Standoff, page 10
For fourteen years after the demise of the Clinton plan, health care reform was virtually a taboo subject in American politics. But Democrats refused to let it die. A month after he first got elected, President Barack Obama said at a press conference, “The time has come, this year, in this new administration, to modernize our health care system.”
The issue had been debated during the 2008 campaign, especially in the Democratic primary race between Obama and Hillary Clinton. “I did try in 1993 and 1994, and I like to say that I have the scars to show for it,” Clinton said at a Democratic primary debate. “But I learned a lot about what we have to do.” Like what? Like you can’t do it with a closed process that produces a scary 1,300-page plan. You’ll frighten Harry and Louise. Obama seemed to understand that. “My goal is to make sure that we have everybody involved—doctors, nurses, patient advocates, businesses, labor, everybody—sitting around the table, Republicans and Democrats,” Obama said. “This is going to be an open, transparent process.”
There was one big difference between 1994 and 2009: the economy. In 1994 the economy was clearly in recovery. The middle class was no longer in a panic over health care. In 2009 economic anxiety had risen to a new peak. The public’s biggest concerns were job losses, mortgage security, business failures, and the credit squeeze. All bigger than health care.
One thing, however, had not changed since 1994: a solid majority of Americans continued to say they were satisfied with their health care (83 percent in a 2009 CNN poll) and with their health insurance (74 percent).7 A solid 71 percent of Americans were satisfied with both. President Obama addressed the satisfied majority at his July 2009 press conference. “Many Americans are wondering, ‘What’s in this for me? How does my family stand to benefit from health insurance reform?’ ” The president’s answer: “If we do not act to bring down costs, everybody’s health care will be in jeopardy.”
Democrats had to convince the satisfied majority that they had nothing to fear from health care reform but that they did have something to fear if reform failed. In a 2009 New York Times–CBS News poll, more than three in four Americans said they were concerned that, if health care reform passed, their health care costs would go up. And if health care reform did not pass? More than three in four said they were concerned their health care costs would still go up.8
The Obama plan was never popular, even after it was signed into law in 2010.9 It was not until 2017, when the Republican Congress threatened to repeal it, that a majority of Americans began to favor Obamacare. The process was part of the problem. President Obama did not make the same mistake as President Clinton and turn the bill-writing process over to a secretive commission. Instead, he made a different mistake. Promising that the process would be open and transparent, he turned it over to Congress. There is nothing less edifying to Americans than witnessing the process of bill writing in Congress—the deal making, the influence peddling, the horse trading. Deals like the “Cornhusker kickback” to get the support of Nebraska senator Ben Nelson and the “Louisiana purchase” to bring Senator Mary Landrieu into the fold. The public’s disgust was captured perfectly by an uninsured eighteen-year-old waitress in New Hampshire who explained her opposition this way to the New York Times: “If you have to bribe people to vote for it, it can’t be good.”
What intensified the opposition was everything else the Obama administration did in its first two years. For Tea Party supporters, the Obama administration epitomized their worst nightmare of big government. Huge increases in federal spending. A federal takeover of major corporations on the verge of bankruptcy. Wall Street bailouts. The mortgage rescue plan. And on top of all that, more government control of health care. The fact that President Obama did it with the support of the New America—minorities and young people—just made it seem more alien. But the core of the complaint was not bigotry. It was fear of the abusive power of big government.
“There’s no fixing the government health care takeover Democrats forced through,” South Carolina senator Jim DeMint told the New York Times. “Freedom dies a little bit today,” Representative Marsha Blackburn of Tennessee warned. A Tea Party activist told a rally in Iowa, “Every single person’s body in this whole country belongs to the government now.”
