Assessing the Nightmare

August 8, 1974, ended in a hot muggy night in upstate New York, and the rental truck was cooling and clicking in the driveway – grad school down south, a bit of a nightmare at times, was over, and the first teaching job started in a few weeks, after setting up the new home. It was a time of transition, but that night it was a quiet dinner on the porch with the in-laws, at the quiet family farm. No one said much. Their daughter was home again, but things were changing. They always do, so it seemed best to watch the evening news. That’s less personal and never all that exciting, but that night Nixon announced his resignation – he’d be gone the next day at noon. It seems many things were changing. We’d have a new president, Gerald Ford, who no one voted for at all, because the vice president people had voted for, Spiro Agnew, had pleaded “no contest” to bribery and tax evasion charges, from when he had been governor of Maryland. He had to leave, and we really did need a vice president. Nixon suggested Ford, and Congress was okay with the former college football star congressman who smoked a pipe and seemed a good guy, for a change. Ford would do, but no one expected this. It was an odd moment in American history.

Gerald Ford knew this, and in his remarks after he took the oath of office the next day, he did his best to frame what had just happened after the Watergate scandal, with key players on the president’s team indicted for this and that and then the articles of impeachment, and him of all people somehow ending up as president, as not a transition to something new, but as a return to how things should have been all along – “My fellow Americans, our long national nightmare is over. Our Constitution works; our great Republic is a government of laws and not of men. Here the people rule.”

Yeah, but the people never elected him, did they? Still, the system worked, if we have a government of laws and not of men. No one gets to ignore the law. Those unhappy with the situation can say a particular law is stupid, but if it was passed by both houses of Congress, and signed into law by the sitting president, and if the Supreme Court, asked to rule on its constitutionality, says it just fine, then there’s no choice but to accept it as the law.

That wasn’t precisely the case with Nixon, who wasn’t opposed to any one new law but rather a whole array of existing laws, but it is the case with Republicans and the Affordable Care Act. Republicans didn’t have the votes to stop the thing from passing in 2010. They didn’t have the votes to repeal it in 2011. They didn’t have the votes to win the presidency and the Senate by campaigning against it in 2012, explicitly. The law was passed fair and square, long ago, by both houses of Congress, and survived a Supreme Court challenge too – and the Roberts court is perhaps the most conservative we’ve had since the Harding administration.

There’s not much to work with there. The rules of the system were followed, scrupulously, and there are explicit rules for repealing a law. You find the votes to pass something else in its place. If you don’t have the votes, you don’t have the votes. Those are in the Republican-controlled House, not in any other part of the government, and one half of one third of the government doesn’t get to stop what the majority enacted and courts blessed, even if they can threaten to shut down the government, crippling the economy, which they did, or force the United States into default, collapsing the world’s economy for a generation or two, which they came close to doing at least twice – both matters entirely unrelated to what they scornfully called Obamacare. They tried to get rid of this law, and gave us four years of nightmare politics. They hated Obamacare. The government should have nothing to do with something as important as healthcare, as the government always screws up anything it attempts – and the second George Bush proved that, conclusively. The free market, if totally unregulated, never screws up – as we all found out when all those worthless mortgages were repackaged and resold and things were wonderful.

No, wait – they’re not using those examples, but they were arguing that what they know in their bones, as men (and women), matters more than the law. The argument is that we should be a government of intense righteous men, not stupid established laws. It’s a Nixonian argument, that the actual law doesn’t really matter all that much, and we’re still waiting for our Gerald Ford to tell us that this particular national nightmare is over.

We may not need that pleasant man with the pipe, however. No one needs to explain anything. The nightmare ended all on its own, not with intense righteous men scuttling the law, but with a burst of enthusiasm for it:

The first six-month window for Americans to gain health insurance under the Affordable Care Act closed on Monday with large numbers of consumers speeding to get coverage at the last minute. Some of them encountered obstacles as HealthCare.gov, the main enrollment Web site, faltered on and off throughout the day.

Union halls, shopping-mall kiosks and insurance company lobbies across the country were jammed with people racing to get insurance on the final day before the law required most Americans to choose health insurance or risk a financial penalty.

“It’s like going into the mall on Christmas Eve,” said Brian Lobley, senior vice president of Independence Blue Cross, which set up a “Countdown to Coverage” with extra desks and phone lines in the usually empty lobby of its headquarters four blocks from city hall in Philadelphia’s Center City. Employees whose jobs have nothing to do with sales were pressed into service, and customers were triaged as they walked in, with priority given to people who had not even begun to shop for insurance before Monday.

In Los Angeles, the local affiliate of the Service Employees International Union began an enroll-athon at 5 a.m. and, by the end of the day, had attracted more than 700 people to a lively scene with food trucks, music and more than 50 staffers and volunteers.

