The eighteenth century, which gave us the concept that we really could figure out the world, all on our own, by careful observation and then thinking about what we saw and then more observation, and which also gave us the new United States with its amazing Constitution, setting out just how we could actually govern ourselves without a king or a pope or any of that nonsense, was also an age of skepticism. The Age of Enlightenment, with the invention of what we now call the scientific method – test that hypothesis, damn it, and prove it’s so – was also the golden age of satire. At the beginning of the century, Jonathan Swift was the guy poking fun at those who took themselves far too serious – the Jon Stewart of his day – but he was merely the first. In 1759, Voltaire gave us Candide, ou l’Optimisme – where the young man, Candide, is told by his mentor, Pangloss, that we do live in the best of all possible worlds – just look around. Candide buys it, and then learns otherwise, rather comically.
The lesson was simple. The world is just the world, for better or worse, and you can figure out how most everything works, sooner or later, but you may not marvel at its perfection. We are, after all, well on our way to figuring out exactly how cancer works, but that doesn’t make cancer any nicer. And you may come up with new and amazing ways to do this and that, but that doesn’t make them perfect. There are no perfect alternatives. There may be no best alternatives, just any number of less-worse alternative ways of doing things – like the form of democracy we have here now, as Winston Churchill said, the worst form of government ever devised, and far better than any other ever devised. It’ll do – and there are ways of talking about this. Don’t let the perfect become the enemy of the good, and a neat turn of phrase attributed to far too many wise men – the optimist believes that we live in the best of all worlds, while the pessimist fears this is so. It hardly matters just who first said that, it’s just healthy skepticism. This may be as good as it gets – so deal with it. Nothing’s perfect. Ask Candide – he eventually decided it was best to “cultivate his own garden” and not worry about such things.
This is what makes the current discussion of Obamacare so frustrating. It’s like we’re all in that Voltaire satire again, with the left hoping their healthcare alternative is perfect, while knowing it’s far from that, and everyone on the right mocking the thing, because it’s not perfect, when we were told, so they say, that it would solve everything. How hard is it to set up a damned website, after all? Voltaire, if he were not long dead, would sigh and point out, in French, that it’s more complicated than that – it always is. Optimism is stupid, and so is pessimism. Do what you can, even if it’s somehow unsatisfying. Cultivate your garden.
This wasn’t going to be perfect anyway, because of the sabotage. That’s what the Washington Post’s Amy Goldstein and Juliet Eilperin finally report here – that most of the so-called flaws in Obamacare had nothing to do with the president’s lack of attention, or his focus, or anything like that:
On the balmy Sunday evening of March 21, 2010 – hours after the bill had been enacted – the president had stood on the Truman Balcony for a champagne toast with his weary staff and put them on notice: They needed to get started on carrying out the law the very next morning. It was not ready even though, for months beginning last spring, the president emphasized the exchange’s central importance during regular staff meetings to monitor progress. No matter which aspects of the sprawling law had been that day’s focus, the official said, Obama invariably ended the meeting the same way: “All of that is well and good, but if the Web site doesn’t work, nothing else matters.”
He knew, but Goldstein and Eilperin also report that healthcare.gov “was hampered by the White House’s political sensitivity to Republican hatred of the law, sensitivity so intense that the president’s aides ordered that some work be slowed down or remain secret for fear of feeding the opposition.”
That odd’s – don’t let the other guys know how hard you’re working on this, because its hard and if it looks too easy they’ll jump on you for that too – but Andrew Sprung sees the logic here:
The dominant charge in the incompetence indictment is that political considerations drove policy. But in this case, the “political considerations” consisted of sidestepping sabotage or trying to avoid providing new fodder for it. Perhaps in some cases, fear of taking propaganda hits should not have trumped operational considerations. But that’s easy to charge in hindsight. And the “political” considerations – evading sabotage – were in service of getting the law implemented well. …
It seems clear to me that Obama should have drilled deeper into the administrative structure of the website-building project. Charges that the tech project did not have the right leadership or management structure seem well founded. Perhaps the responsibility for failing to find that leadership can be laid at the doorstep of DeParle, or Lambrew, or Sebelius, or Obama, or all of the above. But the decisions that Goldstein and Eilperin detail are not on their faces irrational. The damage done to the law and to the country by Republican sabotage, on the other hand, is unmistakable.
