{"id":113734,"date":"2021-02-21T15:48:54","date_gmt":"2021-02-21T15:48:54","guid":{"rendered":"https:\/\/precoinnews.com\/?p=113734"},"modified":"2021-02-21T15:48:54","modified_gmt":"2021-02-21T15:48:54","slug":"what-democrats-can-learn-from-obamacare-according-to-barack-obama","status":"publish","type":"post","link":"https:\/\/precoinnews.com\/politics\/what-democrats-can-learn-from-obamacare-according-to-barack-obama\/","title":{"rendered":"What Democrats Can Learn From Obamacare, According To Barack Obama"},"content":{"rendered":"

The following is adapted from Jonathan Cohn\u2019s \u201cThe Ten Year War: Obamacare and the Unfinished Crusade for Universal Coverage<\/span><\/em>,\u201d to be published by St. Martin\u2019s Press on February 23. <\/span><\/em><\/p>\n

Everybody is talking about how Democrats need to avoid the traps that ensnared them during former President Barack Obama\u2019s first term, when they repeatedly got bogged down in bipartisan negotiations, made all sorts of substantive concessions on policy, and still got virtually no GOP support for their initiatives.\u00a0<\/span><\/p>\n

Not so long ago, I got to interview an expert on the matter: President Obama himself.<\/span><\/p>\n

Our conversation took place in early March 2020, well before anyone knew\u00a0Joe Biden\u00a0would win the nomination and become president this year, or that Democrats would also have full control of Congress, or that the overwhelming political priority would be dealing with COVID-19. And strictly speaking, the interview with Obama wasn\u2019t about how Democrats should govern. The subject was the Affordable Care Act, for a new\u00a0book about the law\u2019s history that is coming out on Tuesday.\u00a0\u00a0<\/span><\/p>\n

But the conversation covered a lot more than health care policy, because it\u2019s impossible to talk about the 2010 law without talking about the ways politics have been changing in the past decade, and how those changes affected what Democrats were and weren\u2019t able to do. In many ways, the saga of the Affordable Care Act is a case study in the challenges that progressives must overcome if they want to pass ambitious legislation \u2015 challenges facing Democrats now just as surely as they did during Obama\u2019s tenure.<\/span><\/p>\n

The Democrats today have one advantage, though. They can learn from the past. And when I asked Obama to reflect on what he and the Affordable Care Act\u2019s architects got wrong, he cited a failure to grasp the depth and duration of GOP opposition.<\/p>\n

\u201cI think what we got wrong was underestimating the degree to which political polarization had \u2015 the degree to which political polarization meant that the issue was never settled,\u201d the former president said, adding later, \u201cI think any progressive president, on any issue for the next several years, is going to have to confront the problem that the GOP has shifted into a perpetual campaign mode.\u201d\u00a0<\/p>\n

Obama\u2019s focus on Republican opposition and its effects may sound self-serving to some people \u2015 whether it\u2019s conservatives who blame Obama for polarizing the country, or progressives who think Obama is trying to avoid blame for compromises he should never have made. Reasonable people can certainly question individual decisions that Obama, along with other Democratic leaders, made at various points in the Affordable Care Act\u2019s history.<\/span><\/p>\n

But the transformation of the Republicans into a more ideologically and temperamentally extreme party <\/span>really has changed American politics in profound ways, and Democrats really do need to adapt to that transformation if they want to succeed.\u00a0That means paying attention to what went wrong with the Affordable Care Act \u2015 although, to be clear, it also means recognizing what went right. And Obama has some ideas about that too.<\/p>\n

A Blueprint For Compromise<\/h3>\n

The conversation with Obama, inside an office building not far from the White House, lasted for nearly an hour. He looked more relaxed than I\u2019d ever seen him. He was wearing a black, open-collar shirt, casual dark gray pants and loafers \u2015 and, as he gleefully pointed out, no socks. \u201cThe best part of not being president anymore,\u201d he said of his attire. But he talked like he always did, with that deliberate, professorial cadence and sentences full of dependent clauses in order to capture every last nuance.<\/span><\/p>\n