Party Government
In 2009 and 2010, Democrats had solid majorities in the House and Senate. Democrats held 257 House seats (59 percent of the House) when health care reform first came up for a vote in 2009. That was about the same number of seats they held during Clinton’s first two years (258 Democratic seats in 1993–94). In 1994 Democrats held 57 seats in the US Senate. In 2009 Democrats had 60 votes in the Senate (including two Independents), just enough to end a filibuster. The Senate Democratic caucus slipped to 59 members when Senator Edward Kennedy died in 2009 and his successor, Republican Scott Brown, was chosen to succeed him in a special election.
But Democrats succeeded this time by hanging together to a degree that Democrats rarely do. House Democrats voted 219 to 39 for the Obama plan in 2009, enabling the measure to pass the House by 5 votes. Senate Democrats voted 54 to 3 for the plan in 2010. (Two Independent senators also voted for the plan.) Not a single Republican voted for the plan when it came up for final passage in 2010. In 1994, when Democrats had comparable majorities, the Clinton health care plan never made it to the floor of either chamber for a vote.
What united Democrats in 2009 and 2010? Answer: Republicans. It’s Sir Isaac Newton’s third law of motion: for every action, there is an equal and opposite reaction. It applies to politics just as it does to physics. Case in point: Representative Joe Wilson’s “You lie!” outburst during President Obama’s speech to a joint session of Congress. Action: Wilson’s apparently spontaneous gesture of contempt. Reaction: outraged Democrats rallied to the cause of health care reform.
Which is exactly what Barack Obama needed to happen. In his speech, the president carefully tried to carve out a middle way between two objectives: building a consensus on health care reform (“I will continue to seek common ground in the weeks ahead”) and standing up to his opponents (“If you misrepresent what’s in the plan, we will call you out”). He got nowhere with Republicans. Their resolve had been strengthened over the previous summer by Tea Party activists, who laid out a path of defiance.
The Democratic Congressional Campaign Committee sent a message to backers that said, “Calling the president of the United States a liar in front of the nation is a new low even for House Republicans.” Americans United for Change charged in a web video, “It’s official: the Party of No has become the Party of No Shame.”
The loss of Ted Kennedy’s seat in January 2010 came very close to killing the health care bill. The crush of press coverage of the Massachusetts race caused Bay State voters to see the election as a national event: a referendum on health care reform in a state that already had it. Polls showed no great enthusiasm for the federal health care bill among Massachusetts voters—in some cases, because they didn’t think they needed it, and, in many cases, because they didn’t like it any more than voters in other states did. The special Senate election invited Massachusetts voters to send a message to Washington: “Stop.”
The only option left for Democrats was to try to pass the bill with a purely partisan majority. In his response to President Obama’s weekly radio address in February 2010, Republican senator Tom Coburn of Oklahoma charged that congressional Democrats “want to use procedural tricks and backroom deals to ram through a new bill that combines the worst aspects of the bills the Senate and House passed last year.” Coburn was referring to the reconciliation process whereby the bill could pass the Senate with 51 votes without being subject to a filibuster. After Kennedy’s death, Democrats were one vote short of the supermajority needed to end a filibuster. Questioned about reconciliation at her news conference, House Speaker Nancy Pelosi replied, “What you call a complicated process is called a simple majority.”
The health care bill did pass the Senate by a simple majority, 56 to 43. It was an unusual experience for the United States. Most major legislation in American history has been passed with bipartisan support: Social security, Medicare, the civil rights and voting rights laws, the Reagan tax cuts, the Bush tax cuts, the Patriot Act. But not the Obama health care law. It was owned exclusively by Democrats, and Republicans have never ceased campaigning for repeal. Even after the defeat of Mitt Romney, who promised to repeal the law even though it was similar to the health care law that he had signed as governor of Massachusetts. The new law became Obamacare, a term the president ultimately embraced.
