THE REAL THREAT TO OBAMACARE

It looks like Obamacare will survive the demands of Tea Party Republicans in the House of Representatives to defund it as part of keeping the government open or raising the debt limit.

But it faces, I believe, a much more serious threat throughout the fall and into the new year, as it takes effect.

Proponents have always assumed that as Obamacare becomes real, as people get protection they’ve never been able to afford, that people’s fears will lessen as they always have with new social programs.  Opposition will melt away or become marginalized.

Well, it could—and, by rights, should—happen that way.

But history suggests another scenario.  It’s not a happy one.  But it’s happened before.

In 1988, Congress passed, and Ronald Reagan signed, a bill that provided prescription drug coverage under Medicare.  It was financed, not by increasing the Medicare payroll tax—or even by adding the cost to the deficit, the way they did for President George W. Bush’s prescription drug benefit—but by a tax on Medicare recipients, with the most prosperous recipients paying the highest rates. The bill passed both houses by overwhelming margins, 328-72 in the House and 86-11 in the Senate.  (Yes, a bill passed with bipartisan support: the past was a different country; they did things differently there.)

But when the law took effect, senior citizens discovered, although it had been there all along, for anybody who had been paying attention, that they—and only they, not everybody, like the rest of Medicare—would have to pay for the new benefit, a little at first, more later.

They didn’t like it.  And they liked it even less after they were rabble-roused by a coalition led by the National Committee to Preserve Social Security and Medicare, a non-profit headed by Franklin D. Roosevelt’s son, former California congressman James Roosevelt, which specialized in direct-mail exhortations to senior citizens claiming that these programs were in financial jeopardy.  Sound familiar?

The revolt of seniors against the drug benefit—or, more accurately, against paying for it—was epitomized by TV news  reports of Chicago congressman Dan Rostenkowski fleeing from a senior citizens forum.  The Chicago Tribune’s account is priceless:

Shouting “coward,” “recall” and “impeach,” about 50 people followed [Rostenkowski] after he left a meeting…Eventually, the 6-foot-4-inch Rostenkowski cut through a gas station, broke into a sprint and escaped into his car, which minutes earlier had one of the elderly protesters, Leona Kozien, draped over the hood.

The video’s even better.

Just sixteen months after it was passed, the drug coverage (and other health care provisions that were part of the same bill) was repealed, by margins almost as lopsided as those by which it had passed, 360-66 in the House and 73-26 in the Senate.

Like the drug benefit of 1988, the advent of Obamacare this fall and early next year will offer its share of surprises.  Just as in ’88, some will be baffling.  Consider that after almost three years of saturation coverage and outreach by friends and enemies alike, almost a third of those surveyed for the Kaiser Health Tracking Poll didn’t know if the Affordable Care Act was still on the books, while an additional 13 percent believed that it was no longer in effect, repealed by Congress or overturned by the Supreme Court.

Then there will be, as Donald Rumsfeld might say, the unsurprising surprises.  After Obama’s promise, which will be played in heavy rotation on the Fox News Channel and the internet, that everyone with employer-provided health insurance could keep it, a succession of employers will discontinue their employee coverage, leaving their employees to apply for coverage on an Obamacare exchange.

They and others without employer-sponsored insurance will also discover that, even under Obamacare, you get what you pay for.  You can get a plan for $100 or $200 and change, depending on where you live and how much you make, but it will pay for just 60 percent of your medical costs.  Want better-than-bronze coverage—silver, gold or platinum?  You’ll pay silver, gold or platinum premiums.  It’ll still be a good deal, but it won’t seem like it, especially if you’re used to your employer paying the premiums and their not showing up on your pay stubs.

And the computer glitches!  There will be computer glitches; there always are, especially with large, interactive systems.  They will be growing-pains kinds of computer glitches and they will be remedied.  But they’ll still be maddening.  And if you’ve put off your search till the last minute, just before your old plan expires, the glitches will be scary too.

And hovering over Obamacare’s first weeks and months will be the same forces that have hated it (and him) from the beginning, the groups that in 2010 mau-maued congressmen over Obamacare at town hall meetings and morphed into the Tea Party.  And their outcry will be amplified by the media that abetted them in 2010, doing their best to fan sparks of irritation into flames of anger and then a blaze of rage.  Or even, if they have to, creating sparks by rubbing dry sticks together.

Did I say “will be”?  They’re already doing it.

As Jonathan Chait of New York magazine has written, anti-Obamacare forces have

[W]hipped themselves into a frenzy over the law through a process of self-deception. The conservative-media world is both completely obsessed with Obamacare and creating a news cocoon in which the most important news about the law — the lower-than-expected premiums and sharply falling health-care inflation — doesn’t exist at all, and the fate of the law can instead be tracked through a procession of exaggerated or completely imaginary events all showing its rapid collapse. Conservative news sites churn out new Obamacare collapse stories every single day, creating the impression of the law’s continued and unmistakable destruction.

And all this will take place during the opening weeks of a congressional election year.  Members of Congress will be confronted at town hall meetings with real or Snopes-worthy accounts of Obamacare problems and asked if they still support the law.  Would they vote for it again?  Will they pledge to repeal it if they are (re-)elected?

That will be the moment of peril for the Affordable Care Act.  Will Obamacare’s proponents respond effectively?  Will supporters in Congress, many running for re-election, hold firm?

Or will they stampede, as they did in 1989?  Will Democrats in swing districts and states reach out to the president, pleading for at least a delay in the individual mandate, the way the employer mandate was delayed, just until the election is past. Will Republicans, as they did in 2010, smell blood in the water, and try to cobble together a coalition of energized Republicans and frightened Democrats, a coalition strong enough to repeal Obamacare, even to override a veto?

Not because Obama care isn’t working—it will.  Not because it costs too much—it doesn’t.  And not because it’s too complicated—it isn’t, at least not for what it does.

But because “a lie gets halfway around the world before the truth has a chance to get its pants on.”  Because the Republicans’ frenzy against Obamacare is not countervailed by a Democratic frenzy for it.  Because, heading into his last two years with his poll ratings dropping, the president will be in no position to offer political protection.

And because members of Congress will remember or be told or shown how in 1989 a health care bill that passed Congress and was signed by a Republican president was, before the election cycle turned, repealed by equally overwhelming margins.  Like Brecht’s Galileo, who recants not under torture but upon merely being shown the instruments of torture, they will look at the tape of Dan Rostenkowski being chased down the street by his constituents, and they will see themselves.

How likely is such a gruesome scenario?

At the end of Dickens’ Christmas Carol, Scrooge begs the Ghost of Christmas Yet To Come for surcease.  “Are these the shadows of the things that will be, or are they shadows of things that may be, only?” he asks.  When the Ghost remains silent, Scrooge grasps the Ghost’s arm and desperately pleads for reprieve—at which point the Ghost dwindles into a post on Scrooge’s bed.

It’s just a bad dream—but one with a warning.

Comments(0)