Obamacare and the politics of deception
In June 2009, as health-care reform was being debated vigorously across the country, President Obama told the American Medical Association’s convention that, whatever the provisions of the health-care bill he would sign into law ultimately included, “we will keep this promise to the American people: If you like your doctor, you will be able to keep your doctor, period. If you like your health-care plan, you’ll be able to keep your health-care plan, period. No one will take it away, no matter what.”
After the Affordable Care Act lurched into effect in 2013, it became clear the president meant to say that if you like your doctor and health-care plan, you’ll be able to keep them . . . footnote. And, as you’d expect from a former editor of the Harvard Law Review, that footnote has turned out to be as long and convoluted as a Russian novel.
When people who did like their health-care plans started receiving notices of cancellation or enormous rate increases, Obama’s defenders tried to qualify the original promise, which Obama had made repeatedly while campaigning, first for president and then for enactment of new health-care policies. Economist Jared Bernstein, who worked in the White House in 2009, said a better formulation would have been, “If you like your plan and it doesn’t get significantly worse such that it’s out of sync with what we’re trying to do here, you can keep it.” In fact, he argued, because “such nuances were clear at the time” — which is not how nuances typically operate — Obama’s veracity about his proposals’ consequences was not in question.
The New York Times editorial page took the same position: The president “clearly misspoke” when he promised that people could keep health-insurance policies they liked, but the controversy over that pledge was “overblown.” After the sanitizing “misspoke” set off a controversy of its own, the paper’s “public editor” prodded chief editorialist Andrew Rosenthal, who allowed that “clearly wrong” or “clearly weren’t true” might also have been fair characterizations of Obama’s promises.
In the main, however, those who spoke up for Obama and Obamacare chose to play offense, not defense. Salon’s Brian Beutler preferred to consider the Obama pledge “a failure to think through the dangers of being so categorical,” but acknowledged that it could have been a Platonic “noble lie.” Obama’s belief that “he had to lie for the greater good” was justified since Republicans had told much worse lies about how Obamacare was just a “stepping stone to single-payer.”
The American Prospect’s Steve Erickson judged Obama more severely than Beutler did: “This is the first time that reasonable people have caught the president telling an explicitly incontestable untruth” (which is itself an appraisal reasonable people might contest). But Erickson was even more severe regarding “those who so often have said so many preposterous things about [Obama],” since the president’s conservative detractors are, in a world that includes al-Qaeda and Kim Jong Un, “the worst enemies anyone can have.”
The Century Foundation’s Michael Cohen cast his net even wider, arguing that it would have been better if Obama had told the truth, but that the president really had no choice because Americans “can’t handle the truth.” Admitting that there would be some losers under Obamacare, as well as inevitable disruptions from an undertaking so ambitious, would have “made the path to reform that much politically harder to traverse,” rendering such candor impossible. “Voters want progress without sacrifice or inconvenience. Seemingly the only path to change is telling voters what they want to hear.”
Such resigned cynicism is, of course, exactly what Barack Obama was supposed to deliver us from. “Hope and Change” meant hoping for that change. At the Iowa Democratic party’s Jefferson-Jackson Day Dinner in November 2007, Obama gave a speech so well received that it propelled him to victory in the Iowa caucuses, and then to the nomination and the White House. The candidate declared, “Telling the American people what we think they want to hear, instead of telling the American people what they need to hear, just won’t do.” Democrats, he said, have “always made the biggest difference in the lives of the American people . . . when we summoned the entire nation to a common purpose — a higher purpose.”
And that’s where things become complicated: Summoning the entire nation to a higher purpose often requires telling people what they want to hear instead of what they need to hear. What people wanted to hear was that the higher purpose of guaranteeing “quality, affordable health care for every American,” to use Obama’s words, could be had easily and painlessly. And it turned out that this historic goal was surprisingly attainable. “Most of this plan,” the president told Congress in a September 2009 address on health-care reform, “can be paid for by finding savings within the existing health-care system, a system that is currently full of waste and abuse.” Giving millions of uninsured Americans health insurance, and improving coverage for millions more who already had insurance, not only wouldn’t increase the federal deficit, but was “a step we must take if we hope to bring down our deficit in the years to come,” Obama had explained earlier that year.
