Every now and then I regret my withdrawal from full time political blogging. It was often a barrel of fun, especially when readers A.I., Bill Fleming, Donald Pay, and a handful of others were also frequent commenters. One of the joys was being proved right, at least about some things on some occasions.
One of the things I was clearly right about was the lack of any honest public thinking in advance of the legislative adventure that became the Affordable Health Care Act. I thought at the time that a serious examination of the American health care system was certainly in order. It should have included a recognition of both its strengths and weaknesses, along with a comparison of our system with both the best and the worst of the systems in other nations. No such thinking occurred.
It’s fair to say that neither Democrats nor Republicans showed much interest in such thinking. The Democrats knew what they wanted (an expanded role for government) and Republicans knew what they didn’t want (anything that the Democrats wanted). However, it was the Democratic Party that held all the cards in the critical period and so it was their responsibility to step back and ask what we needed to do and how we needed to do it.
It is easy to forget that the President initially chose to make the case for health care reform on economic grounds. We needed to “bend the cost curve down” by making the system more efficient. That, however, raised a set of serious questions that were never addressed.
Was the problem that many Americans were being denied basic health care services? If so, then it is not easy to see how we could provide a lot of people with services they had been denied in the past without it costing more money. It was frequently stated that preventive care would save money, but this was based largely on wishful thinking in lieu of evidence and argument. Nor was there any evidence that the basic premise was true. We constantly heard that 30 or 35 or 40 million Americans lacked adequate insurance; but we never heard how many suffered from lack of health care services. There is in fact no good reason to believe that more health insurance would lead to better health.
Was the problem that lack of insurance subjects many people to economic hardship? Again, this was more often stated than argued, let alone supported. If it were true, then fixing it would seem to require more public funding and so hardly seems likely to bend the cost curve down.
It is difficult, in retrospect, to avoid the suspicion that most of the supporters of the ACA knew all along that it would force millions of Americans to pay more for the health care they were getting while surrendering choices concerning their plans, doctors, etc. The ACA was really all about redistributing wealth under the guise of reform. That may be good policy or maybe not, but it was not a policy that the Democratic Party or the President were willing to confess. They may have been hoping to create a large enough client population to sustain the program and their party, in the same way that Social Security and Medicare have done. It is now clear that they didn’t think this through. The disruptions may well be severe for a lot of voters that Democrats have long counted on. It is not at all certain that those who benefit from the reform will be sufficient to support it.
Finally, even if the reform were sustainable (once fully in operation) it still had to be put into operation without it blowing up in our faces. One suspects that someone like Bill Clinton might have been able to pull this off. The current occupant of the White House seems not so much incompetent when it comes to leadership as entirely uninterested in it. We learn from the Washington Post that
The White House systematically delayed enacting a series of rules on the environment, worker safety and health care to prevent them from becoming points of contention before the 2012 election, according to documents and interviews with current and former administration officials.
The Obama Administration has never put anything before the immediate interests of Mr. Obama: not the environment, worker safety, or even the President’s signature piece of legislation. That might not have been fatal if the President had the ability and interest enough to make sure that the actual policy work was done. He doesn’t.
A large part of the blame has to lie with the President’s enablers in the mainstream media. They too systematically delayed the kind of investigative reporting that is now exposing Mr. Obama’s presidency until he was back in for four more years.
The result of all this is a potential disaster for Mr. Obama, his party, and perhaps for the American health care system. His approval rating is now below that of George W. Bush at the same point in his second term. He may recover, of course, but it is not easy to see how. Even if you believe that the ACA can right itself in time (and there is no good reason to believe that right now) it is unlikely to do so before the next two elections have run their course. Meanwhile, the confidence of Americans in their political system has rarely or never been more compromised.
We may all come to rue the day that we entrusted the most important executive office on the planet to a man who had never run so much as a lemonade stand and allowed a Congress to throw our health care system up into the air without any idea what they were doing. I should think that my friends on the left will come to regret it most of all.