You don’t have to be an unqualified fan of the Affordable Care Act to recognize the lunacy of most Republican objections to it. From “death panels” to “a loss of liberty,” there’s only one consistent through-line to most of their objections: They come from Republicans, they’re directed at a Democratic president, and they’re irrational.
The president’s self-imposed deadline for fixing the website has arrived and, while it’s still far from perfect, the complaints are likely to become broader once again. The Republicans may not realize it, but that way lies danger.
More than once, Democrats have made the mistake of taking victory laps for a plan with very real problems. But the Republicans are setting traps for themselves – traps they may find it difficult to escape, especially if Democrats are shrewd enough to take advantage of them.
This shortsightedness already wounded them once, in the 2012 election, when candidate Mitt Romney was forced to attack a program that was nearly identical to the one that Gov. Mitt Romney implemented in Massachusetts. It looked absurd – because it was. Romney’s campaign was probably always a lost cause, but that didn’t help.
For the Republicans, there’s more where that came from.
The trouble starts with their gleeful rubbing of hands over the Healthcare.gov rollout. Gloating about the website is unwise for a couple of reasons. First, the website’s design and implementation was conducted by a private government contractor, CGI Global, not by government employees. There are many lessons to be learned from the website’s problems, but one of them clearly seems to be this: The privatization of government services, a key goal for the Republican Party, can work very poorly.
Accounts of the Obamacare implementation read like a how-to manual in inept contracting with outside corporations, and the administration deserves to take a hit for that. But the problem isn’t that government created the website. A larger part of the problem lies in the fact that it used a private contractor to do the job.
Worse, the administration chose to use a company whose specialty was not healthcare administration but “government contracting.” The fact that this is now an industry of its own, and one with enormous growth, shows just how far the privatization trend has come on the federal level.
That’s a problem. Professional government contractors know how to game the government procurement system for maximum profits, and those profit margins are added to the cost for taxpayers.
CGI Global, the all-purpose government contractor that handled the website, is a case in point. Even though the Obama administration has made a point of saying government should end no-bid contracts, this project – the most important of Obama’s presidency – was offered on a no-bid contract.
As someone who once led a company that contracted with government agencies, I can tell you that somebody “worked the system” extremely well on this one. Unfortunately, the “system” works much better for the contractors than it does for the public. Every time Republicans crow about the website’s problems, another thought should be implanting itself in the public’s mind: privatizing government services is a very bad idea.
The challenge for Republicans runs even deeper than that. They’ve been mocking the very concept behind the Obamacare exchanges. It’s a concept that made the rollout extremely difficult. The idea was that government would create an electronic “marketplace” where people could comparison-shop for health insurance. This, we were told, would keep costs down by employing market forces and competition.
This also happens to be an excellent way to describe the Republicans’ plan for Medicare. The description is still up at Rep. Paul Ryan’s website:
Beginning in 2024, for those workers born in 1959 or later, Medicare would offer them a choice of private plans competing alongside traditional fee-for-service option (sic) on a newly created Medicare Exchange (emphasis ours) … The Medicare Exchange would provide all seniors with a competitive marketplace where they could chose a plan the same way members of Congress do.
Every time the Republicans tell horror stories or make fun of the ACA’s exchange, they’re telling people that their own plan for Medicare is going to turn the most popular, cost-effective and successful health plan in the country into a tragedy – or a joke.
They’re also sabotaging their own arguments for privatizing Social Security. The plan that George W. Bush proposed in 2005 called upon the government to administer a portfolio of private investment plans on behalf of retirees. There’s still talk of reviving this GOP proposal. Rep. Paul Ryan, leading House Republican and 2012 vice-presidential candidate, continues to push a privatization scheme that even the Bush administration described as “irresponsible.”
As Obamacare goes, so goes the Social Security privatization plan.
There’s a reason why their negative characterizations of Obamacare match their own proposals so closely. As many people know, the Affordable Care Act began its life as a right-wing proposal meant to blunt the drive toward healthcare reform during the Clinton administration. Republicans loved the idea back then. They loved it when Gov. Arnold Schwarzenegger proposed something similar in California. And they loved it when future presidential candidate Mitt Romney implemented it in Massachusetts.
That’s why they’re in such a trap now. Their attacks have already trashed the credibility of the Heritage Foundation, which was a principal architect of the plan back in the Clinton years. The Heritage Foundation’s Robert Moffit brought ridicule on himself and his organization when he wrote that the ACA’s individual mandate was “an Unconstitutional Violation of Personal Liberty” that “Strikes at the Heart of American Federalism,” adding that “It is an assertion of federal power that is inherently at odds with the original vision of the Framers.”
In fact, most experts agree that the idea of the individual mandate originated with the Heritage Foundation itself in a 1989 paper that proposed that the government “mandate all households to obtain adequate insurance.” The paper by Stuart M. Butler argues that:
Many states now require passengers to wear seatbelts for their own protection. Many others require anybody driving a car to have liability insurance. But neither the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious injury or illness.
The paper continues, “Under the Heritage plan, there would be such a requirement.” And in case there is still any doubt about whose plan contains this individual mandate proposal, the section of the document containing these words is titled “The Heritage Plan.”
Then there’s the issue on which Republicans have scored most heavily against President Obama, the matter of that infamous promise: “If you like your plan, you can keep it.” The president probably should have phrased that sentence like this: “If you like your plan you can keep it, unless it’s really terrible and affords you very little protection from the cost of serious illness or injury.”
But he didn’t say that. He said what he said, and what he said wasn’t true. Republicans have been having a field day, but even here they need to be careful. People don’t “like” the plans that were initially canceled under the ACA. Those plans are lousy. What they “like” are the low premiums. Insurance plans are complicated and difficult to understand, but premium payments are in-your-face simple. Either you can afford them or you can’t.
So the Republicans have scored on this one. People were upset that plans they felt they could afford were being replaced with costlier ones. That was and is a legitimate issue. Some of us believe that the ACA expects people to pay too much for dubious private-sector health insurance. As a result of the controversy, people with these substandard plans can keep them, thanks to the Republicans (and to quite a few Democrats who crossed the aisle to vote with them).
But when some of the people with these plans find themselves going bankrupt – something that can happen even with “good” coverage – they may start looking for someone to blame. People like the “free market” in theory, but they’re much less fond of it when they find they’ve been ripped off.
Unfortunately for the Democrats, this is a knife that cuts both ways. Their defenses of the ACA hold political peril for them, too. If they defend the exchanges too strenuously, they run the risk of making an argument for Paul Ryan’s Medicare voucher plan. If they agree that the overall implementation plan was a good idea, they are implicitly endorsing the privatization of government services.
The president walked into that trap in his now-famous apology, when he said, “I know that the federal government has not been good at this stuff in the past.”
Actually, the federal government has accomplished impressive things with a whole array of technology projects, from the atomic energy breakthroughs of the 1940s to the space program of the 1960s -- and beyond. The effectiveness of government has also been demonstrated time and time again in programs like Medicare and Social Security – programs that are far more popular than private health insurance companies can ever hope to become.
The success of government is the Democratic Party’s calling card. The president and other Democrats tarnish it at their own peril, especially at a time when the Republicans are proving so effective at undercutting their own ideas and arguments.