Americans also wanted to hear that a reformed health-care system would help them rather than cost them, not just as taxpayers but also as patients and ratepayers. The administration was glad to oblige. A November 2009 post on the White House blog cited research and congressional testimony by MIT economist Jonathan Gruber (a health-care adviser to the administration) to share the glad tidings that the legislation taking shape would unleash a torrent of benefits. The bill being considered by the House would lower premiums for individuals while improving coverage, according to Gruber. Small businesses, too, had “little to fear, and much to gain, from health reform,” since the money it saved them would lead to more workers’ receiving higher take-home pay.
What Americans needed to hear about health-care reform was different. They needed to hear that health-care reform’s benefits would entail costs, so that the republic would be equipped to weigh the inescapable trade-offs realistically and fairly. What they needed to hear, for example, was that “covering people with health insurance doesn’t save money,” as — surprise! — Jonathan Gruber told the Washington Post in January 2014. That whole gauzy notion of reforming the health-care system as a way to reduce public and private medical expenditures was, it turns out, “sometimes a misleading motivator for the Affordable Care Act.” Gruber tells us now what we needed — but apparently couldn’t be trusted — to know then: “The law isn’t designed to save money. It’s designed to improve health, and that’s going to cost money.”
The original noble lie, in Plato’s Republic, was an attempt to solve a fundamental political problem: inducing men, who are strongly inclined to advance their own interests, to sacrifice those interests for the sake of their country. The particular dilemma Socrates addresses is that cities need fierce guardians to protect them from foreign enemies, but are then left with no one to protect them from the guardians. His noble lie addresses that conundrum by persuading guardians that their own interests and the well-being of the city are one and the same. Specifically, if the guardians are tricked into thinking they were born of the earth they protect, they’ll regard the homeland as their mother and all its citizens as their brothers, and will never wish to abuse those they defend.
Classical liberalism (think John Locke, not John Rawls) offered a different way to reconcile individual interest and political duty. Self-interest, rightly understood and pursued, was the public interest. “It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest,” Adam Smith wrote in The Wealth of Nations. We can reduce and ultimately eliminate the discord within and between nations by inducing people to focus on commerce and industry, which can make everyone who plays that positive-sum game better off. “He that encloses land, and has a greater plenty of the conveniences of life from ten acres than he could have from a hundred left to nature,” Locke wrote in the Second Treatise, “may truly be said to give ninety acres to mankind.”
Modern, Rawlsian liberalism is distinctly uncomfortable with this Lockean solution. Even though New Deal–era dreams about a centrally planned economy have been abandoned, liberals refuse to accept that a decent society can rest on the alchemy that purports to turn private interests into the public interest. Franklin Roosevelt hailed Irish and Hibernian societies around the country on St. Patrick’s Day in 1937 for their fealty to the motto “Not for ourselves, but for others.” That spirit, he said, should animate not just charity but private and public life, given that “selfishness is without doubt the greatest danger that confronts our beloved country today.” Similarly, Barack Obama’s equation of common purposes with higher ones signals that private purposes are inherently low. Progress, moving from the lower to the higher, consists of claiming successive arenas of life that have been private in the name of what should be public.
This project is well suited — to Europe. As Jonah Goldberg once wrote, Sweden’s cradle-to-grave welfare state “succeeds as much as it does because it governs Swedes.” Centuries of primacy by central authority have disposed Europeans to rely on government dispensations, and to defer to its decisions about who gets what, when, and how. American liberals see their work as a heroic struggle — both noble and arduous — because, in the words of The New Republic’s John Judis, “since the country’s founding, Americans have always had an abiding distrust of the federal government.” There have been occasional breakthroughs — in the 1930s and, more briefly, the 1960s and after Obama’s election in 2008 — but the default setting is robust public skepticism of government.