When the Affordable Care Act finally passed in March 2010, the public was divided over the new law, with 46 percent favorable and 40 percent unfavorable in the Kaiser Health Tracking Poll. A year later, the public was still divided: 41 percent to 41 percent. In 2012? 41 percent favorable, 40 percent unfavorable. Opposition increased after the disastrous website rollout in October 2013, with 50 percent to 34 percent opposed in January 2014. After the website was fixed, opinion settled back to a closer split: 45 percent opposed, 38 percent in favor in May 2014. Then a barrage of anti-Obamacare ads began running as the 2014 midterm campaign got under way, and opposition peaked at 53 percent in July 2014, with only 37 percent in favor. In January 2016 the public remained divided: 44 percent opposed to the new health care law and 41 percent in favor.10
A Tax?
Public opposition to the law has always focused on the individual mandate requiring people to purchase health insurance or pay a fine. In fact, Barack Obama was against an individual mandate before he was for it. During the 2008 campaign, he said his opposition to a mandate without making health care affordable for all was “a genuine difference between myself and Senator Clinton.” Once he became president, however, Obama was persuaded to accept an individual mandate because it was the only way health insurance companies would support the new law. (A mandate guaranteed them more customers.) No wonder so many voters thought the policy had been imposed on them. They didn’t vote for an individual mandate when they elected Obama.
In 2012 the Kaiser Family Foundation poll gauged public support for twelve specific provisions of the new law. Eleven of the twelve provisions had majority support, ranging from 80 percent who favored “tax credits to small businesses that offer health insurance to their employees,” to 51 percent who favored requiring insurance plans to offer “a minimum package of health insurance benefits to be defined by the government.” Only one provision did not garner majority support: the one requiring “nearly all Americans to have health insurance by 2014 or else pay a fine.” The public opposed the individual mandate by more than two to one (66 percent to 32 percent).11
President Obama reversed himself again on whether to label the penalty a tax. He objected strongly when Republicans called it a tax. But here too, the administration shifted arguments, eventually accepting the idea that the mandate could be called a tax. That reversal proved crucial to the law’s survival.
“The mandate is not a legal command to buy insurance,” Chief Justice John Roberts wrote in his June 2012 health care ruling. It’s not? Really? It sure sounds like it. No, Roberts insisted, “It makes going without insurance just another thing the government taxes, like buying gasoline or earning income.” With that bit of sophistry, the Supreme Court upheld the health care law and refrained from throwing millions of Americans off the health insurance rolls. Democrats were thrilled. They didn’t care how the court got there as long as the court got there.
But it does make a difference how it got there. Because what the court did was to deny that health care is a right. In the court’s view, the right to health care has no constitutionally protected status, such as abortion rights or gun rights. It’s just a benefit. Rights can’t be taken away. Benefits can. If universal health care is simply a tax, it’s dispensable. Taxes can be raised or lowered or abolished. We do that all the time. “Those decisions are entrusted to our nation’s elected leaders, who can be thrown out of office if the people disagree with them,” the court said. Could that have been a partisan recommendation? It sure sounded like it. “It is not our job to protect the people from the consequences of their political choices,” Roberts wrote.
The Supreme Court’s ruling amounted to a challenge to the Obama administration: if you want to keep the health care law, you’re going to have to sell it to the American public. That’s something the administration never really did. Speaking on CNN, former White House chief of staff Jack Lew said, “We have a Supreme Court, and when it rules, we have a final judgment.” In the case of health care reform, however, the court left the final judgment to the American people.
The Debate Goes On . . . and On
I once interviewed an elderly Russian woman who had immigrated to the United States. I asked her what she thought of the US health care system. She said she didn’t like her American doctor. I asked her why not.
“He is nekulturny,” she replied.
“Uncultured?” I suggested.
“Yes,” she said. “My Russian doctor read Balzac. My American doctor has never heard of Balzac.”
“So do you think medicine in Russia is better?” I asked.
She thought about the question for a moment. Finally, she said, “I don’t think so. You see, my American doctor knows where my liver is.”
