Thursday, October 31, 2013

The forest, the trees and Obamacare

THE RED SOX were back home to prep for their dismissal of the St. Louis Cardinals in Game 6 of the World Series, but that wasn’t the only big deal in Boston on Wednesday.

President Obama was in Beantown to visit Faneuil Hall, the same place where Mitt Romney, then the Republican governor of Massachusetts, signed the state’s comprehensive health-care measure into law, thereby creating the DNA for the national law shorthanded as Obamacare. The optics of the location did double duty, of course. It was an oblique dig at Romney, and by extension the Republicans now dead set against a health-care program one of their own helped to create.

But it was also the president’s first real opportunity to respond to a growing chorus of critics whose impatience and duplicity about the Patient Protection and Affordable Care Act has ushered in a downbeat vibe across the ideological spectrum. Obama made the most of it, spelling out the stakes, taking responsibility for the problems with the law’s implementation, and otherwise offering a perfectly reasonable caution: Transformation takes time. Don’t let the perfect be the enemy of the good.

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Obama and Health and Human Services Secretary Kathleen Sebelius managed to fall on the same sword from two different locations Wednesday, taking the blame and accepting responsibility for the technology fail of the federal health exchange Web site,

Sebelius was guest of honor at a House Energy and Commerce Committee hearing. “I apologize. I'm accountable to you,” Sebelius said. “I am committed to earning your confidence back.” House Republicans wanted nothing to do with such anodyne overtures. Tennessee GOP Rep. Marsha Blackburn was one of the more reliable belligerents.

Blackburn leaned hard on Sebelius about why some people with individual health-care plans — about 5 percent of the total — would lose those plans under Obamacare, despite the president’s seeming assurances to the contrary before the law’s rollout on Oct. 1. The secretary did her best to explain that insurance companies retain a certain autonomy about cancellation of policies.

Before long, though, Blackburn was doing her best to lecture Sebelius in culture-coded language meant to play big in red-state Tennessee. “Some people like to drive a Ford, not a Ferrari. Some people like to drink out of a red Solo cup, not a crystal stem," Blackburn said. “You're taking away their choice.”

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THE PRESIDENT’S audience was a lot more receptive. At Faneuil Hall, Obama gave them, and the soundbite hunters in the media, what they needed or wanted: a mea culpa from the top. “Let’s face it, we’ve had a problem,” he said. “The Web site hasn’t worked the way it’s supposed to ... there’s no denying it, right now the Web site is too slow, too many people have gotten stuck ... and I’m not happy about it, and neither are Americans who need health care ... I take full responsibility.”

And Obama said in no uncertain terms what we already knew: that the problems would be corrected, that doing it is a When proposition, not an If proposition. “All the parade of horribles, the worst predictions about health care reform in Massachusetts never came true,” he said. “They’re the same arguments that you’re hearing now.”

“We’re in this together and we are gonna see it through,” he said, before saying it again, the president channeling his inner Samuel L. Jackson, his eyes taking on that glint-fire we’ve seen in the past. “We are going to see this through!

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Obama’s message was clear: the myriad complexity of the nation’s health-care system has met its match — or its evil twin — in the complexity of the computer code needed to get the federal exchange site up and running. But this is a process, not an event, and if we fail to get that, we’ll keep being disappointed by the failure of the process to give us the expected immediate gratification of an event.

Conservatives are generally in no mood for thinking like that now. But some of the same congressmen sat at earlier House hearings, in more congenial judgment of President George W. Bush’s glitch-prone rollout of Medicare Part D in 2006.

Back in the day, Texas GOP Rep. Joe Barton said “This is a huge undertaking and there are going to be glitches. My goal is the same as yours: Get rid of the glitches. The committee will work closely to get problems noticed and solved.”

Back then, Georgia Rep. Phil Gingrey was as gooey as RC cola and a moon pie: “I delivered 5,200 babies, but this may be the best delivery that I have ever been a part of, Mr. Speaker, and that is delivering, as I say, on a promise made by former Congresses and other Presidents over the 45-year history of the Medicare program ... what we have done here is add part D, the ‘D’ for ‘drug’ or, if you want, the ‘delivery’ that we have finally provided to our American seniors.”

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PENNSYLVANIA GOP Rep. Tim Murphy got downright personal about Medicare Plan D: “Any time something is new, there is going to be some glitches. All of us, when our children were new, well, we knew as parents we didn’t exactly know everything we were doing and we had a foul-up or two, but we persevered and our children turned out well. No matter what one does in life, when it is something new in learning the ropes of it, it is going to take a little adjustment.”

Fast forward to now, and these former policy gradualists have no patience for Obamacare’s technological challenges.

Indeed, it’s become the game of the week on Capitol HIll: Find the ways that the rollouts of Obamacare and Medicare Part D dovetail and where they differ.