The timing seemed fortuitous because it was right before the 10-year anniversary of the Affordable Care Act\u2019s signing, a milestone he planned to mark by attending a conference and celebration at American University nearby. Then the pandemic hit, forcing it to be canceled, which felt somehow appropriate given that the law continues to inspire mixed feelings. Approval of the program is higher than in the past,\u00a0according to polls, but it\u2019s still lower than cherished programs like Medicare and Social Security.<\/span><\/p>\n

Some of that is due to\u00a0polarization, with Obamacare popular among Democratic voters and unpopular among Republicans for reasons that probably have little to do with anything but partisan loyalty. But performance is still an issue. Many millions still can\u2019t pay their medical bills, because they don\u2019t have insurance or their insurance covers too little. The U.S. still has the world\u2019s most confusing and expensive system, with little evidence that the extra money buys better quality.<\/span><\/p>\n

Not that the Affordable Care Act\u2019s architects thought they were fixing all of the health care system\u2019s problems. After nearly a century of\u00a0failed attempts\u00a0at passing universal coverage, most recently during\u00a0Bill Clinton\u2019s presidency, Democrats were determined to find a more politically viable path. By around 2006 or so, a consensus had taken shape around a plan that leaned heavily on private insurance and minimized disruption of existing arrangements, and a strategy that stressed negotiating with the health care industry rather than fighting it.<\/p>\n

It was a far cry from the government-run insurance plan that Harry Truman once championed, but Democratic leaders embraced it as the best they could get \u2015 and so did Obama, who repeated in our interview his belief that something like a government-run, \u201csingle-payer\u201d system would probably work best, but creating one right away would be too difficult.\u00a0<\/span><\/p>\n

\u201cWe have a legacy system that is one-sixth of the economy,\u201d Obama said. \u201cThe idea that you could, in some way, dismantle that entire system \u2015 or even transition it entirely \u2015 to a single payer system looked politically impractical and probably really disruptive. … The best chance to actually get people healthier was going to be to design a system that acknowledged 85% of the American people have health insurance and that plugged the gap for those 15% who don\u2019t.\u201d<\/span><\/p>\n

The concept was notional until April 2006, when a state-level reform fitting those criteria became law in Massachusetts, with the signature of a Republican governor (Mitt Romney) and support of some conservative intellectuals (at the Heritage Foundation). It was proof of concept for the Democrats \u2015 including Obama, who, while putting together his campaign health plan, was already thinking about what might get GOP votes.<\/span><\/p>\n

\u201cI was never under an illusion that we would get majority Republican support,\u201d Obama said. \u201cBut it was my belief that a law signed by Mitt Romney, and that could be traced back to ideas that had appeared in the Heritage Foundation literature, would give some political cover to those Republicans who were so inclined to vote for it.\u201d<\/span><\/p>\n

\u201cObviously,\u201d Obama said, \u201cthat did not prove to be the case.\u201d<\/span><\/p>\n

Opposition As The Republican Brand<\/h3>\n

No, it did not \u2014 although, contrary to what some Republicans say now, it was not for Democrats\u2019 lack of effort. In addition to believing in bipartisanship as a virtue, Obama could count votes, especially in the Senate, where a small-state bias gave conservative states disproportionate power \u2015 and where the filibuster was becoming a de facto, 60-vote requirement for all legislation.<\/span><\/p>\n

Among the many political realities of 2009 frequently forgotten today are that Democrats had only 58 Senate seats for the first few months, because of litigation over Minnesota\u2019s close Senate race (eventually Democrat Al Franken won the seat) and because Pennsylvania Sen. Alan Specter was still a Republican (eventually he switched parties).\u00a0<\/span><\/p>\n

Ending the filibuster wasn\u2019t on the political agenda in the way it is now. And Democratic leaders rejected the idea of using the budget reconciliation process, where they wouldn\u2019t have to worry about the filibuster, in part because they thought its complex parliamentary rules would prohibit essential parts of the proposal, turning legislation into \u201cSwiss cheese.\u201d<\/span><\/p>\n

