Originally published in Politico
This article also appeared in Politico on March 31, 2012.
It’s hard to pinpoint the worst moment this week for the Obama Administration. Perhaps Solicitor General Donald Verelli’s stumbling, dodging, gasping performance before the Supreme Court; or Anthony Kennedy’s elegant evisceration of the argument for the mandate’s constitutionality with one sharp question: can government create a market just so that it can regulate that market? Another candidate for the low point must surely be the sinking feeling when Kennedy and Antonin Scalia wondered how a statute can survive if the thing the government says matters most in the law is ripped out.
But the worst point, at least on the cynicism scale, is Majority Leader Harry Reid’s all too telling response that the Affordable Care Act’s overturn would actually help Democrats this fall—so much for the notion that the law is the defining moral cause of our times. It was what Michael Kinsley famously called Washington’s version of a gaffe—telling the truth about one’s motivations without meaning to.
Reid unmasked what critics of the ACA have suspected—that the bill was fashioned more as a clever political instrument than a policy solution. Otherwise, it’s hard to understand how a candidate who punched his Democratic opponent for wanting to fine individuals who don’t buy insurance could turn on a dime within months of taking office. The politics of the matter is that the mandate was a carrot for an insurance industry that shelved its opposition in hopes of raking in high premiums from a new class of healthy, affluent customers.
It’s difficult, absent political strategy, to explain why the administration risked the bipartisan wraith of governors by loading an expanded Medicaid entitlement onto their depleted state budgets without committing long-term to providing federal help to pay for it. The politics of the equation are that state budgetary pressures around Medicaid will eventually provide a compelling, (liberals hope) irresistible case for the supposedly abandoned public option.
It takes politics, and the state of polling in 2009, to explain why the new law was disingenuously sold as status quo for the 85% of Americans who are already privately insured, when every analysis at the time suggested to the contrary–that a competitive network of high-risk pools and insurance exchanges would encourage employers to save money by scaling back the scope of private plans.
In other words, what Republicans call Obamacare was a strategic vehicle to defuse resistance to a systems overhaul and to lay the groundwork for an inevitable realignment of healthcare into a largely government-centric machine. And its collapse, as Reid hints, might galvanize a portion of the left that would say the defeat proves only the limits of incrementalism, and the hard-heartedness of conservatives who despise health-care reform in any shape.
So, no surprise that the potential unraveling of the policy framework brings surprisingly few tears from Democratic insiders like Reid. It was meant less to last, more to set the stage for the reform liberals genuinely want. Of course, the politics of labeling the ACA’s foes as enemies of sick children and the working poor will last for what seems like forever.