Hence, the noble lie. Liberals deplore a fundamental political reality they must nevertheless grapple with: Americans don’t know or want what’s good for them, which is the liberal policy agenda. So many Americans suffer from correctable failings, Michelle Obama told campaign audiences in 2008, because the country is “just downright mean.” If the selfish, shortsighted voters are to be brought around to embrace the only remedy, the liberal agenda, liberal polemicists need to portray its benefits in maximal terms while insisting its costs are minimal or even negative. The only “price” people will pay is to enjoy more and more benefits. In order to get Americans to institute — little by little, but ultimately in its entirety — a Scandinavian safety net, one must assure them every step of the way that its benefits won’t require anything resembling Scandinavian taxes or regulations.
In his 2007 Iowa speech, Obama said Democrats could form a “new majority” by reaching out to voters “who’ve lost trust in their government, but want to believe again.” As has been the case since Obama appeared on the national scene, this assessment reflects a strategic ambiguity. Is he speaking about policy substance, the governing process, or both? People could have lost trust, that is, in government’s capacity to acquit its responsibilities effectively, including the social-welfare responsibilities that account for most of what modern government does. It may be, however, that people have lost trust in the political process because politicians — in their dealings with one another and with the public — are strident, duplicitous, and evasive, rather than respectful, forthright, and accountable.
Ideally, the substantive problem and the procedural problem turn out to be the same problem. This is the central premise of Obamaism. During the first press conference following his 2009 inauguration, the president characterized his approach to congressional Republicans as being “consistently civil and respectful.” That press conference concentrated on the needs of the people of Elkhart, Ind., “a place that has lost jobs faster than anywhere else in America,” and that the president had just visited. Obama’s “bottom line” was the urgent needs of people in Elkhart and similarly afflicted communities around the country, which meant “I can’t afford to see Congress play the usual political games.” The cessation of political games sounds like a procedural objective, but Obama made clear that he would judge whether Congress, especially its Republicans, had gotten serious by the substantive standard of passing a stimulus bill with provisions he wanted. As in the televised “Bipartisan Meeting on Health Reform,” held in February 2010, with Democratic legislators on one side of the table, Republicans on the other, and the president between them moderating the discussion and exploring points he considered important, Obama wanted to have it both ways, to be an umpire and captain of one of the teams.
The hope is that civil and respectful policy debates, ones that tell Americans what they need to hear instead of what they want to hear, will leave voters ever more favorably disposed to assigning new responsibilities to government, confining the arguments to technical details about delivery and financing. But the category of what people need to hear seems to include nothing that would alert them to the prospect that implementing the liberal agenda might incur significant difficulties, costs, and dangers. Rather, what people need to hear includes everything — but only as much as — liberal politicians and publicists want to tell them.
So, throughout the 2008 campaign, Obama made a “firm pledge”: “No family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital-gains taxes, not any of your taxes.” The problem with exempting 97 percent of American households from any federal tax increase is that it makes it impossible to pay for: the expensive obligations that were baked in the cake when Obama took office in 2009; the expensive obligations that government has taken on since then, Obamacare chief among them; and the expensive obligations that will be added to the existing ones the next time Democrats have the power to enact them.
After winning reelection, the term-limited president had the opportunity of a lifetime to tell people what they needed to hear instead of what they wanted to hear. With the fiscal-cliff deal of January 2013, however, he responded by making his reckless campaign promise of 2008 even more reckless, agreeing to exempt not 97 percent of Americans from federal tax increases, but more than 99 percent. And he made this deal, which confined higher income-tax rates to individuals making more than $400,000 and to families making more than $450,000, despite enjoying “overwhelming leverage” against Republicans, as liberal columnist Jonathan Chait lamented, given that all the Bush income-tax-rate cuts from 2001 were set to expire.