People don’t hate the law at all, or Obama for managing to get this unwieldy almost-universal and sort of standardized but free-market Frankenstein of a thing passed, although it was cliffhanger:

By the time President Obama appeared Monday on “The CBS Evening News,” he sounded relieved. “We admittedly had just a terrible start because the Web site wasn’t working,” Obama said, referring to the site’s rocky beginnings. “But given how gloomy I think everybody’s assessment was back in the middle of November, I’d say that we’re on our way to making sure that no American ever has to go without health care.”

There is the evidence:

By Monday evening, federal officials could not say how many people had signed up. But health officials said that by 8 p.m., 1 million people had phoned in to a network of call centers across the country – nearly a half-million more than the total for any other day since the federal insurance marketplace and 14 similar state ones opened on Oct. 1. And 3 million had visited HealthCare.gov, they said.

Late in the day, more than 150,000 people were on the Web site, and the volume stayed at that level through much of the evening, according to a person familiar with the numbers.

The outpouring of last-minute interest reinforced arguments by the Obama administration and its allies, made since the law was enacted four years ago, that it would become popular once Americans had a chance to get the new health plans that it spawned – and, in most cases, with federal subsidies to help pay for them.

Sure, the website faltered and stalled a few times, but that was due to the flood of traffic, which Republicans said would never happen, because everyone hated the law, and they were already irate that this “lawless” president had decided to let people who hadn’t quite finished their applications have a few more days, beyond the official deadline, to finish up.

Jonathan Cohn at the New Republic explores their dilemma:

As of the latest official update, last week, more than 6 million people had selected a private insurance plan through one of Obamacare’s new state marketplaces. But that was before a weekend of huge traffic to healthcare.gov and state-run websites, record call volume to telephone help centers, and queues outside outreach offices in California and even Texas. Charles Gaba, the Michigan-based analyst who runs the website ACASignups.net, now projects that 6.72 million people will sign up for private insurance by the time open enrollment ends.

Even accounting for the fact that some of these people won’t actually pay their premiums, these figures would seem to undermine – or at least weaken – the argument that Obamacare is a catastrophic failure. Republicans and many of their allies obviously think otherwise. They are doing what they almost always do when data confounds their previously held beliefs. They are challenging the statistics – primarily, by suggesting that most of the people getting insurance already had coverage. Some, like Senator John Barrasso of Wyoming, say the administration is “cooking the books.” Others, like Senator Ted Cruz, say that the number of people without insurance is actually rising.

Cohn notes that really is nonsense:

Conservatives making these arguments typically cite the same evidence that Cruz did in his interview: Surveys by McKinsey and Company suggesting that most of the people buying insurance on their own already had coverage. In February, McKinsey said only 14 percent of people buying coverage had no insurance previously; in March, McKinsey said the proportion had increased, but only to 27 percent. That certainly sounds disappointing.

But McKinsey’s survey included everybody buying individual coverage – in other words, people buying through the new marketplaces and people buying directly from insurers. And nobody would expect many of the latter to be among the previously uninsured. Instead, it’s mostly people who had coverage that carriers canceled, because the old policies didn’t comply with Obamacare regulations or because the old policies simply weren’t profitable anymore. News organizations like Politifact have pointed this out. Analysts like Gaba have pointed this out. Even McKinsey itself has pointed this out. That hasn’t stopped conservatives from citing the figures.

Hey, it’s what they do, but it’s still nonsense, and the Los Angeles Times checks with everyone’s favorite think tank down by the Santa Monica Pier out here:

A February survey by consulting firm McKinsey & Co. found 27% of new enrollees were previously uninsured, but newer survey data from the nonprofit Rand Corp. and reports from marketplace officials in several states suggest that share increased in March.

At least 4.5 million previously uninsured adults have signed up for state Medicaid programs, according to Rand’s unpublished survey data, which were shared with The Times. That tracks with estimates from Avalere Health, a consulting firm that is closely following the law’s implementation.

An additional 3 million young adults have gained coverage in recent years through a provision of the law that enables dependent children to remain on their parents’ health plans until they turn 26, according to national health insurance surveys from the federal Centers for Disease Control and Prevention.

About 9 million people have bought health plans directly from insurers, instead of using the marketplaces, Rand found. The vast majority of these people were previously insured.

Fewer than a million people who had health plans in 2013 are now uninsured because their plans were canceled for not meeting new standards set by the law, the Rand survey indicates.

Republican critics of the law have suggested that the cancellations last fall have led to a net reduction in coverage.

That is not supported by survey data or insurance companies, many of which report they have retained the vast majority of their 2013 customers by renewing old policies, which is permitted in about half the states, or by moving customers to new plans. “We are talking about a very small fraction of the country” who lost coverage said Katherine Carman, a Rand economist who is overseeing the survey.