Behind a belief in the necessity of bipartisanship was a faith that it was possible \u2015 a notion that didn\u2019t seem as preposterous then as it does now.\u00a0<\/span><\/p>\n

Lawmakers from both parties had collaborated in the late 1990s to create a new program for insuring children. The senators who led that effort were Orrin Hatch, the conservative Republican from Utah, and Ted Kennedy, the liberal Democrat from Massachusetts. At one point in 2008, a former Kennedy aide told me, Hatch dispatched his advisers to see if the two could work together on a universal coverage bill.<\/span><\/p>\n

Another possible GOP partner was Iowa Sen. Charles Grassley, who had worked closely with the top ranking Democrat on the Finance Committee, Montana\u2019s Max Baucus, on the\u00a0Medicare drug program\u00a0under President George W. Bush.\u00a0They had a close relationship and, at a private meeting of several senators that Baucus convened just after the election in 2008, Grassley said, \u201cI haven\u2019t heard anything here I don\u2019t like \u2026 I can\u2019t think of an issue that isn\u2019t compromise-able,\u201d according to the notes one participant took.<\/p>\n

But even if Hatch and Grassley were truly interested in bipartisanship, they did not speak for their party or for leadership, which from the beginning urged members to oppose Obama\u2019s agenda fully \u2015 as Mitch McConnell, who was (and is again) the Senate minority leader, later admitted. All of this happened at a time when the GOP was also becoming more ideologically extreme, with conservatives displacing the remaining moderates.<\/span><\/p>\n

By the middle of 2009, Jim DeMint, the arch-conservative South Carolina Republican who had riled up Tea Party activists by promising that defeating reform would be Obama\u2019s \u201cWaterloo,\u201d was setting the tone on health care. Grassley, facing the threat of a conservative primary challenge, started talking about \u201cdeath panels\u201d at events back home. And in a meeting Obama later described in his memoir, the Iowa senator told the former president there was no concession that would win his vote.\u00a0<\/span><\/p>\n

The Leverage Of Conservative Democrats<\/h3>\n

The ultimate futility of courting Republicans \u2014 so memorable today \u2014 is one of many grievances more progressive Democrats still hold over Obama\u2019s handling of the health care law. And in the popular imagination, it is the main reason Obama made so many key compromises, like dropping a \u201cpublic option\u201d \u2014 the idea of a government-run insurance plan that would offer a more efficient, more patient-friendly alternative to private insurance.\u00a0<\/span><\/p>\n

But here too it is easy to forget another reality of 2009 politics, one still very relevant today: The big pressure to compromise came from conservative Democrats who had leverage to kill legislation if they wanted. In the Senate, this was a function of the same small-state bias that gave Republicans outsized power, and as a practical matter, it meant that Democratic leaders were constantly trying to satisfy senators from places like Arkansas and Nebraska where voters were especially suspicious of big new federal programs and prone to believing conservative propaganda about what proposed legislation would do.<\/span><\/p>\n

Those conservative Democrats were the ones who were dead set against the public option. They were the ones who kept pushing to give state officials more power over the program. They were the ones most anxious over new spending. And those decisions had consequences later, when the law took effect. Among other things, it meant less financial assistance for some middle-class Americans buying insurance.<\/span><\/p>\n

Whether Obama could have pushed conservative Democrats harder, or picked different places to give ground, remains a source of disagreement between him and some of his liberal allies even today. What\u2019s not in dispute is that Obama always realized the law would need more work. That\u2019s why he talked about it as a \u201cstarter home,\u201d with the expectation that it would be possible to bolster and expand the program over time, through a series of legislative and administrative fixes.\u00a0<\/span><\/p>\n

But that chance never came, because Republicans focused on repeal and, at times, trying to sabotage the program outright. \u201cThink about Medicare,\u201d Obama said. \u201cThat was a big political fight, but once it got passed, everybody moved on and tried to make it work. Bush\u2019s drug benefit program, right? It was a contentious issue. But once it got passed, even those Democrats who had opposed it tried to make it work.\u201d<\/span><\/p>\n

