Prediction: even if HealthCare.gov is fixed by the end of the month (unlikely), Obamacare is going to be repealed well in advance of next year’s election. And if the website continues to fail, the push for repeal—from endangered Democrats—will occur very rapidly. The website is a sideshow: the real action is the number of people and businesses who are losing their health plans or having to pay a lot more. Fixing the website will only delay the inevitable.
It is important to remember why it was so important for Obama to promise repeatedly that “if you like your health insurance/doctor, you can keep your health insurance/doctor.” Cast your mind back to the ignominious collapse of Hillarycare in 1994. Hillarycare came out of the box in September 1993 to high public support according to the early polls. This was not a surprise. Opinion polls for decades have shown a large majority of Americans support the general idea of universal health coverage. But Hillarycare came apart as the bureaucratic details came out, the most important one being that you couldn’t be sure you’d be able to keep your doctors or select specialists of your choice. The Clintons refused to consider a compromise, but even with large Democratic Senate and House majorities the bill was so dead it was never brought up for a vote.
Remember “Harry and Louise”? Obama did, which is why he portrayed Obamacare as simply expanding coverage to the uninsured, and improving coverage for the underinsured while leaving the already insured undisturbed. But the redistributive arithmetic of Obamacare’s architecture could never add up, which is what the bureaucrats knew early on—as early as 2010 according to many documents that have leaked. The wonder is that Obama’s political team didn’t see this coming and prepare a pre-emptive strategy for dealing with the inevitable exposure of the duplicity at the heart of Obamacare’s logic. Now that people are losing their insurance and finding that they may not be able to keep their doctor after all, Obamacare has become the domestic policy equivalent of the Iraq War: a protracted fiasco that is proving fatal to a president’s credibility and approval rating. The only thing missing is calling in FEMA to help fix this Category-5 political disaster.
Senate Democrats endangered for re-election will lead the charge for repeal perhaps as soon as January, after they get an earful over the Christmas break. They’ll call it “reform,” and clothe it in calls for delaying the individual mandate and allowing people and businesses to keep their existing health insurance policies. But it is probably too late to go back in many cases. With the political damage guaranteed to continue, the momentum toward repeal will be unstoppable. Democrats will not want to face the voters next November with the albatross of Obamacare.
The politics of the repeal effort will be a game theorist’s dream. Tea Party Republicans will resist “reforms” to Obamacare in favor of complete repeal. Democrats will try to turn the tables and set up Republicans as obstacles to reform, hoping to inoculate themselves prospectively from mayhem at the polls next November. The House might want to insist that the Senate go first; after all, it was the Senate version of the bill that the House had to swallow after Scott Brown’s election in January 2010. The House can rightly insist that the Senate needs to clean up the mess they made. Obama may well give Capitol Hill Democrats a pass on a repeal vote, and veto any bill that emerges. He’ll never face the voters again.
This wouldn’t be the first time that a health care entitlement was repealed. The same thing happened in the late 1980s with catastrophic coverage for seniors. Because seniors were made to pay for their benefits under that scheme, the uproar forced Congress to repeal the measure barely a year after it went into effect. Obamacare looks to be on the same political trajectory, and for the same reason. Obamacare represents the crisis of big government; the limits of administrative government have finally been breached. For the first time ever, some polls are showing a majority of Americans doubting the goal of universal health coverage.
The hazard of the moment is that a compromise “reform” that drops the mandate and attempts to restore the insurance status quo ante could leave us with an unfunded expansion of Medicaid and a badly disrupted private insurance market. Republicans should avoid both the political traps and a new fiscal time bomb by being ready with a serious replacement policy, based on the premium support tax credit ideas that John McCain advocated (poorly) in 2008. While anxious liberals are in dismay, they should recognize that Obamacare may well have achieved its chief purpose of making universal or at least greatly expanded health coverage a fixture of American social policy. The cost to liberalism may prove fatal, however.
Steven Hayward, Contributor, Forbes