Sunday, February 17, 2013

Liberal: Four Ways Obamacare Could Still Fail

Critical Condition
Conservatives were right about ObamaCare, a lefty website concedes.

By JAMES TARANTO, WSJ Opinion, February 16, 2013

When we saw the headline "Four Ways ObamaCare Could Still Fail," our reaction was that it sounded like an unrealistically low estimate. But we were intrigued enough to read the article because of the source:, a news site with a strong (and acknowledged) liberal Democratic slant. Its framing as friendly criticism makes the piece, by congressional reporter Sahil Kapur, a powerful indictment of ObamaCare.

To be sure, it's not clear Kapur intends to indict ObamaCare, and if he does, he downplays it, presumably in order to avoid alienating his liberal readers or his liberal editors. In his lead paragraph, he summarizes the problem as follows: "Republicans remain committed to botching its implementation, which--along with inherent complexities in implementing parts of the law--leaves in place significant obstacles to achieving its key goals."

When you read the rest of the piece, however, it's clear that the emphasis should be reversed: The law's deficiencies--or "inherent complexities," to use Kapur's obfuscatory euphemism--are the primary difficulty. The Republican commitment to botchery is real, and it does compound ObamaCare's problems, but it is a secondary problem.

Kapur lists "the four biggest obstacles the law faces in meeting its key goals." Let's go through them one by one (or read for yourself: Four Ways Obamacare Could Still Fail):

"1) Ongoing Disapproval of the Law." Kapur quotes "two leading health policy experts," both ObamaCare proponents, who argue that, in Kapur's words, public disapproval is "the overarching threat to Obamacare."

Actually one of them, Jonathan Gruber, "a professor at MIT who helped craft the Affordable Care Act," argues just that, while the other, Washington and Lee's Timothy Jost, blames "the relentless negativity and opposition of the Republicans and their media outlets." But Kapur acknowledges that public disapproval of ObamaCare is a necessary condition for sustaining GOP opposition and obstruction. (Kapur notes parenthetically that ObamaCare supporters of the law are still waiting for Godot, which is to say they are "convinced" the public will "come around.")

"2) States Declining to Expand Medicaid." Although the U.S. Supreme Court upheld most of ObamaCare last year, by a 7-2 vote it ruled that Congress had exceeded its authority in threatening to cut off all Medicaid funds from states that declined to participate in the new law's expansion of the program. Thirteen governors (acting "under pressure from the right," according to Kapur) have announced that they'll decline to participate, and another 10 may yet do so. That leaves it "an open question how--or whether--Americans below 133 percent of the poverty line will obtain insurance" in those states.

"3) States Refusing to Build Insurance Marketplaces." ObamaCare "encourages" states to set up "exchanges" for the sale of one-size-fits-all health-insurance policies, but many states are balking. "The problem: The ACA [Affordable Care Act, an abbreviation for the law's formal title] lacks a funding mechanism for Department of Health and Human Services to set up exchanges for states that decline to do so themselves--and congressional Republicans are unlikely to appropriate additional money for that."

"4) Nullification of the Medicare Cost-Cutting Board." That would be the Independent Payment Advisory Board, colloquially known as the death panel, which would recommend which medical services to deny in order to cut costs. "The problem," according to Kapur, is that "Senate Republicans can--and have signaled their intention to--filibuster nominees to the board."

But that isn't the only problem. As Kapur notes, "even some House Democrats" have voted to abolish the board. Kapur ignores another problem, reported last month by the Washington Post's Sarah Kliff: ObamaCare proponents despair of finding enough experts to serve on the 15-man panel, "a federal job where the compensation is low, the political controversy high and the ultimate payoff unclear."

Kapur's argument amounts to the following: Democrats passed a law that had and still has insufficient public support (points 1 and 4), that cannot achieve its goals without unconstitutional means (point 2), that did not allocate the necessary resources to accomplish its objectives (point 3), and that lacks and still lacks even minimal support across the political aisle (all four points).

That sounds very much like the conservative critique of ObamaCare. At this point it's fair to say that ObamaCare opponents have won the argument. Of course, since supporters won the political battle three years ago (and Obama won re-election), this monstrosity is now the law of the land, ensuring that both sides' victories will have been Pyrrhic.

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