In 2013, Republican senators shut down the federal government for sixteen days rather than pass a budget that included funding for Obamacare. “If you pay for a budget that includes Obamacare . . . you have voted for Obamacare,” Senator Marco Rubio of Florida announced. “Some will say, ‘That is crazy. You are going to shut down the government over Obamacare.’ No. What is crazy is moving forward with [Obamacare].” By the end of 2015, the House of Representatives had voted more than sixty times to roll back all or part of Obamacare, only to see the votes ignored by the Senate. Finally, at the beginning of 2016, a repeal measure made it through both the House and Senate and reached the president’s desk. President Obama vetoed the repeal within two days. Neither House nor Senate Republicans had the votes to override the president’s veto.
As the law moved toward implementation in 2014, President Obama remained optimistic. “If it works, it will be pretty darn popular,” he said in a New York Times interview. The danger was that not enough young and healthy people would sign up. Without those new customers, the insurance rolls would be overwhelmed by older and sicker Americans who couldn’t get coverage otherwise—and who would drive up costs. And insurance premiums.
The problem was that many healthy young people might opt to pay the penalty—up to 1 percent of their income—rather than purchase insurance, which could be far more costly. After all, young people, particularly young men, believe they are immortal. They might prefer to take their chances with health care and use the cash to buy a car or go to Cancun, Mexico, for spring break.
Former Montana senator Max Baucus, one of the architects of the Affordable Care Act, warned of “a train wreck” if preparations for the new law were inadequate. Meanwhile, Republicans were doing everything they could to derail the train. GOP House members withheld funds for the campaign. Congress provided less money than it did for the rollout of President Bush’s prescription drug program in 2004. That program had a constituency of seniors who were eager to participate.
Republicans were determined to resist. Republican governors were uncooperative. A spokesman for the National Republican Senatorial Committee said Republicans intended to make the 2014 midterm a referendum on Obamacare “in a more tangible way than it was in 2010.” Democrats were worried. Senator Ron Wyden of Oregon said “There is reason to be very concerned about what’s going to happen with young people. If their premiums shoot up, I can tell you, that is going to wash into the United States Senate in a hurry.”
The fate of Obamacare remains uncertain as of November 2017. Congressional Republicans continue to plot strategies to defund the law and eliminate the tax penalty for the uninsured. The Supreme Court continues to hear challenges to the law. For Republicans, opposition to Obamacare has become a defining issue. It’s like antiwar sentiment was for Democrats in 2006. In Iraq, of course, people were being killed. But look at what Minnesota representative Michele Bachmann said about Obamacare: “Let’s repeal this failure before it literally kills women, kills children, kills senior citizens.” Senator Coburn, a physician, said the message to seniors was: “You’re going to die sooner. When you restrict the ability of primary caregivers in this country to do what is best for their senior patients, what you’re doing is limiting their life expectancy.”
The Obama administration estimated that more than fifteen million Americans had gained health insurance by the end of 2015 because of Obamacare. “This thing is working,” the president said. The October 2014 Kaiser poll reported that most Americans wanted Congress to work to improve the law (64 percent) rather than repeal it and replace it with something else (33 percent).12 But conservatives will never agree that Obamacare is working. They’re ideologues, and ideologues believe that if something is wrong, it can’t possibly work. Even if it does work.
Obamacare is supposed to be an entitlement program, like Social Security and Medicare. Both of those programs are universal: everyone who pays into the system is entitled to a benefit whether or not he or she actually needs the money. We bribe the middle class to support entitlements. That’s why they’re so expensive. And so popular.
A social welfare program targets benefits by need. Only people who can show they actually need the benefit get it. Under Obamacare, some people who have to purchase health insurance can’t afford it and have to be subsidized. Those subsidies are being paid for with fines, new taxes, and higher premiums for people who can afford it. That’s a transfer of wealth.