In our interview, Obama still seemed taken aback that Republican state officials were refusing to expand Medicaid eligibility, as the Affordable Care Act envisioned, even though the federal government had committed to covering most of the cost and literally millions of low-income Americans scattered across states like Florida, Georgia and Texas stood to get insurance.<\/span><\/p>\n

\u201cWhat I did not see, for example, was Republican governors refusing [federal] Medicaid dollars that would provide health insurance to millions of their people,\u201d Obama said. \u201cWe\u2019ve never seen in American history a situation in which state governments reject benefits for their people purely on ideological grounds.\u201d<\/span><\/p>\n

Fixing The Senate \u2015 And Democracy<\/span><\/h3>\n

Near the end of the conversation, I thought back to something Obama said at the March 2010 signing ceremony: \u201cWe are a nation that faces its challenges and accepts its responsibilities. We are a nation that does what is hard. What is necessary.\u201d Had the difficulty passing and implementing Obamacare shaken that faith?\u00a0<\/span><\/p>\n

\u201cNo,\u201d he said quickly, \u201cbecause it passed, and 20 million people got health insurance, and it\u2019s still there.\u201c Then he paused, opened his eyes a bit wider, and started up again: \u201cBut I think what it does reveal is some major structural problems in our current political system that make it much harder to do big things than it used to be.\u201d\u00a0<\/span><\/p>\n

One of those structural problems, he said, is that \u201cthe conservative media universe operates in an entirely different universe,\u201d less tethered to reality. Another, he said, is the makeup U.S. Senate, where the small-state bias gives lawmakers representing a small portion of the population the ability to block legislation \u2015 and to escape accountability for doing so.<\/span><\/p>\n

\u201cYou can have something that 70% of the country wants and it can\u2019t pass,\u201d Obama said. \u201cAnd that can\u2019t be how any democracy functions over time. If you ask me what has contributed to the cynicism \u2015 of government, and to some degree what contributed to the cynicism around the health care initiative \u2015 it\u2019s the fact that a small minority of people can put a halt to everything.\u201d<\/span><\/p>\n

Eliminating the filibuster would mitigate, although not eliminate, the small-state bias \u2015 and Obama said that \u201cmay\u201d be necessary. When I pressed to see if he\u2019d endorse the idea more clearly, he said, \u201cThat\u2019s a longer argument and discussion to have.\u201d\u00a0(Several months later, at the funeral of Democratic Rep. John Lewis of Georgia, Obama offered\u00a0a stronger endorsement\u00a0for ending the 60-vote requirement, though he was specifically speaking about voting rights legislation.) <\/span><\/p>\n

Obama also said future Democrats need to make different policy design decisions. Specifically, he said, they should expect no more cooperation for implementing their reforms than he got for the Affordable Care Act \u2015 although, he warned, without such cooperation, making government programs work is bound to be a lot more difficult:<\/span><\/p>\n

\u201cYou get the program started, you figure out what the kinks are, what works, what doesn\u2019t. You amend, build, improve, refine \u2015 that kind of iterative process, where you\u2019ve set a goal and gotten the foundations laid, and then Congress in a cooperative fashion works to keep making it better. That process, which is very beneficial because you\u2019re getting real data and feedback about what\u2019s working and what\u2019s not \u2015 that\u2019s less available to you now. The process that built Social Security, built Medicaid, Medicare, that only works if you got both parties working in good faith.\u201d<\/span><\/p>\n

Hard Things Are Hard; Better Is Good<\/h3>\n

The awareness of structural problems in American politics, starting with the Senate, already feels stronger than it did a year ago, when Obama said all of these things to me. And the approach Democrats are taking to their COVID-19 relief bill suggests they are learning to adapt. Party leaders decided early on to use budget reconciliation, so they can pass something with 50 votes in the Senate; Republican support would be nice, they said, but they\u2019re not going to hold up legislation for it.\u00a0<\/span><\/p>\n

But reconciliation isn\u2019t a cure-all for the Senate\u2019s structural problems, especially given the strict, quirky rules about what provisions can even pass through that process. And at least for the moment, ending or even reforming the filibuster seems to be off the table. <\/span><\/p>\n

