Democrats have second thoughts about Obamacare
by William Voegeli • The Weekly Standard
In the Time magazine issue published after the 2008 election—whose cover depicted Barack Obama as Franklin Roosevelt—Peter Beinart anticipated a new “era of liberal hegemony” that would last until “Sasha and Malia have kids.”
President Obama is not yet a grandfather, but his era of liberal hegemony only appears to have lasted months, not decades. Photoshopping gave Obama the pince-nez and cigarette holder that were FDR’s trademarks but could not conjure the startling congressional majorities of the 1930s. The Depression and New Deal left Republicans discredited, irrelevant, and shattered. GOP House and Senate majorities of 62 percent and 58 percent, respectively, after the 1928 election shrank to caucuses of 20 percent and 17 percent after 1936. Under Obama the trajectory has been the opposite: Republicans have gone from 41 percent of the House seats after the 2008 election to 57 percent after 2014 and from 40 senators to 54.
Inevitably, Democrats are trying to figure out why the present that dismays them is so much less congenial than the future they recently anticipated. Some have begun to disparage Obamacare, the incumbent’s most FDR-like achievement. Half of the 60 Democratic senators who voted for the Affordable Care Act in December 2009—the exact number needed to prevent its being filibustered to death, since all Republicans opposed it—are no longer in the Senate. These ex-senators include eight who were defeated by Republicans, and eight more who chose not to run again and were succeeded by Republicans.
One of the latter, Tom Harkin of Iowa, recently told a reporter, “I look back and say we should have either done [health care reform] the correct way or not done anything at all.” Charles Schumer of New York, in the remnant of Democrats whose Senate careers have survived Obamacare, voiced similar sentiments in a National Press Club speech three weeks after the 2014 elections. “Democrats blew the opportunity the American people gave them” in 2008, Schumer said. “We took their mandate and put all of our focus on the wrong problem—health care reform.” Arguing that 85 percent of Americans had health insurance they were satisfied with when Democrats took power in 2009, and few of the uninsured voted at all, much less on the basis of health policy, Schumer contended, “To aim a huge change in mandate at such a small percentage of the electorate made no political sense.”
Despite these recent recriminations, Harkin and Schumer had been like most Democrats in believing that Obamacare was good policy that would quickly prove to be good politics. In 2012 Harkin praised the Affordable Care Act for bringing us closer to the day when “every person has affordable, quality health care.” Months before Democrats were routed in the 2010 midterms, Schumer predicted that Obamacare would be an asset to politicians who had supported it and a liability for its opponents.
Not just health care policy but the value and political feasibility of modern liberalism’s raison d’être is at stake. The main point of Schumer’s recent speech was “Democrats must embrace government” as “what we believe in,” “what unites our party,” and as “the only thing that’s going to get the middle class going again.” He thought that Obamacare was regrettable to the extent it had complicated rather than furthered that fundamental purpose.
The Daily Beast’s Michael Tomasky strongly endorsed Schumer’s argument: Since “Democrats are the party of government,” the “one principle they all subscribe to is a belief that the federal government can and must intervene in the economic and social spheres to even things out.” The party will never create political openings for new government interventions, however, until it solves the public relations problem that afflicts existing ones. Democrats, he wrote, have done a “pathetic job” of getting people to appreciate “the dozens of ways in which the federal government already helps them and their communities.” The resulting “hatred of government we see in this country is sickeningly childish and hypocritical.” Instead of acknowledging and appreciating government successes against water pollution, for example, most people “just think that lake cleaned itself somehow over the years.”
Another liberal columnist, Michael Hiltzik of the Los Angeles Times, agreed and went further, insisting that Obamacare, rightly understood, would greatly help the Democratic cause. That Obamacare is unpopular and voting booth poison is the Democrats’ “own fault.” They’ve “utterly failed” to make voters aware that Affordable Care Act components include popular benefits like preventing health insurance companies from rejecting applicants with preexisting medical conditions and allowing parents to keep sons and daughters as old as 25 on their policies. Democrats’ “spinelessness” has “allowed Republicans and conservatives to depict a measure that improves the lives and health of millions of Americans as harmful, even un-American,” Hiltzik says.
The gullibility of the millions of Americans who have been helped by Obama-care, but can be led to believe it’s harmful, goes without saying. Such sentiments confirm that today’s Democrats are only quasi-democratic. They’re adamant about government of and for the people, but dubious when it comes to government by the people. Yes, they say, government must intervene in the economic and social spheres to do what’s good for the people, but the people are often too limited to understand what’s good for them and too ungrateful to appreciate the benefactions government is already delivering.
The voters’ cognitive deficiencies are a retrospective problem for Democrats, as Tomasky and Hiltzik point out, but also a prospective one. They mean that new government interventions cannot be secured through candor and clarity, but require guile and subterfuge, a position made clear by MIT economics professor and Obama administration adviser Jonathan Gruber. Explaining, in 2012, why the Affordable Care Act taxes insurance companies, which will pass along the costs to policyholders, rather than taxing the insured directly, Gruber said, “It’s a very clever, you know, basic exploitation of the lack of economic understanding of the American voter.”
