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Bill Clinton Chases the ACA Unicorn

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Bill Clinton is making waves with his comments that President Obama should honor his “like it, keep it” promise, even if it means changing the Affordable Care Act. Clinton isn’t only the one saying this: Democrats nervous about the future of the law have been increasingly taking this line over the last week. But Clinton is the most prominent person, besides, arguably, Obama himself, to say it, and Jonathan Cohn has a thoughtful piece at the New Republic about the problem with this position. In brief, Cohn argues that you can’t actually reverse the insurance cancellations without also crippling the law itself. There’s no world in which the ACA could do what it has set out to do—expand access to relatively comprehensive insurance—without disrupting plans people already have.

This is because insurance is a risk-sharing enterprise, and you can’t expand access to high risk people without raising prices on some other sub-set of the population. Forcing young men to have maternity care in their health insurance, for example, helps subsidize that care for women. And you can’t do that unless you eliminate plans that don’t help subsidize that care. More:

Is that a worthwhile tradeoff for reform? Obviously that’s a matter of opinion. The fact that some people—even a small, relatively affluent group—are giving up something they had makes their plight more sympathetic. They are right to say Obama could have made clear his promise might not apply to them. And there’s a principled argument about whether people should be responsible for services they’re unlikely to use presently, whether it’s fifty-something year olds paying for maternity care or twenty-something year olds paying for cardiac stress tests.

But the principle of broad-risk sharing—of the healthy subsidizing the sick, of the young subsidizing the old, and everybody paying for services like pediatrics and maternity care—is one built into the insurance most Americans already have.

Read the whole thing; Cohn is right that Clinton and Obama can’t eliminate the disruption to pre-existing plans without also rolling back the other beneficial effects of the law. That doesn’t mean there isn’t a better way to balance the tradeoffs here, as a truly consumer-directed health care reform would do, but it does mean that as long as the ACA is law, Clinton is asking the near impossible.

But all this ignores the essential problem that is making the rollout such a headache for the administration: this law would never become law if Obama hadn’t made the promises he did. Clinton may misunderstand what’s possible at this point, but he is reacting to more than just the number of people affected. The law has never been popular, and the twin discoveries that the people who pushed it can’t organize a website to make it work and that politically important promises about the law turned out to be wrong will deepen its unpopularity now. It’s almost 100 percent certain that if both the public and the Democrats in Congress had understood the fine print as well as they do now, the ACA would never have passed Congress. Obama could never “have made clear his promise might not apply to [some people]” because if he had been totally transparent and upfront about how the law would work and what it would do, he could never have gotten it passed.

Cohn wants Clinton to stand up and argue that the cancellations are just the expected process of a good law working itself out. But Bill Clinton’s political instincts point him to a different course. Clinton understands what a deep political hole the law is in, even if he doesn’t have a workable fix.

The 2014 election is still a long way away, but many in the MSM seem at this point to be underestimating the danger that the ACA fiasco poses to Democrats in the midterm. It isn’t just that specific ‘promises’ have been broken or that the early rollout has been a fiasco. It is that the differences between the law-as-experienced and the law-as-described are deal-breakers. Without the false impressions about how the law would work, the law would not have been passed. This is the danger that Democrats must address, and it has the potential to be extremely damaging.

Proposals to allow people to keep their plans probably seems like a much needed lifeboat for distressed Democrats. We should expect to see more and more people take the Clinton line as the public becomes aware that the law they’re getting isn’t anything like the law that was pitched to them.

If voters have made some unpleasant discoveries about Obamacare, Democrats are about to have an unpleasant epiphany of their own. Passing Obamacare, Democrats are discovering, wasn’t the end of the national conversation about health care. We are now beginning a conversation about how to fix what is wrong with Obamacare, and in many ways this conversation will make it more difficult, not less, for Democrats to steer health policy in the directions they prefer.


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  • Anthony

    “…The Affordable Care Act seeks to make two sets of changes to what’s called the non group market. It establishes a minimum set of benefits, which means everything from covering essential services to eliminating annual or lifetime limits on payments. At the same time, the law prohibits insurers from discriminating among customers: they can’t charge higher prices, withhold benefits, or deny coverage altogether to people who represent medical risks. They have to take everybody, varying price only for age (within a three-to-one ratio) and for tobacco use.”

