By James Taranto
When we saw the headline "Four Ways ObamaCare Could Still Fail," our
reaction was that it sounded like an unrealistically low estimate. But
we read the article because we were intrigued because of the source:
TalkingPointsMemo.com, 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:
"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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