On Max Baucus, the Iraq War, and the Obamacare "Train Wreck"


Photo credit: Medill DC / Foter.com / CC BY

Ezra Klein takes me to task for poking fun at the Obama administration's new $8 million marketing contract for Obamacare. I snarked that perhaps they ought to try convincing Sen. Max Baucus—a key author of the health legislation who recently warned that of a coming "huge train wreck" with the law—before spending even more millions on marketing the exchanges to everyone else.

Klein responds today that "the particular irony of Suderman's critique is that Baucus's specific concern was that there would be a 2014 'train wreck' because the Obama administration wasn't doing enough to advertise and explain the exchanges. The announcement that it will spend more money to advertise and explain the exchanges is, in part, a way of responding to Baucus's concerns."

It's true that at the same hearing Sen. Baucus predicted that Obamacare would be a train wreck, he also criticized the administration for not doing enough to educate the public about the law, saying that "administration's public information campaign on the benefits of the Affordable Care Act deserves a failing grade."

But lack of marketing communication wasn't his only criticism. And it wasn't the criticism his statement to Health and Human Services Secretary Sebelius led with. The senator's first concern was that the exchanges would not be ready on time—because the administration had not gotten its act together.

"Time is short," he told Sebelius. "You need to use each of these days to work with states and make sure the marketplaces are up and running." Baucus said he was not confident that this would happen. "I am concerned that not every state, including Montana, will have an insurance marketplace established in time." Baucus also complained that the administration hadn't released enough information that people could easily understand the law, even if they wanted to, noting the "lack of clear information" from HHS. That's not a marketing issue. That's an implementation problem.

Nor was this the first time Baucus had publicly criticized the law. At a hearing in February, Baucus seemed skeptical that the administration would be able to manage the technical side of the implementation. The Montana senator "questioned how well the online health insurance marketplaces would interact with what he called 'archaic' computer systems at Social Security and the Internal Revenue Service," according to Kaiser Health News. The Hill reported similarly that Baucus was "skeptical" about "HHS' work on exchanges—specifically, integrating the complex and outdated computer systems of the multiple federal agencies" involved in the exchange system. And when Baucus made his "train-wreck" remark, it was in reference to his long-expressed worries about the administration's failures. "I've got to tell you," he said to Sebelius at last week's hearing, "I just see a huge train-wreck coming down. You and I have discussed this many times and I don't see the results yet."

Baucus is not merely concerned that the administration isn't making enough effort to market the law. He's openly worried that the law won't work—that the administration is not doing an effective job of implementing the law and that the technical challenges involved in creating the exchanges are not being overcome, or at least not being overcome fast enough.

Obamacare's defenders might try to dismiss Baucus's remarks as election-year pandering. But it turns out that Baucus is not seeking reelection again. Which suggests that his remarks are perhaps intended as cautions to his Democratic colleagues.

Klein links my post—along with a Tweet by Ben Domenech saying that "Obamacare is the Iraq of the Obama administration—to an "increasingly destructive information loop" he says is developing amongs critics of the health law. "The only information that is credible to them is information showing the law will be a disaster," writes Klein. "The only news they believe is news that makes Obamacare look bad. The only strategy they've developed is one for when Obamacare collapses under the weight of its failures."

So how bad will Obamacare's first year be? My guess is that it won't be great. If the implementation process was going smoothly, and convinced the law's supporters that it will be a big success right out of the gate, we'd be hearing a lot more about that.

But we're not.

Instead, we're hearing—and not only from critics of the law—stories about how multiple Democratic legislators have pressed the administration about their concerns with the implementation process, about how the administration official in charge of managing the exchange technology is nervous, about how the exchange-building process has run double its expected cost, about the union that supported the law now calling for its repeal, about studies showing that premiums will rise and about how Health and Human Services Secretary Kathleen Sebelius has agreed that costs will rise for at least some of the population. Is that an information loop? Or is it just the news? 

Meanwhile, the expectations-setting we're seeing from people like Gary Cohen, the administration official managing the exchange implementation process, gives a similar impression. Cohen told attendees at an insurance industry conference that HHS is developing contingency plans for exchanges that fail or aren't ready, and said that it's "prudent to not assume everything is going to work perfectly on day one." Indeed, he said, "everyone recognizes that day one will not be perfect." Everyone. 

Now, imperfect on day one is not the same as an unworkable catastrophe, but I think it's safe to say that these are not the signs of an implementation process that is going particularly well. Does this mean Obamacare is destined to crash and burn? Some form of delay seems more likely than total meltdown, especially in light of the delay of the small business exchange's choice provision. But if I had to bet money, I'd bet that the exchanges will be open on time, at least in some form, but there will be a handful of serious malfunctions and a lot more small-scale problems as the system gets up and running.

On this, Klein and I basically agree. "I don't think Obamacare will have an easy first year," he writes. But he argues that the overall reality will likely be somewhat more mixed, granting the possibility that "some parts of the law" end up "proving troublesome or even disastrous" but with the law also insuring tens of millions of people directly and benefiting tens of millions more through subsidies or regulations.

Part of the point of Klein's post is to push back against Domenech's Tweeted notion that Obamacare is to the Obama administration what the Iraq war was to the Bush White House. But Klein's reaction—that the law may have troubles but that its major goals are worthwhile—reminds me of nothing so much as the way so many Bush administration defenders reacted to mounting troubles with the Iraq war. Sure, they admitted, there are problems, even big ones, but overall the project is worthwhile and noble, and history will judge it kindly. Others, meanwhile, settled on troubled execution as the primary problem with the war—arguing, in what came to be known as the incompetence dodge, that the problem was not with the war's fundamental aims but its shoddy administration. 

Klein's post is titled "Does an $8 million advertising campaign really make Obamacare into the Iraq war?" Perhaps not. But Klein's response suggests that they may be more similar than he cares to admit.