That’s a little convoluted, but Goldstein and Eilperin also report this:
The move had a political rationale, as well. Tucked within a large bureaucracy, some administration officials believed, the new Center for Consumer Information and Insurance Oversight would be better insulated from the efforts of House Republicans, who were looking for ways to undermine the law. But the most basic reason was financial: Although the statute provided plenty of money to help states build their own insurance exchanges, it included no money for the development of a federal exchange – and Republicans would block any funding attempts. According to one former administration official, Sebelius simply could not scrounge together enough money to keep a group of people developing the exchanges working directly under her.
Kevin Drum pounces on that:
Now, one obvious question is why the law failed to finance the federal exchanges. That was pretty clearly a mistake. Still, under normal circumstances, even an opposition party would end up cutting a deal eventually to shore up the missing funding. Not this time, though. As one White House official told the Post, “You’re basically trying to build a complicated building in a war zone, because the Republicans are lobbing bombs at us.”
There are plenty of other examples of this, and Sprung outlines them in his post today. No federal program that I can remember faced quite the implacable hostility during its implementation that Obamacare has faced.
This excuses neither the Obama administration’s poor decisions nor its timidity in the face of Republican attacks, but it certainly puts them in the proper perspective.
No federal program that he can remember faced quite the implacable hostility during its implementation that Obamacare has faced? Does Kevin Drum have a poor memory? Michael Tomasky offers some parallels:
Has there ever been a law in the history of the country as aggressively resisted by the political opposition as this? Republicans didn’t do this with Social Security. Most of them voted for Social Security. They didn’t do it with Medicare. They, and the Southern racists who were then Democrats, didn’t do it with civil rights. There was a fair amount of on-the-ground opposition to that, but it wasn’t orchestrated at the national level like this was. And when the Voting Rights Act was passed the year after the Civil Rights Act, Southern states in fact fell in line quickly. Check the black voter-registration figures from Southern states in 1964 versus 1966. It’s pretty amazing.
No, to find obstinacy like this, you have to go back, yes, to the pre-Civil War era – the tariff of 1828, the Kansas-Nebraska Act, which led to the civil war in “Bloody Kansas” and ultimately to the Civil War itself.
That’s a bit terrifying, and historically accurate. That might make one a pessimist, were it not that pessimism is stupid too, except when it’s appropriate. We haven’t seen these tactics since the days just before the Civil War.
There was another sort of sabotage too, of a more subtle kind, from the insurance companies, and that is explained in a long investigative piece from Dylan Scott at Talking Points Memo:
Across the country, insurance companies have sent misleading letters to consumers, trying to lock them into the companies’ own, sometimes more expensive health insurance plans rather than let them shop for insurance and tax credits on the Obamacare marketplaces – which could lead to people spending thousands more for insurance than the law intended. In some cases, mentions of the marketplace in those letters are relegated to a mere footnote, which can be easily overlooked.
The extreme lengths to which some insurance companies are going to hold on to existing customers at higher price, as the Affordable Care Act fundamentally re-orders the individual insurance market, has caught the attention of state insurance regulators.
The insurance companies argue that it’s simply capitalism at work. But regulators don’t see it that way. By warning customers that their health insurance plans are being canceled as a result of Obamacare and urging them to secure new insurance plans before Obamacare launched on Oct. 1, these insurers put their customers at risk of enrolling in plans that were not as good or as affordable as what they could buy on the marketplaces.
That’s the gist of it, and Scott begins by telling the story of a woman named Donna who got one of these letters:
The letter made no mention of the health insurance marketplace that would soon open in Washington, where she could shop for competitive plans and only an oblique reference to financial help that she might qualify for, if she made the effort to call and find out.
