We covered the Obamacare story closely here at The American Interest, both in feature-length analyses and in the ongoing daily analysis at Via Meadia, because it seemed to us that the fate of the biggest new social program in at least a generation would be a powerful indicator of where the country was headed—and whether the Democrats had what it took to consolidate their election victories of 2012 to become the dominant political party in the United States.
Unlike some, we never endorsed total war against Obamacare; it was a program that solved some problems, papered others over, and pushed some difficult decisions a bit farther down the road. But it also made some other problems worse, and created a new set of issues that would dog President Obama’s successors. We thought it was likely to fail, and said so from the beginning, but we followed the law with as open a mind as possible.
Obamacare’s success would have been consequential. Not only would it have secured Democratic Congressional majorities (and likely made Donald Trump’s 2016 victory impossible), it would have been a real-time demonstration that the earnest wonks and public-spirited experts who swell the ranks of Democratic supporters had the wit and the wisdom to devise successful new government programs that could really get to terms with the problems of the 21st century.
Obamacare was not a total failure. There are people who have better access to health care now than they did before the law was passed: millions of people. This is not nothing, and meeting the real life, real world needs of these people is not a trivial question. Plenty of die-hard defenders of the law can still be found, arguing gamely that the benefits outweigh the costs.
But regardless, Obamacare has failed in the political sense: it did not generate enough public support to protect itself from its opponents. In the past, Democratic programs have cleared this hurdle: Social Security, after an initial tough period, went on to become sacred in the eyes of most Americans. Medicare, profligate and unsustainable as it unfortunately is, also enjoys powerful political protection from a vigilant body of beneficiaries. Obamacare has not matched these successes; it is defenseless against GOP counterattacks because not enough people fell in love with it.
The consequences for our politics of a failure on this scale are likely to be large. They contributed to the collapse of center-left liberalism in late-Obama America. They helped fuel the Jacksonian surge that lifted Donald Trump to the presidency. Longer term, the failure of Obamacare weakens the credibility of the experts and the wonks, and encourages the populist instinct to declare that the pompous Emperor has no clothes, no matter how many peer-reviewed articles his tailors have published. There is a decline in confidence that the Federal government can devise and implement constructive solutions to complex national problems; there is anger and frustration on both sides of the debate.
Now the GOP faces a test of its own. If not Obamacare, then what? It is not possible to go back to the old system as it existed in 2008; the health care system has changed as patients, doctors, hospitals, pharmaceutical companies and insurers adjusted to the law’s (sometimes sadly perverse) incentives.
As we’ve argued throughout the Age of Obamacare, ultimately there are two problems in American health care: it is too expensive as a national system, and it is too difficult for too many Americans to access its services. This reflects in part the cost of delivering universal health care to a population with many different expectations, wants and needs; it reflects the toxic mix of bad policy and perverse regulation that goes back well before Obamacare; it reflects the problematic nature of linking health insurance to employment in a rapidly changing labor market; it reflects the failure to capitalize on the immense potential of technology to deliver better health care in innovative ways.
This mess was not created overnight, and it cannot be fixed with one law. This is one of those Gordian knots that must be slowly and patiently unpicked.
Slowly and patiently unpicking complex knots is not, sad to say, the strength for which the Congressional GOP is most renowned. There are times when one follows the ups and downs of the internal politics of the GOP, that one almost feels that the party doesn’t know its own mind and lacks the greatness of soul and seriousness of purpose which ought to animate a great national organization at a time of great crisis. But then one contemplates the magisterial sagacity with which House Republicans handle an issue like congressional ethics reform, and those nasty doubts go back to sleep.
The GOP vote to put Obamacare on the path to repeal through the reconciliation procedure—the same ugly method the besotted Democrats used to enact Obamacare in the first place—gives the GOP very little time to enact a reform. This is not quite as risky as it looks, politically speaking; a botched repeal of Obamacare is unlikely to hurt the GOP as much as its botched enactment hurt the Democrats. Attacking the GOP for failing to clean up a Democratic mess doesn’t work as well in the flyover states as blaming the Dems for screwing things up in the first place. Still, the Republicans may soon wish they had taken a slower and steadier path to gradually unpick this particular knot.
In 2009 the Democrats had an even stronger lock on Washington than Republicans do now. They not only held the White House and the House of Representatives; they had a filibuster proof majority of sixty in the Senate, something today’s GOP lacks. The key element of the Democratic selling proposition in that halcyon year was that their competent and cool-headed planning and management could harness the power of the federal government to solve the problems of the American people. They unwisely chose healthcare, among the most tangled and difficult of all the problems that trouble American society, as the lead example of their problem-solving prowess. The result was Obamacare, and its failure to deliver on the promises made in its name, real or perceived, was devastating not only on the healthcare issue but to the whole Democratic case. The failure of Obamacare and the unfolding electoral and cultural consequences of that failure have been the principal driving force in the decline of the Democrats and the rise of the Republicans since 2011.
Today the Republicans have a lock on DC, but neither an Obamacare repeal nor healthcare in general is their key selling proposition. Republicans, after all, are the party that tells us that Washington cannot solve complex problems like healthcare through legislative fiat and regulatory muscle. The GOP equivalent of Obamacare, the issue that will tighten their hold on power if they get it right but sink their ship if they get it wrong isn’t healthcare; it is the economy.
For the GOP, the slogan “Make America Great Again,” says it all. The GOP promises that through some mix (quantities not yet specified) of orthodox laissez-faire policies, unorthodox Trumpism, and full-throated supply side economics they can revive the U.S. economy and give ordinary Americans new grounds for optimism about their personal futures. If the GOP achieves this, even if inequality increases and even if some other problems worsen, and if the average American comes to feel that Washington is on his or her side, then the GOP will be in good shape and the whole political debate will shift in a Trumpian direction.
The GOP had to kill or at any rate to appear to kill Obamacare for the sake of its relations with its base. It will have to grow the economy to the palpable benefit of middle and lower middle class Americans if the party wants to prosper in power. Hopefully, somewhere along the way, the GOP will do something effective about healthcare. Here at The American Interest we will continue to follow healthcare; it is the country’s largest industry, as well as simultaneously our greatest economic problem and our greatest economic opportunity. However, we are in a new era now. Healthcare is no longer the central issue in American politics; economic growth has taken its place.