Programs targeted by need have always been controversial. How can we be sure people don’t take advantage of the system? That the benefits go only to the “truly needy”? “I think [Obamacare] is viewed more as a social welfare program than a social insurance program,” longtime Obama adviser David Axelrod told the New York Times.
The issue had been debated during the 2008 campaign, especially in the Democratic primary race between Obama and Hillary Clinton. “I did try in 1993 and 1994, and I like to say that I have the scars to show for it,” Clinton said at a Democratic primary debate. “But I learned a lot about what we have to do.” Like what? Like you can’t do it with a closed process that produces a scary 1,300-page plan. You’ll frighten Harry and Louise. Obama seemed to understand that. “My goal is to make sure that we have everybody involved—doctors, nurses, patient advocates, businesses, labor, everybody—sitting around the table, Republicans and Democrats,” Obama said. “This is going to be an open, transparent process.”
There was one big difference between 1994 and 2009: the economy. In 1994 the economy was clearly in recovery. The middle class was no longer in a panic over health care. In 2009 economic anxiety had risen to a new peak. The public’s biggest concerns were job losses, mortgage security, business failures, and the credit squeeze. All bigger than health care.
One thing, however, had not changed since 1994: a solid majority of Americans continued to say they were satisfied with their health care (83 percent in a 2009 CNN poll) and with their health insurance (74 percent).7 A solid 71 percent of Americans were satisfied with both. President Obama addressed the satisfied majority at his July 2009 press conference. “Many Americans are wondering, ‘What’s in this for me? How does my family stand to benefit from health insurance reform?’ ” The president’s answer: “If we do not act to bring down costs, everybody’s health care will be in jeopardy.”
Democrats had to convince the satisfied majority that they had nothing to fear from health care reform but that they did have something to fear if reform failed. In a 2009 New York Times–CBS News poll, more than three in four Americans said they were concerned that, if health care reform passed, their health care costs would go up. And if health care reform did not pass? More than three in four said they were concerned their health care costs would still go up.8
The Obama plan was never popular, even after it was signed into law in 2010.9 It was not until 2017, when the Republican Congress threatened to repeal it, that a majority of Americans began to favor Obamacare. The process was part of the problem. President Obama did not make the same mistake as President Clinton and turn the bill-writing process over to a secretive commission. Instead, he made a different mistake. Promising that the process would be open and transparent, he turned it over to Congress. There is nothing less edifying to Americans than witnessing the process of bill writing in Congress—the deal making, the influence peddling, the horse trading. Deals like the “Cornhusker kickback” to get the support of Nebraska senator Ben Nelson and the “Louisiana purchase” to bring Senator Mary Landrieu into the fold. The public’s disgust was captured perfectly by an uninsured eighteen-year-old waitress in New Hampshire who explained her opposition this way to the New York Times: “If you have to bribe people to vote for it, it can’t be good.”
What intensified the opposition was everything else the Obama administration did in its first two years. For Tea Party supporters, the Obama administration epitomized their worst nightmare of big government. Huge increases in federal spending. A federal takeover of major corporations on the verge of bankruptcy. Wall Street bailouts. The mortgage rescue plan. And on top of all that, more government control of health care. The fact that President Obama did it with the support of the New America—minorities and young people—just made it seem more alien. But the core of the complaint was not bigotry. It was fear of the abusive power of big government.
“There’s no fixing the government health care takeover Democrats forced through,” South Carolina senator Jim DeMint told the New York Times. “Freedom dies a little bit today,” Representative Marsha Blackburn of Tennessee warned. A Tea Party activist told a rally in Iowa, “Every single person’s body in this whole country belongs to the government now.”
Party Government
In 2009 and 2010, Democrats had solid majorities in the House and Senate. Democrats held 257 House seats (59 percent of the House) when health care reform first came up for a vote in 2009. That was about the same number of seats they held during Clinton’s first two years (258 Democratic seats in 1993–94). In 1994 Democrats held 57 seats in the US Senate. In 2009 Democrats had 60 votes in the Senate (including two Independents), just enough to end a filibuster. The Senate Democratic caucus slipped to 59 members when Senator Edward Kennedy died in 2009 and his successor, Republican Scott Brown, was chosen to succeed him in a special election.