Otherwise, she’d be automatically rolled over to a new plan – and, as the letter said, “If you’re happy with this plan, do nothing.”
If Donna had done nothing, she would have ended up spending about $1,000 more a month for insurance than she will now that she went to the marketplace, picked the best plan for her family and accessed tax credits at the heart of the health care reform law.
“The info that we were sent by LifeWise was totally bogus. Why the heck did they try to screw us?” Donna said. “People who are afraid of the ACA should be much more afraid of the insurance companies who will exploit their fear and end up overcharging them.”
Donna is not alone.
The rest fills in the details, and it’s not pretty – insurance executives telling state regulators that there had been “a major disconnect” between the marketing and government compliance arms of their companies and such things, saying they were sorry about that and laughing all the way to the bank. Nothing’s perfect, but with the Obama crowd being too careful and the Republicans cutting off critical funding and all the rest, and the insurance companies’ deceit about the real options available to their policyholders, not much was actually possible. Obama wasn’t Pangloss, saying Obamacare was the best of all possible worlds, but he probably was depressed that what happened was the best that could be done, and it was failing. This may have been the only possible thing that could have happened, given the players involved.
After all, Rupert Murdoch’s Wall Street Journal jumped in with this piece – a tale of outrage and despair – “I had great cancer doctors and health insurance. My plan was cancelled. Now I worry how long I’ll live.”
The right was all over this, citing it again and again. It’s the story of a cancer survivor named Edie Littlefield Sundby, whose insurer, United Healthcare, is about to end her coverage, and pull out of the individual market, and thus direct Sundby into an exchange where she’ll have new coverage and a new physician. The piece blames the White House and the Affordable Care Act for ending her “world-class health plan” – and the new meme is that Obama is effectively delivering a “death sentence” to this woman who’s fought stage-4 gallbladder cancer for years. It’s not much different from the Death Panel stuff that Sarah Palin came up with, actually.
It’s not that simple. In this case, Sundby isn’t being sentenced to death because of Obamacare – she’s in a bit of a bind because her insurer made a business decision, as Igor Volsky carefully explains – United Healthcare dropped her plan because it’s “struggled to compete in California’s individual health care market for years and didn’t want to pay for sicker patients like Sundby.”
Why would they? United Healthcare, which only had eight thousand individual policy holders in California out of the two million who participate in the market, announced that it would be pulling out of the individual market in May. A second insurer, Aetna, is pulling out too. Neither company could compete with Anthem Blue Cross, Blue Shield of California and Kaiser Permanente, who control more than eighty percent of the individual market – so they chose to make their money elsewhere and later:
“The company’s plans reflect its concern that the first wave of newly insured customers under the law may be the costliest,” [United Healthcare] Chief Executive Officer Stephen Helmsley told investors last October.
Everyone on the right might want to blame the president, or the Democrats, or the law itself, but Volsky sees it this way – “The company packed its bags and dumped its beneficiaries because it wants its competitors to swallow the first wave of sicker enrollees only to re-enter the market later and profit from the healthy people who still haven’t signed up for coverage.”
That makes sense, good business sense, and Edie Littlefield Sundby got left behind. It’s just business, and as Dylan Scott reported, sometimes that’s in the form of letters to scare people into staying with their quite expensive current policies, without mentioning the alternatives. Either way, it’s all about making a buck, and sometimes people die. There’s no reason a free-market no-regulation Republican should object to any of this, but they do. Go figure.
It’s odd, as Kaiser polled the public on how they now feel about Obamacare – and far more people want to keep it or expand it than want to repeal it. Something is amiss, and Josh Barro points out here that only twenty-nine percent of Republicans favor replacing Obamacare with a Republican alternative to it, if there even were such a thing:
Republicans spent the last two election cycles hammering Democrats for cutting Medicare. Now they are hammering the president for not letting everyone keep their old plans if they like them. The de-facto Republican health policy platform is a defense of the pre-Obamacare status quo, period, and Republican base voters are with them.