Face it – at least 9.5 million previously uninsured people have gotten health insurance since Obamacare started, so it’s not failing and people don’t hate it, and Kevin Drum sees the writing on the wall:

It’s something that nearly everyone has neglected in the frenzy to figure out what’s happening right now. Here it is: the world doesn’t stop in 2014. Enrollment of around 6 million makes Obamacare hard to repeal, but for now that’s not really what’s holding it in place. What’s holding it in place is the fact that Democrats control the Senate and Barack Obama occupies the White House. And even if the Senate switches parties next year, I think we can all agree that Obamacare is going nowhere as long as Obama stays president. So 2017 is the earliest it could even plausibly be repealed.

Drum then looks at the latest CBO estimates and sees this:

By 2017, a total of 36 million Americans will be covered by Obamacare. Of that, 24 million will have private coverage via the exchanges and 12 million will be covered by Medicaid. Those are very big numbers. Even if Republicans improbably manage to get complete control of the government in the 2016 election and eliminate the filibuster so Democrats can’t object, they’ll still have to contend with this.

Does this make Obamacare invulnerable? Of course not. Nothing makes it invulnerable. It’s always possible, though it seems vanishingly unlikely at this point, that it will fail so badly that even Democrats sour on it in a couple of years. It’s also possible that Republican hostility will remain so furious that they just flatly don’t care about 36 million constituents. And maybe they won’t care that the healthcare industry is fully invested in Obamacare and will fight efforts to get rid of it.

Anything is possible. But when you talk about the chances of repealing Obamacare, you should be talking about 2017.

And Jed Lewison adds this:

For the first time since ABC News and Washington Post started polling on public support for Obamacare, the law has more support than opposition. According to their newest survey, conducted nationally from March 26-30 among American adults with a margin of error of ±3.5 points, 49 percent of the country supports Obamacare and 48 percent opposes it.

The numbers aren’t decisive, but they represent a major improvement since November, when problems with the HealthCare.gov website were severe. At that time, just 40 percent supported the law and 57 percent opposed it. Now that gap has shifted by a net margin of 19 points – in favor of the law. Democrats are particularly enthusiastic about the law, with 76 percent now supporting it.

That’s bad news for Republicans, as is this:

It’s worth noting that this poll had two glaring problems. One is that it didn’t ask opponents of the law why they oppose it. As CNN’s polling has repeatedly shown, many Obamacare opponents don’t think it is progressive enough.

The poll also asked a nonsensical question about whether people supported “efforts by Republicans in Congress to replace the new health care law.” A plurality, 49 percent, said no, compared with 47 percent who said yes, but given that there is not a Republican plan to replace Obamacare, it’s an absurd question to ask. The only thing Republicans have ever voted to replace Obamacare with is nothing, which means the only sensible question to ask is about repeal, since that’s the only thing Republicans have actually supported in any concrete form.

Yeah, there’s that, and it’s getting embarrassing:

Fox News host Jenna Lee on Monday repeatedly asked Sen. Lindsey Graham (R-SC) about the GOP’s alternative plan to Obamacare, but the senator did not lay out any specific proposal.

When Lee first asked Graham what his plan for health care reform would look like, he listed a few ideas, such as not denying coverage to those with pre-existing conditions, letting young adults stay on their parents’ insurance and allowing consumers buy plans from out-of-state exchanges. The first two proposals are already stipulated in the law, however.

Later in the interview, Lee pressed Graham on the Republican plan again.

“Why do you think that Republicans can put together a better plan to get the trust back in government? What are Republicans putting out there that says to the American people, ‘No, you can trust us?’” she asked.

“I think the first thing we’ve got to explain to the public is the Democrats who want to fix Obamacare have a political problem,” Graham responded.

Lee interrupted Graham as he continued to answer.

“Why hasn’t a full proposal of a completely different plan from the GOP been developed, put out to the press for us to look at and really dig into?” she asked.

He had no answer, and muttered a few likely things, but this Fox News woman wouldn’t be put off, and got him to admit the Republicans blew it:

“I think we should have an outline of a health care plan that would be better for America,” he said. “But between now and then, our Democratic friends are trying to sell the American people, ‘You can fix this Obamacare.’ It can’t be fixed. It’s got to be torn down, and start over.”

And what about those thirty-six million constituents who will soon be using Obamacare as a way to buy health insurance, and the insurance industry that depends on them, as paying customers, customers that the government will subsidize, making sure cash comes in? It not only seems a little late to tear it all down, that also seems like a way to guarantee a lot of newly insured voters, and the insurance companies, will be your enemies.

Lindsey Graham knows better. His party knows better. Fox News is trying to help them out – please, please, please don’t make all those enemies – come up with something, anything – but the Republicans aren’t getting it. Everyone hates Obamacare, right?