    Health care as presently constituted is complicated sector with competing interests as well market contradictions; the question ought to be can comprehensive health care provision be accomplish within market principles inside U.S. and if not how do 300 million plus U.S. citizens acquire said (granting that the citizenry should have access to sufficient medical care) in a most effective way.

    • Andrew Allison

      Exactly. However, I don’t think that comprehensive health care provision can be accomplished within market principles. Every country which provides it does so with public primary (in which everybody is required to participate), and private secondary insurance. Since I also think that Congress is owned lock, stock and barrel by special interests, a non-market solution appears very unlikely.

      • Boritz

        A market solution is completely unacceptable to those who passed this or they would not have.

        • Andrew Allison

          Sorry, but what they did pass was, and is, a market disaster. The only people who will benefit from ACA are insurance companies (who benefit from charging higher premia because of increased coverage), Big Pharma (which benefits from the greatly expanded approved drug list they lobbied for) and the service providers who will have more customers for more covered services. All these goodies will be paid for by the insured and/or the taxpayer.

      • ljgude

        Right on the money Andrew! That is exactly what OECD countries do. Universal healthcare with optional private insurance. In Australia I buy the private Insurance ($2000 a year and I’m 71!) and have access to MDs of my choice and don’t face waiting lists. But if I get injured in an accident I will be taken to the nearest public hospital and get the same treatment as the poorest person. It will cost me nothing. But what I have done in private hospitals is paid for by my insurance company. I honestly don’t know how the US can get from where they are to a better system, but I can tell you the key to Australia’s success is that the public and private systems compliment each other. If private insurance gets too expensive, people drop it and rely on the public system. Likewise if the waiting lists get too long. people start buying private insurance.

  • lord acton

    Oh what a tangled web we weave; when first we practice to deceive………[Sir Walter Scott]

  • S.C. Schwarz

    Clinton understands perfectly well that Obama can’t do what he is suggesting. All he is doing is distancing the Clinton brand, and by extension Hillary, from the Obamacare fiasco in preparation for 2016.

    • Pete


      Slick is merely posturing to position his old battleaxe away fro ObamaCare.

  • Gene

    2 points:

    First, there is no one who is literate and of average intelligence–citizen, politician, journalist, pundit, bureaucrat, you name it–who has an excuse for not knowing the structure and likely effects of this law a long, long time ago. Apathy or short attention spans do not get people off the hook. Irrational fealty to one political tribe or another is something to be ashamed of but not an excuse for not paying attention. And as for the politicians, these SOBs actually VOTED FOR THIS. Please, Reps and Senators, spare us your phony shock.

    Secondly, to build on a point WRM made in the last paragraph, the “national conversation about health care” is now a permanent part of American life. We will be arguing over health care for the rest of our lives. Putting health firmly into the political arena makes it a political football forever. Enjoy!

    • Dexter Scott

      Plenty of Democrats knew this would happen, but they didn’t care. The word you are looking for is “evil” not “apathetic” or “ignorant”.

      • Gene

        I agree with you, but in keeping with the tone of our host–who apparently never gets angry though god knows I don’t understand why, I thought I’d dial it back. I’m also practicing for some conversations I’m likely to have with family members this week.

    • Corlyss

      “We will be arguing over health care for the rest of our lives.”
      I certainly hope not. But if you’re right, it would certainly be consistent with the wags that identified the West and specifically the US as an nursing home with an army. All of this nattering about health care for the last 50 years since medicare went in has been the effort to deal with the Boomer Bow Wave when it achieves old age. The systems were set up to relieve Boomers of having to save for old age and their health care so they could spend spend spend and float the economy to stratospheric heights. Okay. That’s exactly what happened. Now the debris cloud is rocketing to earth, and there’s no serious plan to deal with nations’ necessity to continue the routine business of nationhood.

  • Dexter Scott

    Unusually good liar Bill Clinton thinks successor should tell better lies. Film at 11.

    • tarentius


  • Anthony

    Obama care seems like an old fashioned Rube Goldberg drawing, it’s too complicated for the average person to understand and it might be too complicated to work at all.

