There’s something verging on unseemly in the glee so many journalists have taken in the disastrous rollout of the Affordable Care Act and in the incontrovertible fact that the Obama administration knowingly misled the American people about “keeping your plan”. Magazine covers! Feuds! Late night comedians! Pursed-lipped statements of disappointment! The “breakdown” of the ACA has made analysts bold: “The Collapse of the Obama Presidency“,“Why Obama’s ‘iPod Presidency’ Was Doomed“, “the entire presidency is riding” on the exchanges, the promise that “you can keep your plan” is (quoting Rush Limbaugh here) “the biggest lie ever told by a siting president.” Most people do not understand the ins and outs of the ACA. Most journalists don’t understand it, either – and the clearest proof of that is that Obama shouldn’t have been able to get away with the blanket language that he did. He was called on it, by Politifact, Factcheck.org and ABC in particular. Instructively, the fact-checking organizations found that the statement was at least “half true”, and ABC allowed that the line “isn’t literally true” and that Obama acknowledged in a press conference that it would be impossible for the government to entirely prevent changes to everyone’s plan. It has never been a secret that there would be Americans whose coverage would change under the ACA, that some would face higher prices or, as they correctly surmise, “better” coverage is in the lead of the Washington Post story about the bill’s passage.
All those accusations about how “Obama knew there would be cancellations and still lied about it”? Yes, the administration knew. But so did any reporter that read the press releases put out be the Department of Health and Human Services. To be sure, that language favored the interpretation the administration still prefers: that policy holders would have to “transition” to “ACA-compliant” plans. But there was no subterfuge about the fact of change.
Most Americans, I’m sure, still feel they were lied to. Obama’s deception will cost him and the Democratic party goodwill moving forward, and in the short term, he will face even more resistance in moving along any substantial policies. (One can reasonably ask if that’s enough of a price, given that it’s no different than the situation he was facing before.) But the American people have been lied to before. A lot. This is not a trait they associate with Democrats or Republicans. It is one they associate with politicians. This experience will sour them on Obama, but they were already pretty sour on the system. That said, there is little evidence that people’s feelings about politicians sour them on their legislative legacies, if those policies are working. Plenty of Tea Party voters are happy with the interstate highway system. President Nixon gave us Title IX educational benefits. And, more to the point given its problems in implementation, Medicare Part D came from President Bush II. And unlike a lot of legislation, especially legislation designed to address social ills, there is a definite metric, or just a few of them, that will tell us if the ACA has done the job it was intended to do: whether more Americans will have health insurance after its full implementation than those who did in 2009. I already know the answer to this question, and so does everyone covering the story: more Americans already have health insurance today, because of the expansions to government programs that were a part of the ACA’s initial phase: about 2m more people, to be exact. The highest estimate for those who will receive cancellation notices I’ve seen is 16m (which is probably too high). Before the ACA, there were 50m Americans without any form of insurance. That 16m estimate will include people who get better, cheaper plans. It will include people who get more expensive, better plans. It will also include people who decide to pay the fine. But if the majority of them wind up with healthcare coverage, it will still be a preferable result to the state of the system prior to ACA. Most people who don’t have health insurance want it – only 1.5% of the uninsured say they don’t have it because they “don’t need” it. Even the “young invincibles” you hear so much about want insurance, 80% of them. The GOP will have to run a lot of “don’t enroll in Obamacare!” ads to keep pace. The sob-stories flogged by conservative and non-partisan outlets alike have already proven, when investigated, to be more complicated than “Obamacare took away my healthcare” headlines would have you believe. (See , here, and here, to start.) Any story on health insurance under ACA is going to be complicated, that’s one of the law’s many flaws: there’s a lot of moving parts to keep track of. That jerry-rigged system of subsidies, exchanges, expanded programs and penalties is one of the reasons the website crashed. Plenty of carpers bemoaned the government not bringing in better programmers and designers to work on HealthCare.gov, but the truth is that the best information architects would have seen the potential problems and could have offered an elegant solution: a government program for all that would eliminate the need for any website at all. There’s been much ink and venom spilt on the irony of our “tech president” presiding over a logistical and logical failure, but I sympathize with Obama. I think he did see all these problems coming. He’s a smart guy. The biggest big lie he’s told about Obamacare is that he actually believes it’s a better idea than single-payer.