Four years ago, countless Democratic leaders and allies pushed for passage of Barack Obama’s complex healthcare act while arguing that his entire presidency was at stake. The party hierarchy whipped the Congressional Progressive Caucus into line, while MoveOn and other loyal groups stayed in step along with many liberal pundits.
Lauding the president’s healthcare plan for its structure of “regulation, mandates, subsidies and competition,” New York Times columnist Paul Krugman wrote in July 2009 that the administration’s fate hung in the balance: “Knock away any of the four main pillars of reform, and the whole thing will collapse—and probably take the Obama presidency down with it.” Such warnings were habitual until Obamacare became law eight months later.
Meanwhile, some progressives were pointing out that—contrary to the right-wing fantasy of a “government takeover of healthcare”—Obama’s Affordable Care Act actually further enthroned for-profit insurance firms atop the system. As I wrote at the time, “The continued dominance of the insurance industry is the key subtext of the healthcare battle that has been raging in Washington. But that dominance is routinely left out of the news media's laser-beam concentration on whether a monumental healthcare law will emerge to save Obama's presidency.”
"Obamacare is a mess largely because it builds a revamped healthcare system around the retrenched and extended power of insurance companies—setting back prospects for real healthcare reform for a decade or more."
Today, in terms of healthcare policy, the merits and downsides of Obamacare deserve progressive debate. But at this point there’s no doubt it’s a disaster in political terms—igniting the Mad Hatter Tea Party’s phony populism, heightening prospects for major right-wing electoral gains next year and propagating the rancid notion that the government should stay out of healthcare.
That ominous takeaway notion was flagged days ago on the PBS NewsHour by commentator Mark Shields, who worried aloud that “this is beyond the Obama administration. If this goes down, if … the Affordable Care Act is deemed a failure, this is the end—I really mean it—of liberal government, in the sense of any sense that government as an instrument of social justice, an engine of economic progress… Time and again, social programs have made the difference in this country. The public confidence in that will be so depleted, so diminished, that I really think the change—the equation of American politics changes.”
At this pivotal, historic, teachable moment, progressives should not leave the messaging battle about the ACA to right wingers and Obama loyalists. While critiquing the law for its entanglement with the profit-voracious insurance industry, we should fight for quality healthcare for everyone—definitely including the people who live in states where right-wing officials are blocking expansion of Medicaid coverage. (In a recent Nation article, historian Rick Perlstein cited a grim example of a chronic mentality: “the policy wizards in the Obama White House build a Rube Goldberg healthcare law that relies on states to expand Medicaid and create healthcare exchanges, and then are utterly blindsided when red-state legislatures and governors decline.”) We should challenge all efforts to deny the human right of healthcare.
What we should not be doing is what MoveOn.org is now doing—proclaiming that the Obamacare law is just fine. In a November 14 email blast, subject-lined “Obamacare in serious trouble,” MoveOn acknowledged that the rollout “has been badly botched” but flatly declared: “Obviously, the law itself is still really good.”
The problems with Obamacare involve far more than simply bad website coding. They’re bound up in the enormous complexity of the law’s design, wrapped around a huge corporate steeplechase for maximizing profits. As a Maine physician, Philip Caper, wrote this fall, the ACA “is far too complicated and therefore too expensive to manage, full of holes, will be applied unevenly and unfairly, be full of unintended consequences, and be easily exploited by those looking to make a quick buck.” The ACA is so complicated because it has been so relentlessly written for the benefit of—and largely written by—insurance companies.
Along the way, the “individual mandate” cornerstone of the ACA—required by government yet actually enriching the private insurance industry—is a tremendous political boost to demagogic GOP leaders. I’m not engaging in hindsight here. Like many others, I saw this coming before the ACA became law, writing in March 2010: “On a political level, the mandate provision is a massive gift to the Republican Party, all set to keep on giving to the right wing for many years. With a highly intrusive requirement that personal funds and government subsidies be paid to private corporations, the law would further empower right-wing populists who want to pose as foes of government ‘elites’ bent on enriching Wall Street.”
Obamacare is a mess largely because it builds a revamped healthcare system around the retrenched and extended power of insurance companies—setting back prospects for real healthcare reform for a decade or more. Egged on by corporate media and corporate politicians, much of the public will blame higher premiums on government intervention and not on the greedy insurance companies which, along with Big Pharma, helped write the law in the Obama White House and on Capitol Hill.
It should now be painfully obvious that Obamacare’s little helpers, dutifully reciting White House talking points in 2009 and early 2010, were helping right-wing bogus populism to gather steam. Claiming that the Obama presidency would sink without signing into law its “landmark” healthcare bill, many a progressive worked to throw the president a rope; while ostensibly attached to a political life preserver, the rope was actually fastened to a huge deadweight anvil.
In the process, the political choreography included a chorus of statements by Congressional Progressive Caucus members before ultimate passage of the Affordable Care Act. Having previously removed the words “single payer” and “Medicare for all” from their oratorical vocabulary while retaining the laudatory language—and after later excising the words “public option” in a similar way—those legislators still pretended that passage of the ACA would be an unalloyed positive triumph. Like the president, they resolutely oversold Obamacare and made believe it would bring about an excellent healthcare system.
With such disingenuous sales pitches four years ago, President Obama and his Democratic acolytes did a lot to create the current political mess engulfing Obamacare—exaggerating its virtues while pulling out the stops to normalize denial about its real drawbacks. That was a bad approach in 2009. It remains a bad approach today.