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. 
National Journal
Major Garrett
Nov. 5, 2013, 4:45 p.m.

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

At­tent­ively.

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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