The Affordable Care Act is an administration-defining failure
Obama lied, insurance plans died.
Okay, it’s not as catchy as the equivalent Bush-era slogan. The thought — that there are parallels between the signature initiative of the George W. Bush administration and that of the Obama administration — has nonetheless occurred to a lot of people, especially in recent weeks, as Obamacare’s exchanges have failed to launch.
In both cases, presidents undertook ambitious projects: to remake part of the world, or a huge portion of the economy, along the lines that our government wanted. Redesigning Iraq proved to be impossible, and reorganizing health care may prove impossible as well. It is at least proving to be very difficult.
The Iraq War contributed to Republicans’ losing control of Congress in 2006. Obamacare contributed to Democrats’ losing control of one of its chambers in 2010. But the political trajectory of these projects was different. The Iraq War started with a level of bipartisan and popular support that Obamacare never had. Most Senate Democrats voted for the authorization of force in Iraq, while Republicans were nearly unanimous in opposition to Obamacare. But if the Iraq venture reached greater heights of support than Obamacare, eventually it also hit lower depths than Obamacare so far has.
In both cases, as well, the president governed differently than he had campaigned. George W. Bush said he would advance a “humble” foreign policy when he was running. The attacks of September 11, 2001, changed his agenda. Obama made clear he wanted to reshape health care. But he opposed what would become the least popular part of his health-care law, the requirement that all people buy insurance. His opposition to it was one of the few differences of policy he had in the Democratic primaries with the second-place finisher, Hillary Clinton. During the fall campaign he relentlessly attacked the Republican candidate, John McCain, for proposing to tax employee health benefits. The law Obama eventually signed included such a tax.
Once the Iraq conflict became unpopular, Bush’s critics said he had “lied us into war.” The administration had rested its case on the claim that Iraq was developing weapons of mass destruction. That’s the main reason it went to war, and the reason the public agreed to it. And the claim turned out to be false. But it was believed by the administration, as by the world’s intelligence services, and thus not a knowing falsehood.
The untruths involved in selling Obamacare were smaller but more deliberate. The president continually said that the law would cause insurance premiums to drop by $2,500 per family. He surely hoped that it would restrain the growth of costs so that families would be spared a $2,500 increase that would take place in the law’s absence. But that’s not what he said. Whether his hope has come true is a matter of fierce debate among experts, with the balance of evidence on the negative side. His actual statements were clearly false.
Obama also repeatedly promised that people who liked their health insurance would be able to keep it under his plan. On at least one occasion he added a verbal “period” to the promise, meant to convey that no lawyerly dodge was being executed. The administration knew better. The law’s requirement that all health-insurance plans cover certain “essential benefits” made some insurance plans illegal whether or not customers liked them. The law also will create incentives for some employers to drop their health plans even if some or many employees would prefer to keep them.
The administration reportedly considered weakening its statements in light of these features of its bill. It decided instead to keep making them. The bill ended up barely passing the House, and its chances of passage probably could not have borne much more truth.
Some liberals react angrily to any comparison of Obamacare to the Iraq War, saying that their project is not getting anyone killed. The point should be conceded to them, but not too hastily. They have maintained, with more vehemence than evidence, that Obamacare will save lives by extending health insurance to people who lack it. If their premise is right but their plan ends up reducing the number of people with insurance, then they will indeed have caused deaths. Anyway, an analogy is not an identity.
There is a final parallel between the troubles that beset the Iraq and Obamacare projects that has not received much attention in the partisan debate. Both sets of troubles were not really predicted by the opponents who later claimed vindication because of them. The anti-war movement warned that fighting in Iraq would produce blowback terrorism against American civilians and chemical-weapons deaths among American troops. What actually happened — the disintegration of the Iraqi state followed by America’s desperate attempt to pick up the pieces — did not feature heavily in the opposition’s arguments.
The foes of Obamacare argued that it would increase rather than decrease costs, reduce access to doctors, and so forth. Very few of them, however, foresaw that the federal government (and many state governments) would be incapable of developing the websites the program required in the requisite time. They thought that the “markets” that Obamacare created would be misshapen and irrational. They did not doubt that the administration would be able to create them at all.
Thanks to the law and its implementation, many Americans are finding themselves without the old insurance plans they were told they would have, unable to buy replacement plans, and liable to pay the fines for not getting them that Obama opposed in 2008. That is not a scenario even the most committed enemies of Obamacare expected.
The websites may be fixed eventually, but even if they are, the program may be lastingly handicapped by their early difficulties. Those difficulties may very well mean that the initial pool of people in the exchanges is much sicker and older than the administration hoped, and that premiums and subsidies will therefore have to be much higher. And that in turn will affect for the worse how those risk pools develop in the future.
Supporters of the Iraq War, many of them, could hardly believe what they read and saw from 2004 through 2007. Surely there were smart people in our government who knew what they were doing. Surely they had plans for all contingencies. The Obama administration, judging from some of the recent reporting, had a similar faith that the smart tech experts within its orbit would be on top of implementation.
If there is a wider lesson here, it is that the grand designs of governments, left or right, can go wrong in many more ways than they can go right, than anyone can foresee, and than even the “best and the brightest” — as Obama recently, and without irony, called his Web designers — can fix.