October 30, 2013
Kathleen Sebelius. (AP Photo/Ross D. Franklin)
Kathleen Sebelius. (AP Photo/Ross D. Franklin)

Today Health and Human Services Secretary Kathleen Sebelius is set to take a grilling from Capitol Hill Republicans over Obamacare’s awful rollout problems. She’ll be confronted with questions about what the administration knew and when about the website’s readiness. She’ll be pressed to say how many people enrolled in Obamacare thus far. And she’ll be asked about charges that the administration lied in claiming people could keep their plans, which continue this morning.

What all of these topics of dispute have in common is that they are obscuring, rather than clarifying, the core differences between the two parties over what to do about the country’s pressing national health care problems. Yet this larger argument is, ultimately, what this is all about.

To understand how the current dust-ups are obscuring this larger argument, start with Brian Beutler’s piece this morning. The crux is that conservative complains about the law aren’t about solving problems; they are being deployed “as subterfuge to wreck the entire reform edifice”:

Conservatives only care about these problems insofar as they can be used to trash or undermine the law in its entirety. That’s why they never, ever mention any of the millions of people who will or are already benefiting from the law. [..]

The disruption we’re seeing in the individual insurance market is mostly by design. And it’s mostly a good thing. Until October, the individual market existed to sell insurance to people who needed it least. Rates were low for healthy people precisely because their old, sick neighbors were priced or locked out of the system. They were also low because many of the policies on the market didn’t actually fulfill the function of insurance, which is to hedge against financial catastrophe. Obamacare eliminates each of these enormous flaws. [...]

Taken together, the changes create winners and losers, but almost by definition more winners than losers. That doesn’t make it perfect by any means. We could reduce the impact of cross-subsidization on young, healthy people by making subsidies more generous or stretching the age band or loosening minimum essential coverage standards or some combination of the three…[Conservatives'] tremendous outpouring of grief for young, middle-class people comes couched in the assumption that the only available solution is complete repeal. You could counter that by any moral standard the system the Affordable Care Act creates is preferable to the one we had before.

Right. It all comes down to a fundamental difference on the core question of whether the federal government should act to protect consumers from a broken health care system and expand coverage to tens of millions of Americans. Democrats believe it should. Because single payer is an impossibility, they have constructed an admittedly elaborate system that regulates the market to prevent discrimination against the sick and protect consumers from harm; mandates that young and healthy people sign up for insurance to make such regulations possible; and subsidizes insurance costs to make the mandate workable and cover those priced out of the market.

Republicans don’t believe the federal government should regulate the system this ambitiously or spend money in a redistributive fashion (though how redistributive this proves remains to be seen) to expand coverage — and financial security — to tens of millions of uninsured. Their solutions would not be anywhere near as far reaching either in protecting consumers or in bringing security to many millions.

The current arguments obscure these differences. The Republican attacks over website problems and, possibly, over low enrollment figures, obscure the basic fact that Republicans are actively working to block the law from benefitting as many people as possible, explicitly to make the law fail, which would then show the federal government should not play the role Dems want it to play. And the Republican complaints about those who are “losing” their insurance or seeing “rate shock” is entirely one sided, because admitting the law would benefit millions risks making the federal role Dems envision seem reasonable to middle of the road voters who aren’t prone to reflexive ideological hostility towards that role for government.

Polls suggest widespread public confusion over Obamacare, accompanied by discomfort with GOP tactics against it. Opinion is tremendously unsettled. But in the end, all of the noise we’re hearing right now can only obscure the true nature of these differences for so long. There’s only one way Dems can win the larger argument: If, over time, the policy known as the Affordable Care Act works.

* WHY PEOPLE ARE “LOSING” THEIR INSURANCE: The Washington Post has an excellent editorial putting this in perspective, noting that it all flows from what has been the whole point of reform all along, i.e., to set minimum standards for the quality of health insurance:

Though some people might pay more than they did before, they and many others will also get more…Reform still might not sound like a great deal to people who are young, feel healthy and don’t want to pay for coverage . Yet having lots of healthy people paying into the new system on its terms will not only limit their financial risk, but also their participation will allow others who have been priced out of the health-insurance market — those with serious preexisting conditions, for example — to obtain good coverage…None of this is an outrage.

