I chose not to argue that Obamacare was going to collapse and be repealed in its entirety, but rather, that Obamacare would not, and could not, be the program that had been promised or intended. It had already failed to deliver on key promises for coverage, affordability and of course, the infamous promise that “if you like your doctor, you can keep your doctor.” It was also dangerously unstable, requiring steady executive intervention just to keep the program from collapsing. I argued that these executive interventions, enthusiastically supported by the law’s proponents, were setting a precedent that would eventually be used against it. Worried that health care was too hostage to the vicissitudes of the markets, Democrats had instead made it the prisoner of politics.
“Essentially they’ve made it so that Republicans can undo two-thirds of this law with a stroke of the presidential pen,” I said at the close of my opening statement. “Obamacare is now beyond rescue. The administration has destroyed their own law in order to save it.” Four years later, we are watching those dominos fall.
Remember how we ended up with the particular version of Obamacare that became law. Democrats had 60 votes in the Senate, and a growing sense that they were on the verge of a second New Deal. They thought they didn’t need Republicans, and they thought they couldn’t get Republicans, so they made little effort to involve Republicans in drafting, beyond offering token concessions to a handful of liberal Republicans who might have made nice bipartisan window-dressing at the signing ceremony. Republicans, predictably, spent a year talking down the bill, and by the time it was nearing passage, a majority of the public opposed it.
Then Massachusetts — Massachusetts! — sent Republican Scott Brown to Ted Kennedy’s old Senate seat, a phenomenon that was widely (and in my view correctly) put down to a desire to block Obamacare. Rather than saying “if we’ve lost Massachusetts, we’ve lost America,” Democrats rushed a draft version of the bill into law through a parliamentary procedure that obviated the need for Brown’s vote.
This draft bill, unsurprisingly, had problems. It also overhauled almost a fifth of the economy. It also had the implacable hostility of the opposition, and a public that was pretty angry at politicians for passing it. By the end of the year, Democrats had lost control of Congress, and with it, any hope of making all the changes they’d fantasized after they passed the bill and found out what was (and wasn’t) in it.
That put Obama in the nasty situation of presiding over a program that couldn’t work as written, and couldn’t be legislatively altered. So he proceeded with the only avenue open to him: dubious executive measures that temporarily shored up the program, but weakened even further the slim foundation of political legitimacy that held it up. And here we are seven years later, watching as one by one, those supports sway or snap.
And thanks in part to the voter revolt that Obamacare triggered, those powers have now been handed over to a president who doesn’t simply take political legitimacy for granted, but seems actively hostile to it. The scramble to pass and sustain Obama’s signature initiative may have badly hurt the cause: to make the health-care system fairer, broader and more efficient.
If Obamacare dies now, in this way, the country will be worse off than if it had never passed. And I’m not just talking about the growing notion among both parties that the idea of elections is to get into power and exercise whatever power you can, by whatever means you can get away with, until voters take your toys away again.
In the worst-case scenario, large swathes of the country will have “bare” individual markets where everyone will be magnificently equal in their inability to purchase insurance. And the memory of Obamacare staggering onward for years, down a trail of broken promises and underwhelming results, will make voters reluctant to trust any politician who suggests that we embark on another such journey.
Is Obamacare beyond rescue? If not, it could certainly use some. And at this point, it’s hard to see who is going to swoop in to save the day.