Liberals rely on bait-and-switch tactics because they fear the results of describing their agenda clearly and candidly to voters, who can’t handle the truth. Even an elementary truth, such as the proposition that improving health care will cost money rather than save money, must be denied over and over, lest don’t-tread-on-me rubes start asking awkward questions about how much improving health care is going to cost and where the money will come from. Once a policy such as Obamacare is enacted and implemented, making the switch means admitting the obvious, and then claiming it’s so obvious — “everyone always knew” it would cost money and disrupt existing health-care arrangements — that it doesn’t really qualify as a switch. The villains in this story are not the liberals who spoke incontestable untruths when political circumstances called for telling people what they wanted to hear. The villains are conservatives who complain about the deception.
As Obama’s diffidence about raising taxes suggests, however, bait-and-switch liberalism poses difficulties of its own. Once people have been accustomed to expecting benefits, they can be counted on to demand more of them. This is the basis for New Republic editor Noam Scheiber’s defense of Obamacare against liberals who complain America really needs a Medicare-for-all, single-payer system. Obamacare’s virtue is that it’s a “deceptively sneaky way” to hasten the arrival of single-payer, he says, since its shortcomings will create an “organized constituency” with “a whole set of grievances to get exercised about.” The hysterical, prevaricating tea-party zealots who denounced Obamacare as a step to something much bigger were basically right, in other words.
People can be relied on to demand more government benefits without prodding, but not to demand the taxes those benefits will require. What the people most need to hear is also what liberal opinion- and lawmakers need to avoid telling them: Benefits correspond to burdens, so higher benefits will require heavier burdens. Liberalism has advanced by relying on people to get the hint, without the vulgar necessity of anyone’s spelling it out. Payroll taxes, for example, grew from 2 percent of earned income in 1937 to 15.3 percent today (16.2 percent for families making more than $250,000) because cutting benefits was unthinkable, which made increasing taxes, some two dozen times, the only realistic, pragmatic choice. But there are only 100 percentage points of anything, which means the politics of raising payroll taxes from 15.3 percent to 20 or 25 percent will be much more difficult than going from 2 percent to 15.3.
The keys to bait-and-switch liberalism are: a) serial responsibility, so that the people who do the baiting are not the ones who do the switching; and b) plausible deniability, so that those baiters still on the scene are not held to account for the switching. Either the welfare state will need to be scaled back, or taxes will need to be raised on Americans making less — much less — than $250,000, but those unpleasant necessities will be confronted on some future president’s watch.
Similarly, the first Supreme Court decision to uphold affirmative action in private employment, Steelworkers v. Weber (1979), saw the majority argue that the 1964 Civil Rights Act’s fundamental concern was with the “plight of the Negro in our economy” and “the problem of opening opportunities for Negroes.” That being the case, the law’s prohibition of racial discrimination in employment practices gave no protection to white employees who were denied advancement opportunities given to blacks with less seniority.
In a dissenting opinion, Justice William Rehnquist quoted two of the senators (Clifford Case, a New Jersey Republican, and Joseph Clark, a Pennsylvania Democrat) who guided the bill to passage. In a memorandum refuting those senators who said the bill would result in preferential treatment for racial minorities, they stated that the sections concerned with employment “would have no effect on established seniority rights. . . . [An employer] would not be obliged — or indeed permitted — to fire whites in order to hire Negroes, or to prefer Negroes for future vacancies, or, once Negroes are hired, to give them special seniority rights at the expense of the white workers hired earlier.” Both men were out of politics by the time Weber was decided. Hubert Humphrey, the senator who promised to eat the pages of the bill if anyone could show it would authorize discrimination against whites, had died the year before.
The interesting and prospectively important thing about the speed with which Obamacare’s contradictions have become apparent is that the executive and legislators crucial to its enactment are still in office. The politicians responsible for the switching are the same ones who did the baiting, not their successors. “At the end of the day,” President Obama recently told The New Yorker, “we’re part of a long-running story. We just try to get our paragraph right.” But the Obama paragraph will not be finished for almost three more years. Republicans will do themselves and their country a service by highlighting the sentences about Obamacare that appeared early in the paragraph, and contrasting them with the very different ones being written today.
– Mr. Voegeli, a senior editor of the Claremont Review of Books, is the author of The Pity Party: A Mean-Spirited Diatribe against Liberal Compassion, to be published this year.