    The Nixon administration had a much better idea. Under the Nixon plan, people too poor to buy insurance, or who were not provided it by their employers, would be given money that they could use to buy their own insurance. This would accomplish the goal of providing care for the needy without raising the specter of a
    government takeover over of healthcare. I wonder why the GOP hasn’t adopted this old idea, which was created by one of their own presidents?

    • Corlyss

      But what do you do about the ones who don’t want insurance? Nobody has an answer for them as long as this remains a nation where freedom of choice trumps every other freedom.

  • Jacksonian_Libertarian

    The Democrats own this program, and nothing Clinton says is going to change that fact. It’s also true that Obamacare can’t be changed or reformed without Republican support, and why would they support any change except to get rid of the program. From the Republican point of view, as millions of people lose their insurance and doctors every month, the more damage the Democrats take, and that is on top of the incompetent website, insecure private information, and Obama’s lies. The 2014 midterm elections are looking like they might result in another Shellacking like the historic 2010 midterms, as rage against Washington’s high handed arrogance leads to throwing the bums out.

    • Corlyss

      I would like to think that a smart opposition party would hang Obamacare around the necks of Democratic politicians and set fire to it. The jury is still out on whether the Republicans are smart enough to make something out of this debacle. They have a boat load of crocodile consultants selling them all kinds of tripe about winning Latinos and Asians and blacks and making the tent bigger, crap that’s going to avail them nothing if they pursue that phantasm. What they need to do is get more conservative white voters to the polls, period. It was the white vote Republicans lost last time, not the Latinos and the Asians and the blacks. Those latter voters they never had in the first place and never will have because they cannot match the Santa Claus mentality of the Dems. It’s the white conservatives voters that are dispirited and feeling hopeless in the face of the anti-American Communist onslaught from Washington.

  • Stephen Jenks

    There is no question in my mind that this “reform” is going to harm the Democrats in the next election, and I would argue it may be an absolute political cataclysm for them. The point made by WRM is that the experience of the populace is very different from the basis on which the reform was sold. Let’s review the bidding; 1.) The pitch; Obamacare would increase insured access to healthcare. The reality; it looks likely that more people will lose insurance than will gain it in the initial phase. 2.) The pitch; Obamacare will lower costs across the spectrum.That’s why it’s called the Affordable Care Act. The reality; most insured will see higher premiums and deductibles and/or restricted access. In other words, less healthcare for the dollar. 3.) The pitch; If you like your plan and your doctor, you can keep them period. The reality; you can’t. The American populace will be reasonable in the face of poor results if an honest effort is made to achieve a common good, but the American populace does not forgive or forget being intentionally misled. If the Democrats had been up front when crafting the legislation, it never would have passed. It is now crystal clear that they intentionally, with malice aforethought, defrauded the American populace. I predict they will pay an extremely heavy price for years to come.

    • Fred

      If only you were right. But the American public has the attention span of a gnat. A year from now with this being ignored/buried/spun by the Obamedia, which will be busily pointing out how “extreme” the Republicans are with their “war on women/gays/minorities/whatever”, the morons will behave much as they did in 2008 and 2012.

    • ljgude

      It was pretty clear in 2010 that the electorate was smart enough to spike Obama’s guns by putting a huge Republican majority in the House. And dumb enough to reelect him in 2012. And I can see them electing Hillary in 2016, but I don’t think the Democrats will fare well in 2014 the way things are going for the simple reason that for most Americans the experience they will have over then next year will be one of having less coverage or more expensive coverage or choosing to pay a fine to the IRS. They are going to be grumpy.

  • Corlyss

    “the public becomes aware that the law they’re getting isn’t anything like the law that was pitched to them.”

    It wasn’t THAT hard to figure out. Even a tiny bit of voter diligence would have told them in 2008 that Obama should never have been on the ticket. The idea that they didn’t discover how cold was the comfort of voting for the first black president until their ox was gored is shameful.

  • Corlyss

    “thoughtful piece at the New Republic”

    Gosh! I’m havin’ a devil of a time trying not to think of that phrase as one of the biggest oxymorons I’ve ever come across. The last time New Republic had a thoughtful piece was the last one written by Walter Lippmann

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