The Affordable Care Act is not a free-market reform. It is redistribution. In order to make health insurance more affordable and available to poor people, sick people, and old people, it makes it more expensive and less available for younger, healthier people. There is the essence of the law. Sure, it gives the younger and healthier people better, more comprehensive plans, but these will come at higher costs. In short, the Affordable Care Act works through redistribution. But, the administration could never, ever explain how this works.
Instead they made three promises they knew they couldn’t keep. As I noted in this editorial:
First, people were worried that they would lose their health insurance policies; the president promised that they could keep their policies. Second, people were worried that Obamacare would raise premiums; the president promised that premiums of those with insurance would go down. Third, people did not want a tax increase; the president promised that there would be no new taxes under Obamacare.
These three promises were instrumental in selling the law to Americans, many of whom voted for the president. Now, we are coming to realize that these promises have all been broken. And most troubling, the President knew these were promises that would not be kept.
Why couldn’t the administration simply tell the truth about the law? Because it would require them to explain that the ACA works through redistribution. A new piece in the Times sheds light on this decision.
“Redistribution is a loaded word that conjures up all sorts of unfairness in people’s minds,” said William M. Daley, who was Mr. Obama’s chief of staff at the time. Republicans wield it “as a hammer” against Democrats, he said, adding, “It’s a word that, in the political world, you just don’t use.”
These days the word is particularly toxic at the White House, where it has been hidden away to make the Affordable Care Act more palatable to the public and less a target for Republicans, who have long accused Democrats of seeking “socialized medicine.” But the redistribution of wealth has always been a central feature of the law and lies at the heart of the insurance market disruptions driving political attacks this fall.
As Ezra Klein noted in this 2008 NetRoots talk, one of the key reasons First Lady Clinton’s health care reform failed was because people did not want to change their health insurance. Klein admitted, quite candidly, that in order to reform the health care system, people would have to leave their inefficient plans, and move onto something new. This was widely understood among supporters of the plan. In fact, the Administration knew that millions, and perhaps as many as 93 million Americans would be unable to keep their policies.
The President knew how toxic this was, so he had to sell Obamacare on false premises.
But throughout the process, they knew that some level of redistributing wealth — creating losers as well as winners — was inescapable.
And yet for those nervous about potential changes, the president promised stability. “If you like your current insurance, you will keep your current insurance,” Mr. Obama said the day he signed the legislation in March 2010, a promise he made repeatedly as the Oct. 1 opening day of the online health insurance marketplaces approached.
Hiding in plain sight behind that pledge — visible to health policy experts but not the general public — was the redistribution required to extend health coverage to those who had been either locked out or priced out of the market.
Now some of that redistribution has come clearly into view.
In other words, redistribution was the hidden, core element of the ACA that all health policy wonks realized.
“The A.C.A. is very much about redistribution, whether or not its advocates acknowledge that this is the case,” wrote Reihan Salam on the website of the conservative National Review.
Having obscured much of that vulnerability before, Mr. Obama has responded to recent political heat by apologizing — and expanding the scope of his discredited “you can keep it” promise.
David Axelrod, now that the law is passed, has finally conceded what is at stake here. He had to pass the law so we can find out what is in it.
In the end, America’s political culture may have made it unrealistic to expect a smooth public reception for the law, no matter how cleverly the White House modulated Mr. Obama’s language or shaped his policy to minimize the number of losers.
“The reality is, any big thing you take on, any big change, is hard to accomplish,” said David Axelrod, the president’s longtime strategist. In America, he said, “we’ve created a sense that everyone can expect to win — nobody has to sacrifice.”
At the same time, Mr. Axelrod argued that widening income inequality has, to some Americans at least, changed the meaning of redistribution. “The whole redistribution argument has shifted in the country because there’s a sense that a lot of redistribution has been to the top and not the bottom,” Mr. Axelrod said.
But, the President is still in denial.
Still, the word is hardly a favorite of the president these days. The last time Mr. Obama used it in public, according to Federal News Service transcripts, was 18 months ago during his re-election campaign in Elyria, Ohio.
“Understand this is not a redistribution argument,” the president told his audience then. “This is not about taking from rich people to give to poor people. This is about us together making investments in our country so everybody’s got a fair shot.”
This should be fodder for my Unprecedented sequal, Unraveled. I almost want to do a Back to the Future type history, where I have one version of history (the constitutional challenge) going on simultaneously with the political history (political implementation).