As noted here yesterday, many opponents of the law refuse to acknowledge this basic tradeoff at the heart of the law, which would require them to recognize that it benefits millions of people.

* OBAMA’S PLEDGE GETS FOUR PINNOCHIOS: But Glenn Kessler concludes that Obama’s sweeping promise that people can keep insurance they like is indefensibly false on multiple levels. However, note this tidbit:

[I]’s certainly incorrect to claim, as some Republicans have, that people are losing insurance coverage. Instead, in virtually all cases, it’s being replaced with probably better (and possibly more expensive) insurance.

I would say both Kessler’s conclusion and the Post editorial board’s conclusion can be true: The goal of reform was to remake the insurance market to protect consumers and to expand coverage to tens of millions who lacked it, which would of necessity result in people having to replace coverage deemed substandard by the law. But the White House should not have falsified the fact that people would not be able to keep that coverage.

* INITIAL ENROLLMENT NUMBER WILL LIKELY BE SMALL: Robert Pear highlights a key quote from Marilyn Tavenner, who is overseeing the health insurance marketplace, on the administration’s expected rollout next month of the law’s enrollment totals:

“That number will not be available until mid-November,” Ms. Tavenner said. “We expect the initial number to be small.”

If and when this happens the press coverage will be brutal. And perhaps enrollment will end up being too low in the long run. But the experience in Massachusetts shows people tend to enroll late, key context that will be widely forgotten in the rush to declare the law a disaster months before the deadline.

* RED STATE DEMS STICKING BY KATHLEEN SEBELIUS: The Hill notes an interesting dynamic: Vulnerable red state Democratic Senators are not joining GOP calls for Health and Human Services Secretary Kathleen Sebelius to be fired over the awful Obamacare rollout. Here is Mary Landrieu, who is up in 2014:

“I believe we need to keep all hands on deck getting this fixed. Yes, Kathleen Sebelius needs to take responsibility, but it will cause more problems, in my view, having the secretary step down at this point.”

Dems can respond to GOP attacks on the rollout with a “keep and fix” message, and that mostly seems to be what they are doing, despite wild GOP exaggerations about Dems supposedly running from the law.

* WHITE HOUSE “FLEXIBLE” ON TAXES? The Wall Street Journal reports:

The White House has cracked open the door to a budget compromise with congressional Republicans by signaling it might not insist on raising taxes as part of a deal to replace some scheduled spending cuts, people familiar with the matter said.

I’m not worried about this yet. The story specifies this would only concern a small deal and not even the type of entitlement cuts Dems would object to. But more on this later.

* REPUBLICAN SABOTAGE OF OBAMACARE CONTINUES: Alex Seitz-Wald has a very good piece explaining a key aspect of the GOP game plan:

As Republicans in Washington prepare to grill…Sebelius on Wednesday over problems a broken website is creating for accessing Obamacare, their fellow party members in a dozen-and-a-half states have added complications for people trying to access those benefits through alternate means….whether by fees, background checks, tests, extra training, certifications, threats of civil penalties, or delays, Republican legislatures and officials in at least 17 states across the country have thrown up all manner of bureaucratic roadblocks in front of the program.

* AND ONE POLL SHOWS TIGHT RACE IN VIRGINIA: The new Quinnipiac poll finds that Dem Terry McAuliffe is leading Republican Ken Kuccinelli by only four points, 45-41, in sharp contrast to the Post poll earlier this week that showed McAuliffe ahead by 11 points. But the Real Clear Politics polling average has the Democrat leading by over nine points, so the Q-poll may be an outlier.

What else?

Greg Sargent writes The Plum Line blog, a reported opinion blog with a liberal slant -- what you might call “opinionated reporting” from the left.