What Democrats whine about when they whine about ObamaCare
Leading members of President Obama's party continue to second-guess his health care law. Here's what they get wrong.
Democrats have reacted to crushing losses in November's midterm elections in the usual manner: with a circular firing squad. And one of the targets has been the signature policy of the Obama administration, the Affordable Care Act.
Sen. Chuck Schumer of New York took the lead earlier this month, arguing that it was a mistake for Democrats to pass comprehensive health care reform. Retiring Sen. Tom Harkin (Iowa) has come to the same conclusion for different reasons.
While it's not surprising that this argument has intensified after the midterm bloodbath, it isn't a new one. Massachusetts congressman Barney Frank was saying the same things in 2012, and former White House Chief of Staff Rahm Emmanuel urged Obama to abandon health care reform in 2010, after the election of Scott Brown to the Senate cost Democrats their brief filibuster-proof majority.
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But whether made now or at the time, whether from the left, right, or center, whether driven by policy or pragmatism, all of these arguments have one thing in common: they're dead wrong. Horribly wrong. Wrong about the ACA, wrong about what was possible in 2010, and wrong about American political history in general.
Before analyzing each variation of the claim that Democrats were wrong to pass the ACA, it's important to start with this: the ACA has been a remarkable policy success. It has substantially reduced the number of Americans without health insurance, and in so doing has alleviated a great deal of needless suffering, anxiety, and financial stress. It has slowed the growth in health care costs. And its medley of wonky reforms has improved health outcomes.
Furthermore, had it been allowed to work as intended, rather than having its Medicaid expansion ineptly re-written by the Supreme Court and obstructed by Republican statehouses, the scope of the achievement would be even greater.
The ACA doesn't represent optimal health care policy by any means — to find a better one you need only throw a dart at a map of Western Europe. But it's a success that Democrats should be very proud of, one that can stand alongside the great achievements of the New Deal and the Great Society.
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Arguments that Democrats should not have done health care face a very, very high burden of proof. And they don't even come close.
Democrats should have focused on something else.
This is a recurring theme in the anti-ACA arguments being made by Democrats. Schumer says Democrats should have focused on the "middle class" rather than health care reform, while Frank argued that the Democrats should have emphasized financial reform instead.
The main problem with these arguments is that no alternative course of action would be remotely worth trading for the ACA. As Paul Krugman points out, "focusing" on the economy in and of itself has no value, and Schumer can't point to any concrete policy that would have passed had the Democrats not pursued comprehensive health care reform. There was not going to be a second major round of stimulus no matter what. The Obama administration didn't do nearly enough for underwater homeowners, but this failure was independent of the ACA.
The only alternative policy course that could have arguably been preferable to the ACA would have been legislation addressing climate change. But given the Senate's heavy tilt towards conservative fossil-fuel states, cap-and-trade legislation was always going to be stillborn. The idea that two Democratic senators from North Dakota, two Democratic senators from Montana, Mary "I'm going to my political grave defending the Keystone pipeline" Landrieu, and other relatively conservative Democrats were all going to vote for major climate change legislation is fantastical. In addition, much of what cap-and-trade would have accomplished can be addressed through regulatory action, which is not the case with health care.
Democrats should have waited for a pony.
Harkin's argument is somewhat different — and is superficially more appealing — than Schumer's. Instead of arguing that health care reform was a misguided priority, Harkin argues that the ACA wasn't good enough. "We should have either done it the correct way or not done anything at all," he asserts. Democrats should have tried for "single-payer right from the get go or at least put a public option [which] would have simplified a lot."
This is like saying that Democrats should have gotten "two weeks at the penthouse suite at the Ritz-Carlton in San Francisco…or at least a night at the Motel 6 in Tulsa." It misleadingly conflates two very different policies with two different political possibilities. Single-payer would certainly have been a better policy than the ACA, but it would be hard to get 20 votes for it in the Senate, let alone 60. (It's worth noting that Sen. Bernie Sanders' 2009 single-payer bill had a grand total of zero co-sponsors.)
The question of the public option is more complicated. There are variants of the public option — most obviously a universally available Medicare buy-in — that would have been major reforms, representing a pathway to single-payer. But that is precisely why a robust public option was as DOA in Congress as single-payer itself. The public option in the House bill — which would not have been universally available or cheaper than private alternatives — was small potatoes that would not have made the ACA simpler, more popular, or significantly more progressive. And even so, there almost certainly weren't the votes in the Senate to pass even the neutered version of the public option.
Should the Democrats have just given up then, as Harkin suggests?
No. Let's put this in historical perspective. Harry Truman tried and failed to pass comprehensive health care reform. Lyndon Johnson, in extraordinarily favorable circumstances, failed to pass comprehensive health care reform. Ted Kennedy's efforts under the Nixon administration failed. Bill Clinton's efforts failed. The idea that Democrats will nationalize the health insurance industry the next chance they get is just the purest wishful thinking. And the idea that millions of people should be denied health insurance for such a long-odds gamble is not merely wrong but immoral.
Democrats would have avoided big losses in the midterms.
At the core of these arguments is the fact that the ACA is unpopular, which presumably played a major role in the Democratic Party losing big in the 2010 and 2014 midterms. This argument might be the least convincing of all.
Let's set aside the fact that Democrats held on to the Senate in 2010 and 2012, despite the ACA's unpopularity, as well as the presidency. The argument, at its core, is deeply problematic. It presumes that Democrats should maintain power as an end in itself. But it's not an end in itself — the point of being elected is to do things that benefit your constituents. What's the point of political capital if you don't spend it?
Again, it's worth putting things in historical perspective. The problem with waiting for the perfect, risk-free time to pass major reform legislation is that there's never a perfect time. There have been three major periods of progressive reform legislation in Congress between the Civil War and 2008. (The fact that there have been only three should give pause to those who think that Obama, Reid, and Nancy Pelosi are worthless sellouts because they failed to completely transform the American political economy in Obama's first two years.) In 1966, Great Society Democrats lost 47 seats in the House and three in the Senate, a preview of the crack-up of the Democratic coalition that would (with a detour created by Watergate) lead to the election of Ronald Reagan in 1980. In 1938, New Deal Democrats lost 72 seats in the House and seven in the Senate, and this tally doesn't account for the failure of FDR's efforts to defeat anti-New Deal Democrats in the primaries. In 1874, the Reconstruction-era Republicans lost 93 (out of 293) seats in the House and a net of seven seats in the Senate, effectively ending Reconstruction.
Does this mean that Lyndon Johnson shouldn't have signed the Civil Rights Act? That FDR should have waited until he didn't need Southern segregationists to pass New Deal legislation? That Republicans should have nominated Andrew Johnson rather than Ulysses S. Grant in 1868? Of course not.
The perfect response to these kind of arguments was made by Pelosi: "We come here to do a job, not keep a job. There are more than 14 million reasons why that's wrong." This is exactly right. The window for progressive reform in the United States is always narrow and treacherous — you get the best you can get when you have the chance. The unpopularity of the greatest progressive achievement passed by Congress in nearly five decades is unfortunate, but misguided Monday-morning quarterbacking isn't the right response.
Scott Lemieux is a professor of political science at the College of Saint Rose in Albany, N.Y., with a focus on the Supreme Court and constitutional law. He is a frequent contributor to the American Prospect and blogs for Lawyers, Guns and Money.