This Isn’t the First Time Obama Ignored Health Care Warnings

The president needs to apply an overdue reality check to the problem-plagued Affordable Care Act.

A woman looks at the HealthCare.gov insurance exchange internet site October 1, 2013 in Washington, DC. US President Barack Obama's Affordable Care Act, or Obamacare as it is commonly called, passed in March 2010, went into effect Tuesday at 8am EST. Heavy Internet traffic and system problems plagued the launch of the new health insurance exchanges Tuesday morning. Consumers attempting to log on were met with an error message early Tuesday due to an overload of Internet traffic. 
National Journal
Charlie Cook
Oct. 24, 2013, 5 p.m.

An eer­ie fa­mili­ar­ity at­tends the stor­ies of warn­ings to Obama ad­min­is­tra­tion of­fi­cials that the enorm­ously cum­ber­some Af­ford­able Care Act was hav­ing sig­ni­fic­ant im­ple­ment­a­tion prob­lems and that the web­site about to be launched was in danger of crash­ing. The dis­clos­ures are a meta­phor for the his­tory of this le­gis­la­tion, one that could be sub­titled, “Damn the tor­pedoes, full speed ahead.”

Let me first di­gress. To hear the de­bate over the health care law, you’d think that all Amer­ic­ans either love it and fully be­lieve that it is a ter­rif­ic and long over­due pro­gram, or that they ab­so­lutely hate it and are con­vinced it will des­troy most busi­nesses and the U.S. eco­nomy. Those two views of­ten tend to cor­res­pond with wheth­er people con­sider them­selves lib­er­als or con­ser­vat­ives. Polls, however, sug­gest that pub­lic opin­ion is not that clear-cut, and that many Amer­ic­ans, about a quarter, have a much more nu­anced view of Obama­care. Per­son­ally, I find my­self in that middle group.

Think back to 2009, when health care costs were skyrock­et­ing at an un­sus­tain­able level. Such costs were weigh­ing heav­ily on busi­nesses’ bal­ance sheets and were a ma­jor driver of fed­er­al budget de­fi­cits and the na­tion­al debt. The eco­nomy would have paid a ter­rible price if health care costs con­tin­ued to grow at such an ex­plos­ive pace. While most Amer­ic­ans had some kind of health in­sur­ance cov­er­age (either through their em­ploy­ers, in­di­vidu­al policies, Medi­caid, or Medi­care), the un­in­sured found them­selves ig­nor­ing med­ic­al prob­lems, of­ten de­vel­op­ing chron­ic ill­nesses and even­tu­ally seek­ing care in hos­pit­al emer­gency rooms, one of the most ex­pens­ive and in­ef­fi­cient meth­ods of health care any­where. Soon­er or later, something had to give; the is­sue had to be ad­dressed.

But noth­ing hap­pens in a va­cu­um, and as Barack Obama took of­fice, in the im­me­di­ate af­ter­math of the fin­an­cial crisis, the eco­nomy was in hor­rible shape and get­ting worse. Obama and his large Demo­crat­ic ma­jor­it­ies in the House and Sen­ate first fo­cused on passing a stim­u­lus pack­age to jump-start an eco­nomy that seemed on life sup­port. They at­temp­ted to do so with a pro­pos­al that Re­pub­lic­ans in­sisted was too large and ex­pens­ive, but one that to me (and I wrote this many times dur­ing that peri­od) was not ag­gress­ive enough, a view that is now widely ac­cep­ted by eco­nom­ists, in­clud­ing some who did not think so at the time. Obama’s de­fend­ers in­sist that it was the biggest pack­age they could move through Con­gress; I would ar­gue that a pres­id­ent with a bet­ter re­la­tion­ship with Con­gress could have got­ten much more.

After check­ing the box with an in­ad­equate stim­u­lus pack­age, with the eco­nomy still worsen­ing and polls show­ing Amer­ic­ans want­ing Wash­ing­ton to fo­cus on job cre­ation and sta­bil­iz­ing the eco­nomy, the ad­min­is­tra­tion and House Demo­crats tackled cli­mate change, for­cing a cap-and-trade bill through the House — at great polit­ic­al cost. All of this was done in spite of the fact that the bill had dim pro­spects at best in the Sen­ate, where mem­bers from fossil-fuel states were al­most cer­tain to kill it.

Next, Con­gress turned to health care re­form. House Demo­crats muscled through a bill in late 2009, in the face of polling data show­ing that Amer­ic­ans des­per­ately wanted Wash­ing­ton to do something about the eco­nomy. Not sur­pris­ingly, the ini­ti­at­ive im­me­di­ately proved to be a very heavy lift in the Sen­ate. It be­came clear that Re­pub­lic­ans would op­pose it and that the eco­nomy was worsen­ing. Sev­er­al books have since cited a key White House meet­ing in early Au­gust 2009 when the pres­id­ent’s con­gres­sion­al li­ais­on staff de­livered a neg­at­ive as­sess­ment of the le­gis­la­tion’s out­look. Obama dis­missed the ad­vice, say­ing, “No, I feel lucky,” and op­ted to push ahead. That same week, the Ju­ly un­em­ploy­ment re­port showed job­less rates at or above 9 per­cent for the third con­sec­ut­ive month. In ret­ro­spect, the de­cision to plow for­ward on health care re­form prob­ably cost Demo­crats their House ma­jor­ity.

The rest is his­tory. Demo­crats pushed the Af­ford­able Care Act through Con­gress on largely a party-line vote, al­though by any meas­ure it was a bas­tard­ized ver­sion of Demo­crat­ic and Re­pub­lic­an prin­ciples. The ACA’s sub­stance was not what any re­former had in mind, but what ended up be­ing doable at the time. The pub­lic re­ac­tion to this enorm­ous and com­plic­ated piece of le­gis­la­tion, which chewed up the bet­ter part of two years of Wash­ing­ton’s at­ten­tion, was pre­dict­able. Demo­crats lost 63 House seats and con­trol of the cham­ber; sur­rendered six Sen­ate seats, cut­ting their mar­gin over Re­pub­lic­ans by two-thirds; and were beaten in gubernat­ori­al and state le­gis­lat­ive races that res­ul­ted in the worst re­dis­trict­ing map for Demo­crats in mod­ern his­tory. Quite a price.

At just about every step, Obama has pushed ahead on health care re­form, even when it would have been more prac­tic­al to put it aside, wait­ing per­haps un­til the eco­nomy sta­bil­ized or un­til the pub­lic was more ac­cept­ing of the law. He most re­cently chose to plow ahead when the ap­par­at­us to im­ple­ment the ACA had huge prob­lems. Warn­ings in­side the ad­min­is­tra­tion were ig­nored. If per­sever­ance were the only vir­tue, the pres­id­ent and con­gres­sion­al Demo­crats would be the most vir­tu­ous people around and as­sured a place in heav­en. But some­times bal­ance and real­ity should in­ter­vene. They cer­tainly did not here. 

COR­REC­TION: The print ver­sion of this column mis­states when in 2009 the House passed its health care re­form bill.

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