-called in­vin­cibles) must sign up to cre­ate large risk pools and ab­sorb the costs of provid­ing bet­ter in­sur­ance to the old and sick who were un­in­sured or who had what Obama con­siders mea­ger cov­er­age. If they don’t, costs rise be­cause the risk pool is too shal­low — not enough healthy en­rollees are off­set­ting the costs of older, sick­er con­sumers. Then premi­ums rise. That be­gets more stick­er shock. The only phrase Mikul­ski left out in fore­shad­ow­ing the end res­ult of a “crisis of con­fid­ence” was “death spir­al.”

One com­pon­ent of this crisis is Obama’s own cred­ib­il­ity. The fed­er­al web­site lacks cred­ib­il­ity. The prom­ise that people who liked their plan could keep their plan lacks cred­ib­il­ity. Prom­ises of trans­par­ency about the web­site’s pri­vacy pro­tec­tions lack cred­ib­il­ity. Vows of trans­par­ency on en­roll­ment num­bers, now ap­par­ently to be re­leased next week, lack cred­ib­il­ity.

To para­phrase the White House, the crisis of con­fid­ence for Obama­care is more than a web­site.

For the crisis to be lif­ted, cred­ib­il­ity has to be re­stored. In 2008, I re­mem­ber Obama telling town-hall audi­ence after town-hall audi­ence the hall­mark of his polit­ics would be candor. Said Obama: “What we need from the next pres­id­ent is some­body who will not just tell you what they think you want to hear but will tell you what you need to hear.”

What the pub­lic needs to hear is that in­sur­ance plans change, and that, in some cases, Amer­ic­ans won’t be able to keep the plan Obama prom­ised they could keep. What the pub­lic needs to hear is how few people have en­rolled on the fed­er­al health care web­site and what the ad­min­is­tra­tion will do to in­crease en­roll­ment. What the pub­lic needs to hear is that web­site pri­vacy, com­prom­ised by the poor ini­tial design, is locked down. What the pub­lic needs to hear is something as de­clar­at­ive, dir­ect, and mem­or­able as this.

Obama has to eat those words. It won’t be easy. And the pres­id­ent is off to a bad start.

“In polit­ics, when you have to eat shit, you don’t nibble,” said Demo­crat­ic strategist Chris Kofinis.

For Kofinis, the col­or­ful meta­phor is uni­ver­sal, mean­ing it ap­plies to all polit­ic­al cata­strophes. In this par­tic­u­lar case, Kofinis and oth­er Demo­crats be­lieve Obama would be wise to ad­mit his like-your-plan-keep-your-plan dodge was a mis­take and apo­lo­gize im­me­di­ately and con­spicu­ously.

Obama took a halt­ing step in that dir­ec­tion Monday, telling a crowd of sup­port­ers this: “If you have or had one of these plans be­fore the Af­ford­able Care Act came in­to law and you really like that plan, what we said was you could keep it if it hasn’t changed since the law was passed.”

That’s nib­bling.

A good num­ber of Demo­crats also think the White House should pub­lish health care plan en­roll­ment num­bers (which the House Ways and Means Com­mit­tee sub­poenaed late Tues­day) weekly or even daily just to get the data out there and lift the veil of secrecy. That’s a bad story that’s go­ing to be told any­way, they ar­gue, so tell it now and track the num­bers as they rise to try to turn around the nar­rat­ive. Some Demo­crats, like Sen. Di­anne Fein­stein, be­lieve the fed­er­al web­site should be taken down for full re­pairs and not re­star­ted un­til it can func­tion fully.

No pres­id­ent wants to ad­mit he mis­s­poke, let alone misled. The ad­min­is­tra­tion is ter­ri­fied of fre­quently pub­li­ciz­ing pi­ti­fully small en­roll­ment num­bers. And it can­not fathom tak­ing the web­site off­line for weeks of re­tool­ing.

Each of these choices tastes like shit.

But they sit at the heart of Mikul­ski’s “crisis of con­fid­ence.”

The time for nib­bling has passed.

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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