Stop the Obamacare metaphor madness
This post originally appeared in National Journal.
Can we, before our L-Tryptophan coma commences, vow to abandon all attempts to festoon Obamacare with ridiculous historical metaphors? The damn law is big, with a regulatory heft now in excess of 20,000 pages. But even this governmental behemoth groans under the weight of metaphorical ornaments both daft and dull.
Obamacare is not Katrina, not in fact or political impact.
Obamacare is not Iraq, not in its human or material cost or in the reckless misuse of a commander in chief's most sacred obligations of truth, judgment, and management.
Obamacare is not the Bay of Pigs, not in concept, execution, or political appraisal.
It's not President Obama's Iran-Contra affair or his Mayaquez or Pueblo. It's not his Yalta or Munich. It's not his Tet, Dunkirk, or Waterloo, either. And it isn't Obama's Teapot Dome, Credit Mobilier, or XYZ Affair. And it isn't Thermopylae, either. At least not yet—though Republicans might love to play the Greeks and possibly nominate Sen. Ted Cruz as their Leonidas.
The Affordable Care Act is a singular creation, a partisan-constructed, partisan-maneuvered, and partisan-defended hybrid of government coercion and private-sector collaboration. It is not the apotheosis of liberalism, though it is lately mistaken for that (a single-payer system would have been). Therefore, its fate cannot and will not write the final or necessarily even next chapter of liberalism or progressivism's role in American life. The ACA is not the Heritage Foundation's free-market alternative to Hillarycare it is often mischaracterized to be, and therefore its component parts shed no light on GOP antecedents or alternatives. Antecedents there are many, for there was a time when Republicans seriously crafted such legislative structures. This they no longer do, and thus they are stuck and stymied with a repetitive procedural campaign against Obamacare that thus far has neither succeeded in Congress nor galvanized the public.
The ACA is, most of all, a mess.
And I don't mean HealthCare.gov, a subject I will return to momentarily.
I mean the law and its consequences, its regulations and taxes, its causes and its effects are messy. Winners and losers abound. This is true now and will be true for as long as the law remains. And remain it likely will, precisely because of the tight and self-reinforcing alliance the law constructed with insurers, hospitals, and doctors. Americans who lacked insurance coverage will find it through the private sector on federal or state exchanges or via Medicaid. Americans who had policies on the individual market will lose their old coverage and possibly find new and better coverage or more expensive and inferior plans. Americans employed by large corporations will see modest changes in benefit and premium schedules, and those who work for smaller companies may see previous coverage vanish and choose new options that may or may not live up to their expectations. All of this will be destabilizing and generate in different regions and among different demographic groups anxiety, possibility, relief, and rage.
In this, Obamacare will unintentionally but unmistakably resemble the old system—where these powerful emotions and wrenching economic dislocations were common but engineered entirely by the private insurance market. To cover those who lacked insurance, Obama decided to interpose the federal government in this messy market, and his hyper-simplistic rhetoric about keeping insurance plans and doctors exposed his contempt for public discourse and corroded his credibility, by far the most durable personal attribute of his presidency.
Obama's rhetoric has been his political undoing, driving his poll ratings to new lows and grinding his other legislative ambitions to dust. Obamacare has become a crucible of accountability and believability. Within that confined space, made hotter and more vaporous by his own discredited platitudes, Obama's ability to lead, inspire, and persuade has suffered. But the law remains, and the next four months will be but the first of many moments to judge its outcomes against its ambitions and promises.
Instant analysis of the political import of Obama's current malaise misses the arc of the story and the law. Obamacare's implementation is not a watershed, turnstile, or hinge of history. It is an ongoing saga. It's not a three-act play, but a governmental serial that will run continuously, productively, destructively, and monotonously for the remainder of the Obama presidency and, quite probably, through the presidency of his successor.
Amid the tangled snare of winners and losers will joust Republican opponents and Democratic defenders. And make no mistake, for Democrats there is no other practical place to stand but in defense of Obamacare. Republicans and disenchanted independents will give no credit, and party loyalists will savage the squeamish.
The first test comes next week with the rollout of the post-op HealthCare.gov. So fearful that it will crash under heavy use, the White House on Monday asked its health care allies (Enroll America, Families USA, and many big unions) not to launch a second enrollment campaign. Hardly encouraging. Even so, White House advisers insist that the site will be able to—mostly—accommodate 50,000 simultaneous users, and that means upward of 800,000 customers per day. During peak usage, meaning anything above 50,000 consumers, delays are predicted. But instead of getting error messages, stalled users will receive an email instructing them when they can sign in later and be at the front of the line. Should do wonders for the Late Show ratings. As for error rates, they've fallen from 8 percent frequency three weeks ago to less than 1 percent (nearly as good as the Top Ten list).
The next test comes in mid-December, when the White House expects a surge in enrollment as consumers attempt to purchase insurance that will begin Jan. 1. Before the six-month enrollment period ends, the administration anticipates two significant bulges in enrollment—one for the first coverage window (to obtain coverage by Jan. 1) and one for the final enrollment deadline of March 31. How the website and insurers handle the first surge in mid-December will explain a lot about the website's triage and the efficacy of the insurance pricing and selection models. The White House also expects enrollment to taper off after Dec. 23 (the new enrollment deadline for Jan. 1 coverage) before it reaches a maximum peak from mid-February to the final cutoff date of March 31. For historical and comparative purposes, in the first two months of Massachusetts' health care law, 17 percent of enrollees were 18 to 34; in the final two months of the 11-month enrollment period in Massachusetts, 39 percent of enrollees were 18 to 34. The administration expects this pattern to repeat itself under the ACA, though on the shorter, six-month timeline. Also in December, insurance companies will ramp up direct enrollment outreach to future consumers—offering them plans and then connecting to the state or federal website for assistance with subsidies for premiums and coverage offered. December will be an acid test for HealthCare.gov 2.0 and the new, ad hoc recruitment of enrollees by insurance companies. The verdicts, while not conclusive, will be instructive.
All this will serve as the backdrop for Obama's State of the Union address, which will unquestionably be the State of Obamacare address. Landing between the expected conclusion of budget/sequester talks on Jan. 15 and a debt-ceiling extension on Feb. 15, the State of the Union (Obamacare) address will be Obama's next best chance to—in White House jargon—pivot, reset, or reach an inflection point on the ACA as a matter of law, implementation, and politics. Obamacare will be able, the White House hopes, to admit past mistakes, errors of management, and leaky health care promises but spin the larger debate forward with tales of website redemption, enrollment surges, and satisfied consumers with newfound coverage and contentment.
As I said, Obamacare is a saga and a mess, singularly so. It needs no metaphorical embroidery.
As Michael, played by Robert DeNiro, famously said in The Deer Hunter: "See this. This is this. This ain't something else. This is this. From now on, you're on your own."
Obamacare is Obamacare. It ain't something else. For Obama, the next two months will go some distance in determining if he is also on his own.