In 2013 he told a University of Pennsylvania audience that the ACA “was written in a tortured way” so that neither the Congressional Budget Office nor the public would see its individual mandate to buy heath insurance as a new tax. “Lack of transparency is a huge political advantage,” Gruber concluded. “Call it the stupidity of the American voter or whatever, but basically that was really, really critical to getting the thing to pass.”
When, days after the 2014 midterm elections, Gruber’s remarks were publicized, Democratic politicians and journalists scrambled to denounce them, and Gruber himself apologized in congressional testimony for his “glib, thoughtless, and sometimes downright insulting comments.” Disdaining and deceiving the people are indeed affronts to democracy, but are not the only transgressions against American self-government. Gruber’s arrogance was gratuitous, but the deceptions he smugly praised served a Democratic purpose: convincing people that government interventions that can bestow formidable benefits while imposing negligible costs are, despite sounding too good to be true, low-hanging fruit ready to be harvested.
If Democrats were forthright and respectful they would have enough confidence in their proposals and their countrymen to speak plainly. They would say: “We’re not idiots; you’re not idiots; and only an idiot could believe it’s possible for government to do big things that help lots of people without also imposing big costs, through taxes and regulations, that adversely affect lots of people. The reason you should support the Democratic agenda is not that we’re magicians who can make something out of nothing. It’s that the benefits of our programs will exceed their costs—so much so that our country and most of our citizens will be better off paying the higher taxes and complying with the more stringent regulations than we would be absent the taxes, the regulations, and the benefits they make possible.”
Democrats eschew such candor with reason. In 1984 Walter Mondale told the voters, “Mr. Reagan will raise taxes, and so will I. He won’t tell you. I just did.” Mondale went on to sweep the jurisdictions of Minnesota and the District of Columbia, forcing President Reagan to cobble together an Electoral College majority by carrying the other 49 states.
Subsequent Democratic politicians have chosen to acknowledge difficult realities at such a high level of abstraction that no voter could possibly object. In 2007, presidential candidate Obama said, “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.” He spent the following year promising to: (a) create dozens of new government programs and expand dozens of existing ones; and (b) confine federal tax increases to the 3 percent of the population with incomes above $250,000. His decisive victory in November 2008 suggested that telling the people what they want to hear instead of what they need to hear will, at least for electoral purposes, do just fine.
In 2009 the newly inaugurated President Obama said the time “of putting off unpleasant decisions . . . has surely passed.” And yet, Obama’s audacious hope to provide health insurance to tens of millions of people, while improving the quality and lowering the cost of health care for those already insured, seemed to require nothing other than extremely pleasant decisions. His campaign promised in 2008, “Obama’s plan will reduce a typical family’s premium by up to $2,500 by reducing costs, improving technology, and reining in the power of insurance companies.”
In November 2009 the White House blog declared, “Objective Analysis Shows Reform will Help Small Businesses, Lower Premiums for American Families.” The analysis, performed by the legendarily objective Jonathan Gruber, discovered that the Democratic proposal would lower health insurance premiums, saving the typical individual from $500 to $3,000 per year, and the typical family from $1,260 to $9,000. These reductions would come “in addition to the more generous benefits consumers would receive,” and “also in addition to increased protections.” (Emphasis in the original.)
Obama himself bore nothing but glad tidings when urging support for his reforms. Most famously, he promised over and over that all Americans who were satisfied with their health care providers and health insurance arrangements would be able to keep them. And the costless benefits he promised would help people not only in their capacity as patients and policyholders, but as taxpayers and citizens. Speaking to Congress in September 2009, the president declared, “I will not sign a plan that adds one dime to our deficits, either now or in the future.” Because of the “skyrocketing costs” of Medicare and Medicaid, he said, “our health care problem is our deficit problem. Nothing else even comes close.” Because the existing health care system “is currently full of waste and abuse,” it will be possible to extend health insurance to 30 million uninsured Americans and improve the coverage and health care for millions more without increasing federal debt. “Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan.”
In 2009 the federal government spent $425 billion on Medicare and $251 billion on Medicaid. Together they accounted for 19 percent of all federal spending that year. If the two programs were indeed full of waste and abuse, citizens would be fully justified in the modest demand that their elected officials treat making Medicare and Medicaid effective and honest as an urgent end in itself, rather than hold the discharge of that duty hostage to the political effort to make those wasteful, abusive programs even bigger. They would be further justified, as opposed to sickeningly childish and hypocritical, in supposing that if two huge, 44-year-old government programs’ endemic waste and abuse had not been rooted out, there might be good, daunting reasons for that problem’s persistence. Voters would go on to conclude, plausibly, that prudence dictated reducing the waste and abuse first, rather than making massive new spending commitments that were predicated upon reducing it somehow, someday.