A big reason for that is the same one that checked liberal ambitions in 2009: the resistance of more conservative Democrats. Already two of them, West Virginia\u2019s Joe Manchin and Arizona\u2019s Kyrsten Sinema, have said they would oppose eliminating the filibuster. They\u2019ve also expressed skepticism about ideas high on the progressive agenda, like raising the minimum wage to $15 an hour.\u00a0<\/span>\u00a0<\/p>\n

<\/p>\n

They could change their minds of course. And the pressure to enact these policies could build, thanks to a progressive movement that is already louder and more organized around goals than it was during Obama\u2019s presidency. But even if Democrats succeed at reducing structural barriers to change, and even if a progressive movement succeeds in demanding more action, legislation is likely to be full of compromises and fall short of Democrats\u2019 loftiest goals, just like the Affordable Care Act did.\u00a0<\/span><\/p>\n

Those kinds of compromises are frequently deflating. That doesn\u2019t mean they should be, and the Affordable Care Act is an example of why. It still achieved a lot \u2015 more, in fact, than even many liberals seem to grasp. It\u2019s already transformed the political conversation on health care, so that the principles of universal coverage now have wide acceptance.<\/p>\n

The proof is in the rhetoric of Republicans, who claim to support these goals as much as Democrats do, while promising supposedly better alternatives they\u2019ve never been able to pass as legislation.<\/p>\n

\u201cThe fact that they haven\u2019t been able to come up with something,\u201d Obama said, \u201cindicates either bad faith on their part or the fact that we were pretty thorough and looking at all the options and we arrived at what was the most realistic way to deliver universal health coverage.\u201d<\/p>\n

The Affordable Care Act\u2019s other impact is the\u00a0human one\u00a0\u2015\u00a0the people who got insurance and are better off,\u00a0financially\u00a0and\u00a0medically, according to a\u00a0substantial\u00a0and growing pile of research. The number of Americans without insurance remains near\u00a0historic lows. It\u2019s no exaggeration to say that the Affordable Care Act, for all of its inadequacies, is still the most far-reaching and significant domestic policy achievement in half a century.<\/p>\n

Talking about his \u201cstarter home,\u201d Obama told me, \u201cIt\u2019s been vandalized. And people at times tried to undermine its foundations. But it\u2019s held up.\u201d He\u2019s right, and now the Biden administration may even have a chance to do some of the repair work Obama never could, starting with extra funding for subsidies that is already in the Democratic COVID-19 relief bill.<\/span><\/p>\n

Two of Obama\u2019s favorite sayings are \u201chard things are hard\u201d and \u201cbetter is good.\u201d Both apply in this case, and today\u2019s Democrats would do well to keep them both in mind.<\/span><\/p>\n

Source: Read Full Article<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

The following is adapted from Jonathan Cohn\u2019s<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[23055],"tags":[],"yoast_head":"\nWhat Democrats Can Learn From Obamacare, According To Barack Obama - Pre Coin News<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/precoinnews.com\/politics\/what-democrats-can-learn-from-obamacare-according-to-barack-obama\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"What Democrats Can Learn From Obamacare, According To Barack Obama - Pre Coin News\" \/>\n<meta property=\"og:description\" content=\"The following is adapted from Jonathan Cohn\u2019s\" \/>\n<meta property=\"og:url\" content=\"https:\/\/precoinnews.com\/politics\/what-democrats-can-learn-from-obamacare-according-to-barack-obama\/\" \/>\n<meta property=\"og:site_name\" content=\"Pre Coin News\" \/>\n<meta property=\"article:published_time\" content=\"2021-02-21T15:48:54+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/img.huffingtonpost.com\/asset\/603180ab27000076036822a4.jpg?ops=scalefit_970_noupscale\" \/>\n<meta name=\"author\" content=\"mediabest\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"mediabest\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"16 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/precoinnews.com\/politics\/what-democrats-can-learn-from-obamacare-according-to-barack-obama\/\",\"url\":\"https:\/\/precoinnews.com\/politics\/what-democrats-can-learn-from-obamacare-according-to-barack-obama\/\",\"name\":\"What Democrats Can Learn From Obamacare, According To Barack Obama - 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