November 16, 2013
The Three Burials of Obamacare
By ROSS DOUTHAT
THE first time Obamacare seemed finished, doomed, doornail-dead, the voters of Massachusetts played the would-be executioner. In January 2010, they sent a pickup-driving Republican to the Senate to fill Ted Kennedy’s seat, apparently depriving the health care bill of its crucial 60th vote and sending Democrats scrambling for a Plan B.
Except that Plan B turned out to be Plan A, thanks to the maneuverings of Harry Reid and Nancy Pelosi and the surprising stiffness of Democratic spines — and a bill that seemed undone by voter backlash went staggering across the legislative finish line instead.
The second time Obamacare seemed headed for an early grave, it was the conservative justices on the Supreme Court who were was going to see it off, by following through on their oral-argument inclinations and finding the individual mandate unconstitutional.
Except that Chief Justice John Roberts Jr. took the more politically cautious route instead — declining to overturn the mandate even though that’s where his analysis seemed to point, and finding a legal via media that kept the health care law limping toward implementation.
Now we’ve reached Obamacare’s third near-death experience, and if the law actually goes down this time there will be a lot of fingerprints on the murder weapon: Kathleen Sebelius and her hapless crew of Internet engineers; the voters infuriated at being thrown from their existing coverage into the not-really-working exchanges; panicking Congressional Democrats and gleeful Congressional Republicans; the media, long favorably disposed to the project but now scenting second-term blood; and of course the president himself, whose “noble lie” that everyone could keep their coverage has made the backlash that much worse.
But the deeper force at work, the reason that these near-death experiences keep happening, isn’t a website or a broken presidential promise. It’s a problem inherent to contemporary liberalism, which is that liberals’ proudest achievement, the modern welfare state, tends to resist, corrupt and baffle their efforts at comprehensive reform.
This was the message of Jonathan Rauch’s book “Government’s End,” which was first published in the Clinton era, and which I’ve recommended before as essential to understanding liberalism’s struggles in the Obama years. Because our government spends and regulates so much, Rauch argued, because its influence sprawls into so many walks of life, because so many clients and beneficiaries and interest groups depend on its programs and policies, the policy status quo is far harder to dislodge today than it was during the Progressive Era or the New Deal or the Great Society.
This status quo bias is structural rather than ideological; it frustrates limited-government conservatives as well as liberal technocrats. But the frustration has been much more acute and ironic for Democrats, who find themselves handcuffed by the very achievements they aspire to emulate, and attacked by the beneficiaries of yesterday’s liberal programs when they attempt to propose programs for tomorrow.
Up to a point, these are realities the Obama White House seemed to grasp, which is why they’ve gotten further with health care reform than Bill Clinton did in 1993. From a political perspective, both the complexity of Obamacare’s interlocking mandates, subsidies and regulations and the disingenuous promises that accompanied its passage were arguably design features rather than bugs — intended to buy off, to appease, to burden-spread and cost-conceal and generally reassure everyone just long enough to get the system up and running.
But the White House’s cleverness had inevitable limits, which is why the law keeps facing backlash in fresh places, and why the media keep getting the chance to prepare Obamacare’ obituaries. And what’s going on right now, the convergence of the website’s technical problems with the backlash surrounding canceled plans, reveals the perils of trying to outsmart the political system’s status quo bias. Your strategy can end up so intricate and deceptive, and your policy so complex and jerry-built, that something as basic as a malfunctioning website can suffice to bring the whole policy crashing down.
The welfare state’s ability to defend itself against reform, however, carries a cautionary message for Obamacare’s critics as well. What isn’t killed outright grows stronger the longer it’s embedded in the federal apparatus, gaining constituents and interest-group support just by virtue of its existence even if it doesn’t work out the way it was designed. And as disastrous as its launch has been, if the health care law can survive this crisis in the same limping, staggering way it survived Scott Brown and the Supremes, then it will be a big step closer to being part of the status quo, with all the privileges and political strength that entails.
So yes — it’s possible that this brush with death will be fatal, possible that the law will fall with the lightest, most politically painless push. But it’s still likely that Obamacare will be undone only if its critics are willing to do something more painful, and take their own turn wrestling with a system that resists any kind of change.