But Democrats succeeded this time by hanging together to a degree that Democrats rarely do. House Democrats voted 219 to 39 for the Obama plan in 2009, enabling the measure to pass the House by 5 votes. Senate Democrats voted 54 to 3 for the plan in 2010. (Two Independent senators also voted for the plan.) Not a single Republican voted for the plan when it came up for final passage in 2010. In 1994, when Democrats had comparable majorities, the Clinton health care plan never made it to the floor of either chamber for a vote.
What united Democrats in 2009 and 2010? Answer: Republicans. It’s Sir Isaac Newton’s third law of motion: for every action, there is an equal and opposite reaction. It applies to politics just as it does to physics. Case in point: Representative Joe Wilson’s “You lie!” outburst during President Obama’s speech to a joint session of Congress. Action: Wilson’s apparently spontaneous gesture of contempt. Reaction: outraged Democrats rallied to the cause of health care reform.
Which is exactly what Barack Obama needed to happen. In his speech, the president carefully tried to carve out a middle way between two objectives: building a consensus on health care reform (“I will continue to seek common ground in the weeks ahead”) and standing up to his opponents (“If you misrepresent what’s in the plan, we will call you out”). He got nowhere with Republicans. Their resolve had been strengthened over the previous summer by Tea Party activists, who laid out a path of defiance.
The Democratic Congressional Campaign Committee sent a message to backers that said, “Calling the president of the United States a liar in front of the nation is a new low even for House Republicans.” Americans United for Change charged in a web video, “It’s official: the Party of No has become the Party of No Shame.”
The loss of Ted Kennedy’s seat in January 2010 came very close to killing the health care bill. The crush of press coverage of the Massachusetts race caused Bay State voters to see the election as a national event: a referendum on health care reform in a state that already had it. Polls showed no great enthusiasm for the federal health care bill among Massachusetts voters—in some cases, because they didn’t think they needed it, and, in many cases, because they didn’t like it any more than voters in other states did. The special Senate election invited Massachusetts voters to send a message to Washington: “Stop.”
The only option left for Democrats was to try to pass the bill with a purely partisan majority. In his response to President Obama’s weekly radio address in February 2010, Republican senator Tom Coburn of Oklahoma charged that congressional Democrats “want to use procedural tricks and backroom deals to ram through a new bill that combines the worst aspects of the bills the Senate and House passed last year.” Coburn was referring to the reconciliation process whereby the bill could pass the Senate with 51 votes without being subject to a filibuster. After Kennedy’s death, Democrats were one vote short of the supermajority needed to end a filibuster. Questioned about reconciliation at her news conference, House Speaker Nancy Pelosi replied, “What you call a complicated process is called a simple majority.”
The health care bill did pass the Senate by a simple majority, 56 to 43. It was an unusual experience for the United States. Most major legislation in American history has been passed with bipartisan support: Social security, Medicare, the civil rights and voting rights laws, the Reagan tax cuts, the Bush tax cuts, the Patriot Act. But not the Obama health care law. It was owned exclusively by Democrats, and Republicans have never ceased campaigning for repeal. Even after the defeat of Mitt Romney, who promised to repeal the law even though it was similar to the health care law that he had signed as governor of Massachusetts. The new law became Obamacare, a term the president ultimately embraced.