That’s the plan, but Jonathan Bernstein suggests they’re dreaming:
No one is ever going to kick young adults off their parents’ insurance (or change the law so that insurance companies are allowed to do it). No one is going to bring back the various limitations in pre-ACA insurance policies. Some trimming of the new Medicaid rolls might be possible. But no one – no politician who has to face reelection, at least – is going to just toss all those people off their insurance with nothing to replace it.
Beyond all this is simply the Humpty Dumpty-ness of the situation: The old system has been slowly pushed off the wall for three years now, and by this point it’s really beyond repair, whatever the merits or politics of the situation.
Sometimes there’s no good option, and sometimes there’s no option at all, although Ed Kilgore wonders about that:
I won’t go as far as Jonathan and say that the idea of repealing Obamacare is “dead.” His recitation of what no politician with a brain would do reminds me a lot of all those confident predictions (not by him, but by many others) that no state political leadership would be stupid or benighted or ideological enough to turn down the Medicaid expansion. And there’s also the possibility that Republicans, if they were in a position to do so, would repeal Obamacare and then quickly re-enact some of the easier and more popular provisions, like the provision allowing young adults to stay on their parents’ policies.
But yes, it’s true, the more Obamacare puts paid to the old system, the harder it would be, mechanically, to resurrect it. So Republicans had better get it in gear in designing and agreeing upon a “replacement” agenda for health care, even if they know in their hearts it will be wildly unpopular in practice.
Or, as an alternative, they could cultivate their own garden and be done with Obamacare. They could bring up Benghazi again, or the IRS scandal, or new proof that Obama was born in Kenya – or they could raise vegetables.
Nope, no vegetables. The Los Angeles Times covers and participates in what follows the Republicans giving up on Obamacare, a shift to a far more serious issue, which is President Obama’s poor management style:
A year after his reelection triumph, President Obama is facing an awkward question from friends and foes alike: Why can’t he run the government as well as he ran his campaign?
What with the IRS targeting of tea party groups; the poor security at the U.S. mission in Benghazi, Libya; the eavesdropping on close allies; and the botched rollout of the landmark healthcare law, Obama increasingly seems to be battling top-level management failures as much as policy or political problems.
On each of these controversies, Obama has claimed ignorance before the fact and outrage afterward, leaving even some Democrats to see him as asleep at the wheel.
Here, Kevin Dum is not impressed:
Oh please. The IRS didn’t target tea party groups, and eavesdropping on close allies wasn’t a result of poor management. It was a deliberate policy choice. Benghazi does indeed seem to have exposed some weak management practices, but let’s be honest: they were the kinds of things that are routinely found in every audit ever done of a government agency.
In any case, you’re really stretching things if the best you can do is find one example from over a year ago to help make your case. The plain truth is that Obama’s management style is about as good as any other president’s. Obamacare obviously shows him at his worst, but it doesn’t demonstrate some kind of cosmic management deficiency.
Nothing is perfect, even what seems perfect:
As for Obama’s campaign prowess, that’s easily explained. First, compared to rolling out Obamacare, a presidential campaign is a small, uncomplicated operation – and it’s one that can be run dictatorially without regard for federal purchasing and bidding rules. Second, who says it was it all that great? As near as I can tell, it was run perfectly well, but it’s not as if it was a model of campaign efficiency. It was just an ordinary well-run campaign. The fact that Obama won – thanks mostly to improving economic fundamentals and a poor opponent – doesn’t really change that.
That sounds familiar. Candide is told by his mentor, Pangloss, that we live in the best of all possible worlds – just look around. Candide buys it, and then learns otherwise – here he learns that Obama is just a moderately competent guy – but the whole thing was a satire. There are no perfect alternatives. There may be no best alternatives, just any number of less-worse alternative ways of doing things – all of which beats doing nothing, as with Obamacare. We do live in the best of all possible worlds, ironically enough, because this is the only possible world. It’ll have to do. That’s what Voltaire was getting at.