It’s easy for a sweeping new program to “pay for itself,” when its specific, generous benefits are “offset” by notional stringencies. (The advocates of each one of the sweeping government programs that drive our perma-deficit announced at one time or another that it would pay for itself, if not pay for itself “many times over.”) As left-leaning economics journalist Robert Kuttner wrote of Obamacare in 2013, “Obama, looking to fund his initiative without raising taxes, hit on the idea of imagining a trillion dollars in yet-to-be specified savings in Medicare.” Mr. Full-of-Surprises, Jonathan Gruber, told a reporter last year that the whole idea of saving money was “sometimes a misleading motivator for the Affordable Care Act.” In reality, “The law isn’t designed to save money. It’s designed to improve health, and that’s going to cost money.”
Of course it will. The dark secret always turns out to have been the obvious, commonsense truth that everyone knew all along. Its revelation, long after the law has been passed, refutes the promises about huge benefits that will require no costs, assurances that should have been derided from the start.
Milton Friedman’s favorite maxim—there’s no such thing as a free lunch—doesn’t mean that there’s no such thing as a lunch worth paying for at the price listed on the menu. This is true whether the diner is privately or publicly owned and operated. In either case, some lunches are and others aren’t worth the cost. And in either case, an advertisement promising free lunches should make us more skeptical, not more enthusiastic.
If the Democratic party were a private business worried about the declining sales of its flagship model, Government Intervention, it might call in a management consultant to figure out what was wrong. He would do well to follow the advice of the Democrats’ CEO and tell the clients what they need to hear rather than what they want to hear. What every business wants to hear in these circumstances is the same reassurance: Because there’s absolutely nothing even slightly wrong with the product, the changes needed are in the sales, marketing, and public relations departments. Once the buying public is reacquainted with Government Intervention’s many extraordinary features, it will fly off the shelves the way it did in the glory days of the 1930s and 1960s.
The assessment Democrats need to hear is less comforting. Their problem is not solely or even primarily in sales and marketing, but in production, management, and quality control. The customers shunning Government Intervention today are no less intelligent than the ones who embraced it two or three generations ago. And the GOP, the competing firm disparaging it, is no more aggressive.
What’s changed is that a growing portion of the electorate has come to suspect that the Democrats, while still the party of government in the sense of advocating government intervention as the solution for many, many problems, has become the party of government in other, more disquieting ways. It seems strongly committed to the idea that government should do more, but not that it should do it well. The party of government demands more responsibilities for government, but can’t or won’t demand consistently high performance from government.
President Obama has acknowledged this problem but, again, at a high level of abstraction. “The question . . . is not whether our government is too big or too small, but whether it works,” he said in his first Inaugural Address. “Where the answer is yes, we intend to move forward. Where the answer is no, programs will end. And those of us who manage the public’s dollars will be held to account to spend wisely, reform bad habits, and do our business in the light of day.”
But no programs have ended since January 2009. Is it because all of them work? After Presidents Carter and Clinton, Obama has led the third Democratic administration entrusted with operating and improving the megastate for which Franklin Roosevelt and Lyndon Johnson are largely responsible. All three devoted rhetoric to making it work efficiently and responsively. Carter hailed the transformative power of sunset laws and zero-based budgeting. In 1993 Clinton promised to redesign, reinvent, and reinvigorate the entire national government. In 2011 Obama promised to “merge, consolidate, and reorganize” it, so government would be more affordable, competent, and efficient.
After all these improvements, it should have been easy for the party of government to refute political scientist Steven Teles, who argued in 2013, “America has chosen to govern itself through more indirect and incoherent policy mechanisms than can be found in any comparable country.” Democrats would have cited endless instances of successful programs and consequential reforms that belied Teles’s contention that “sluggish administration, blame-shifting, and unintended consequences” were pervasive problems. But they didn’t. And their silence suggests they couldn’t.
It appears that Obama’s attempt to stipulate the terms of national debate at the outset of his presidency has failed. The question of whether government should be smaller or bigger—and if the latter, how much bigger—remains important and legitimate. It is not, in other words, kept alive by “cynics” who “fail to understand . . . that the stale political arguments that have consumed us for so long no longer apply.” The explicit call by such Democrats as Schumer and Tomasky for their party to recommit to government intervention as its central purpose demonstrates that this contested proposition remains vital.
Furthermore, the question of whether government works is not the real issue to be debated in lieu of the spurious question of government’s size. To the contrary, both are valid, necessary topics. Whether government works; whether and how it can work better; and what it means if experience and analysis argue that in some respects it cannot be made to work better—these are all legitimate questions in themselves.
But they are also closely connected to the question of determining government’s right size. The public is justifiably dubious about assigning government more powers and responsibilities when even the party of government’s leaders say it needs a complete overhaul—one which they fail to perform and scarcely attempt. And when the costs that were supposed to be trivial turn out to be substantial, while the benefits sometimes do and sometimes don’t come through the pipeline, the skepticism deepens and hardens into cynicism.
That some Democrats want to deny these problems by blaming the unpopularity of government intervention on the ignorant, ungrateful voters or on the feckless Democratic politicians who won’t proclaim their triumphs is the strongest evidence that the party of government won’t or can’t remove the political barriers preventing more government. In that regard, the news in the aftermath of the 2014 elections is even better for Republicans than the reports on election night.
William Voegeli, a senior editor at the Claremont Review of Books, is the author of The Pity Party: A Mean-Spirited Diatribe Against Liberal Compassion.