When the Affordable Care Act finally passed in March 2010, the public was divided over the new law, with 46 percent favorable and 40 percent unfavorable in the Kaiser Health Tracking Poll. A year later, the public was still divided: 41 percent to 41 percent. In 2012? 41 percent favorable, 40 percent unfavorable. Opposition increased after the disastrous website rollout in October 2013, with 50 percent to 34 percent opposed in January 2014. After the website was fixed, opinion settled back to a closer split: 45 percent opposed, 38 percent in favor in May 2014. Then a barrage of anti-Obamacare ads began running as the 2014 midterm campaign got under way, and opposition peaked at 53 percent in July 2014, with only 37 percent in favor. In January 2016 the public remained divided: 44 percent opposed to the new health care law and 41 percent in favor.10
A Tax?
Public opposition to the law has always focused on the individual mandate requiring people to purchase health insurance or pay a fine. In fact, Barack Obama was against an individual mandate before he was for it. During the 2008 campaign, he said his opposition to a mandate without making health care affordable for all was “a genuine difference between myself and Senator Clinton.” Once he became president, however, Obama was persuaded to accept an individual mandate because it was the only way health insurance companies would support the new law. (A mandate guaranteed them more customers.) No wonder so many voters thought the policy had been imposed on them. They didn’t vote for an individual mandate when they elected Obama.
In 2012 the Kaiser Family Foundation poll gauged public support for twelve specific provisions of the new law. Eleven of the twelve provisions had majority support, ranging from 80 percent who favored “tax credits to small businesses that offer health insurance to their employees,” to 51 percent who favored requiring insurance plans to offer “a minimum package of health insurance benefits to be defined by the government.” Only one provision did not garner majority support: the one requiring “nearly all Americans to have health insurance by 2014 or else pay a fine.” The public opposed the individual mandate by more than two to one (66 percent to 32 percent).11
President Obama reversed himself again on whether to label the penalty a tax. He objected strongly when Republicans called it a tax. But here too, the administration shifted arguments, eventually accepting the idea that the mandate could be called a tax. That reversal proved crucial to the law’s survival.
“The mandate is not a legal command to buy insurance,” Chief Justice John Roberts wrote in his June 2012 health care ruling. It’s not? Really? It sure sounds like it. No, Roberts insisted, “It makes going without insurance just another thing the government taxes, like buying gasoline or earning income.” With that bit of sophistry, the Supreme Court upheld the health care law and refrained from throwing millions of Americans off the health insurance rolls. Democrats were thrilled. They didn’t care how the court got there as long as the court got there.
But it does make a difference how it got there. Because what the court did was to deny that health care is a right. In the court’s view, the right to health care has no constitutionally protected status, such as abortion rights or gun rights. It’s just a benefit. Rights can’t be taken away. Benefits can. If universal health care is simply a tax, it’s dispensable. Taxes can be raised or lowered or abolished. We do that all the time. “Those decisions are entrusted to our nation’s elected leaders, who can be thrown out of office if the people disagree with them,” the court said. Could that have been a partisan recommendation? It sure sounded like it. “It is not our job to protect the people from the consequences of their political choices,” Roberts wrote.
The Supreme Court’s ruling amounted to a challenge to the Obama administration: if you want to keep the health care law, you’re going to have to sell it to the American public. That’s something the administration never really did. Speaking on CNN, former White House chief of staff Jack Lew said, “We have a Supreme Court, and when it rules, we have a final judgment.” In the case of health care reform, however, the court left the final judgment to the American people.
The Debate Goes On . . . and On
I once interviewed an elderly Russian woman who had immigrated to the United States. I asked her what she thought of the US health care system. She said she didn’t like her American doctor. I asked her why not.
“He is nekulturny,” she replied.
“Uncultured?” I suggested.
“Yes,” she said. “My Russian doctor read Balzac. My American doctor has never heard of Balzac.”
“So do you think medicine in Russia is better?” I asked.
She thought about the question for a moment. Finally, she said, “I don’t think so. You see, my American doctor knows where my liver is.”
