[yframe url=’http://www.youtube.com/watch?v=Y9yVy-RXhxQ’]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.[UPDATED]