David Nather of Politico wrote on Wednesday: “Obamacare is ... far more complex than the Medicare prescription drug program — not just because the website has to be able to do more things, like calculating subsidies and talking to several agencies to verify who’s eligible, but because it has to deal with entire health insurance plans, not just drug coverage.

“And Republicans say the two programs aren’t directly comparable, arguing that Obamacare could affect more people — if you count disruptions like people who might lose their employer-based coverage or have to change their health plans, not just uninsured people signing up for coverage for the first time.”

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Some conservative thought leaders have gone to great lengths to put all this in historically precipitous terms. The columnist Charles Krauthammer took such a macro perspective on Tuesday on MSNBC:

“What I find the most remarkable about [Obama] is not only his intelligence, but his ideological ambition. He said something very interesting in 2008. He said Ronald Reagan was historically consequential, in a way that Clinton was not. And what Obama meant was: Reagan changed the ideological trajectory of the country, which for 60 years, since FDR, had been dominated by a liberal zeitgeist ...

“Obama has always seen himself — and it is remarkable because he did this as an outsider, somebody who really had a long shot at the White House — he saw himself as world historical, as a figure that would change that trajectory, end the 30-year conservative ascendancy ushered in by Reagan, and begin a new liberal ascendancy.

“The irony is that his signature achievement, Obamacare, is the test of this new liberalism, and today it hangs in the balance of a Web site or a promise here and there ... If he does not succeed with Obamacare, the cause of the kind of expansive liberalism, the kind of entitlement state he’s been looking for, I think, will be set back a full generation.”

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DESPITE KRAUTHAMMER’S implicit wish that conservatism runs roughshod over the United States for another 20 years, there are holes in his reasoning.

The first is his belief that the years since Reagan won the presidency in 1980 have been one long nonstop march of conservative ideology and governance. Two terms of Bill Clinton as the Democratic 42nd president dispel that idea. The re-election of Barack Obama as the Democratic 44th president — by the representatives of a new mosaic America, people who renounced conservative policies and identity at the polls — dispels that idea, too.

Krauthammer’s second mistake is looking at Obamacare as “the test of this new liberalism,” as if the president won the 2008 election with the intention of pursuing the Affordable Care Act as a favor to liberal Americans and nobody else. In Krauthammer’s pinched world, affordable health care is an “entitlement” — a gift, a token, a benevolence — rather than a basic human right, one easily achievable, in practical terms, by making the current health-care system more responsive to, and affordable for, the people it’s meant to serve.

That existential/ethical disconnect lies at the root of current conservative ideology in general, and at the center of the all-consuming, teeth-bared conservative contempt reserved specifically for Obamacare.

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As anyone with any sense knows, this isn’t personal, and it shouldn’t be political. Deval Patrick understands. “The Affordable Care Act is not a Web site, it’s a values statement,” said the Massachusetts governor on Tuesday, on MSNBC. “It’s about whether we believe that health is a public good. The president does, the majority of the Congress does, and it’s now been upheld by the Supreme Court.”

And also as any one who lives in this country knows: Americans are notoriously impatient. It’s part of our charm and our power; it’s also our failing and our tragedy.

People have been willfully confusing the objective — aspirationally universal health care — with the Web site, the technological vehicle by which the objective will be achieved. We use the expression “can’t see the forest for the trees” to describe someone who gets overly mired in the details without the ability to see the big picture. That’s been happening since the launch of the Affordable Care Act. There’s been a lot of piling on by everyone — from Democrats to Republicans, from people in both philosophical hemispheres of the mainstream media to Jon Stewart. “Forest for the trees”? Most of the early complaints point to people not making sense of the forest or the trees ... because they’re paying too much attention to the blades of grass on the ground.

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THE INTERSTATE Highway System was started in September 1956, during the Eisenhower administration. The last part of that massive public-works project was completed in October 1992.

The Obamacare exchange site, and the formidably expansive health-care system it means to contain and codify, represents an undertaking bigger than the Medicare Plan D rollout — bigger by literally orders of magnitude. The Interstate Highway System has given way to the Internet Health-Care System. The complexity of that challenge is already daunting; we’ve got every reason to think the final result will ultimately be rewarding.

“Yes, this is hard. The health care system’s a big system, and it’s complicated,” Obama said at Faneuil Hall. “If it was hard doing it just in one state, it’s hard doing it in 50 states -- especially when the governors of a bunch of states, and half of Congress, don’t want to help. But it’s important. We have to keep moving forward -- just like you did in Massachusetts.”

Transformations take time. The one that effectively created a central nervous system for national commerce took more than a generation to complete. It’s now an indispensable part of American life, so much a part of our lives and our culture that we take its existence, and its benefits, for granted.

In time — after the incidental disconnects in technology are resolved, after the deliberate sabotage on Capitol Hill is overcome — the Affordable Care Act should be no damn different.

Image credits: Obama: Stephan Savola/Associated Press. Sebelius: Reuters. Bush signs Medicare Part D: via Krauthammer: Fox News via Web site detail. 

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