In 2013, Republican senators shut down the federal government for sixteen days rather than pass a budget that included funding for Obamacare. “If you pay for a budget that includes Obamacare . . . you have voted for Obamacare,” Senator Marco Rubio of Florida announced. “Some will say, ‘That is crazy. You are going to shut down the government over Obamacare.’ No. What is crazy is moving forward with [Obamacare].” By the end of 2015, the House of Representatives had voted more than sixty times to roll back all or part of Obamacare, only to see the votes ignored by the Senate. Finally, at the beginning of 2016, a repeal measure made it through both the House and Senate and reached the president’s desk. President Obama vetoed the repeal within two days. Neither House nor Senate Republicans had the votes to override the president’s veto.
As the law moved toward implementation in 2014, President Obama remained optimistic. “If it works, it will be pretty darn popular,” he said in a New York Times interview. The danger was that not enough young and healthy people would sign up. Without those new customers, the insurance rolls would be overwhelmed by older and sicker Americans who couldn’t get coverage otherwise—and who would drive up costs. And insurance premiums.
The problem was that many healthy young people might opt to pay the penalty—up to 1 percent of their income—rather than purchase insurance, which could be far more costly. After all, young people, particularly young men, believe they are immortal. They might prefer to take their chances with health care and use the cash to buy a car or go to Cancun, Mexico, for spring break.
Former Montana senator Max Baucus, one of the architects of the Affordable Care Act, warned of “a train wreck” if preparations for the new law were inadequate. Meanwhile, Republicans were doing everything they could to derail the train. GOP House members withheld funds for the campaign. Congress provided less money than it did for the rollout of President Bush’s prescription drug program in 2004. That program had a constituency of seniors who were eager to participate.
Republicans were determined to resist. Republican governors were uncooperative. A spokesman for the National Republican Senatorial Committee said Republicans intended to make the 2014 midterm a referendum on Obamacare “in a more tangible way than it was in 2010.” Democrats were worried. Senator Ron Wyden of Oregon said “There is reason to be very concerned about what’s going to happen with young people. If their premiums shoot up, I can tell you, that is going to wash into the United States Senate in a hurry.”
The fate of Obamacare remains uncertain as of November 2017. Congressional Republicans continue to plot strategies to defund the law and eliminate the tax penalty for the uninsured. The Supreme Court continues to hear challenges to the law. For Republicans, opposition to Obamacare has become a defining issue. It’s like antiwar sentiment was for Democrats in 2006. In Iraq, of course, people were being killed. But look at what Minnesota representative Michele Bachmann said about Obamacare: “Let’s repeal this failure before it literally kills women, kills children, kills senior citizens.” Senator Coburn, a physician, said the message to seniors was: “You’re going to die sooner. When you restrict the ability of primary caregivers in this country to do what is best for their senior patients, what you’re doing is limiting their life expectancy.”
The Obama administration estimated that more than fifteen million Americans had gained health insurance by the end of 2015 because of Obamacare. “This thing is working,” the president said. The October 2014 Kaiser poll reported that most Americans wanted Congress to work to improve the law (64 percent) rather than repeal it and replace it with something else (33 percent).12 But conservatives will never agree that Obamacare is working. They’re ideologues, and ideologues believe that if something is wrong, it can’t possibly work. Even if it does work.
Obamacare is supposed to be an entitlement program, like Social Security and Medicare. Both of those programs are universal: everyone who pays into the system is entitled to a benefit whether or not he or she actually needs the money. We bribe the middle class to support entitlements. That’s why they’re so expensive. And so popular.
A social welfare program targets benefits by need. Only people who can show they actually need the benefit get it. Under Obamacare, some people who have to purchase health insurance can’t afford it and have to be subsidized. Those subsidies are being paid for with fines, new taxes, and higher premiums for people who can afford it. That’s a transfer of wealth.
Programs targeted by need have always been controversial. How can we be sure people don’t take advantage of the system? That the benefits go only to the “truly needy”? “I think [Obamacare] is viewed more as a social welfare program than a social insurance program,” longtime Obama adviser David Axelrod told the New York Times.