No, that nightmare is over. The Affordable Care Act became law in 2010 – the matter was settled then, and Paul Waldman lays out the post-nightmare world:

We should mark this day, because barring some kind of unforeseen catastrophe, it’s the last time the ACA will be the lead story everywhere in the media.

Of course, there will be another open enrollment deadline every year, and new insurance policies taking effect every January 1. But today is the last of the law’s key dates, when everyone’s attention turns to it. We had the dreadful opening of healthcare.gov (and the state exchanges) on October 1st, then on January 1st the last round of key provisions took effect, and today open enrollment concludes. And that’s the end of major ACA news events.

That isn’t to say there won’t be more ACA news in the coming months and years, but it won’t all blow in at once. Later this year, insurers will begin to set their premiums for 2015; those premiums will rise, just as they do every year, but the big question is by how much. Starting in the fall, people will begin signing up for insurance that takes effect next January, and the number who do so will be important to track the law’s success in continuing to reduce the ranks of the uninsured. At least some states that have held out on expanding Medicaid will likely give in and allow their poor citizens to get insurance. How the health care system handles all these newly insured people, many of whom have medical issues that they haven’t sought treatment for before, is yet to be seen. Those will all be important stories that deserve attention. But none of them will produce screaming headlines.

It’s time to move on:

Republicans are the only group of voters that wants repeal – but Republican lawmakers will keep telling their base what it wants to hear. As long as that base is motivated by hatred of the law (and its symbolic value for them as a representation of Barack Obama himself) at least some will keep shaking their fists at it and talking about repeal. And every positive development will be met with assertions that it can’t possibly be true.

Journalists will continue to discuss enrollment numbers as stragglers come in – for a few days or weeks. But before long, political reporters who have been paying attention to health care will go back to their usual beats, and only the wonky health care reporters will continue to discuss the details of the ACA. Sure, Republicans may be able to use the law to get their own voters to the polls this fall, and that is significant, but I’m skeptical it will matter all that much to swing voters. By now, they aren’t going to change how they think about this law, and the opportunity to shift opinions is receding in the rear view mirror. Voters want to move on to other issues.

And thus our long national nightmare has ended. We are a nation of laws, not men, after all. Every now and then we figure that out, even if Gerald Ford isn’t around anymore to explain how things should have been all along. Some things are just obvious. Back on that muggy evening on the farm in upstate New York in 1974, the moment Nixon’s sweating face with the beady eyes was on the little television screen, and he was resigning, it was obvious that nightmare was ending. And this one just ended, and the ghost of Gerald Ford wrote all the words here.

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About Alan

The editor is a former systems manager for a large California-based HMO, and a former senior systems manager for Northrop, Hughes-Raytheon, Computer Sciences Corporation, Perot Systems and other such organizations. One position was managing the financial and payroll systems for a large hospital chain. And somewhere in there was a two-year stint in Canada running the systems shop at a General Motors locomotive factory - in London, Ontario. That explains Canadian matters scattered through these pages. Otherwise, think large-scale HR, payroll, financial and manufacturing systems. A résumé is available if you wish. The editor has a graduate degree in Eighteenth-Century British Literature from Duke University where he was a National Woodrow Wilson Fellow, and taught English and music in upstate New York in the seventies, and then in the early eighties moved to California and left teaching. The editor currently resides in Hollywood California, a block north of the Sunset Strip.
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One Response to Assessing the Nightmare

  1. Rick says:

    As for Jerry Ford becoming Nixon’s Vice President, I’ve always been pretty sure the bipartisan powers-that-be in Washington back then worked together behind the scenes to make sure Spiro Agnew himself was out of there before Nixon either resigned or was impeached, which by then seemed pretty likely. After all, you think President Nixon was a problem? Try “President Agnew”! To this day, I’m surprised we haven’t heard any details of something like that happening.

    I’m not sure there’s anything I have to say about Obamacare that I haven’t already said, including that, for their part, the Democrats have Obamacare — something they reluctantly settled on instead of their real preference, which is Medicare-for-all — and for their part, the Republicans are afraid to admit that they prefer the way things were before the bill became law.

    Yes, it’s still fun to watch Republicans like Lindsey Graham try to song-and-dance their position whenever someone asks them what they would replace Obamacare with. You’d think the fact that they keep coming up with nothing might hurt them politically, but maybe the reason it doesn’t is because the people who already vote for them aren’t looking for answers anyway, especially if it means coming up with some other damn “program” of some kind, which is precisely what they don’t want.

    But what I will say is, if repealing Obamacare — as relatively ineffectual as that turned out to be — now ceases to be a political issue, I shudder to think what those people will find to take its place.

    Rick

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