Obamacare

The Problem With Obamacare Isn't That It Was Designed to Fail—It's That It Was Designed to Pass

The law's failures stem from its many compromises and concessions to political reality.

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whitehouse.gov

Was Obamacare purposely designed to fail in order to pave the way for an even greater government takeover of the health care system? This is an idea I have heard in various forms for years, and it's getting some attention again thanks to an op-ed in The Hill which charges that Obamacare was merely a setup for a far more intrusive policy reform.

The piece, by California based doctor Jeffrey Barke, is framed as a response to patients who wonder why the health law's architects didn't see its current problems coming. In response, he wonders: "What if they did? What if ObamaCare was purposely designed to fail?" This is not really a question so much as a way of floating a theory for which he does not have much evidence.

He argues that when Obamacare was passed back in 2010, "President Obama and Democrats in Congress wanted to fundamentally revolutionize health care," but that public opposition prevented them from passing a more sweeping bill.

Yet "liberals never backed down from the radical healthcare dreams that were dashed by the American people in 2010," he writes. "They simply needed to bide their time and lay the groundwork. That's why they rushed to pass ObamaCare with so little debate, and without a single Republican vote. Its authors purposely designed the law so that it would fail. And when it did, they could return to the American people with the promise that even greater government intervention in healthcare could end the ObamaCare nightmare."

This is both an odd reading of the history and a thoroughly unconvincing theory of political change. One the one hand he argues that the law's scope was limited due to public opposition; on the other hand he argues that it was rushed through with little debate. If Democrats could rush through anything they wanted without opposition or debate, why not pass the more sweeping bill he claims they preferred? Especially if the plan was to wait until the law failed and then mount yet another risky political campaign in which they would finally pass the law they wanted to see—but this time without the certainty of control of the White House and majorities and Congress, and with the original law's failure as potentially damaging political context?

His idea, basically, is that in 2009 and 2010, Democrats covertly worked together to use their unusual dominance of American government to make the public upset with them by passing a failed law in hopes that the public would give Democrats another chance to pass something even more sweeping later. It is a Rube Goldberg theory of political action that relies on an implausible level of secret coordination in service of a foolish plan of action.

The reality is that Obamacare was debated extensively for the better part of a year. Indeed, it is hard to remember another piece of domestic policy legislation that inspired so much debate and discussion. And while critics successfully predicted many of the law's failures (as well, to be sure, as some problems that did not come to fruition), Democrats believed that those problems would either not occur or would not be significant enough to cause the law to fail. Democrats—especially those in leadership—did not believe the law would fail; on the contrary, they believed when the law passed that it would be successful and politically popular. That belief turned out to be incorrect, but all evidence suggests that the belief was sincere at the time.

These sorts of unlikely conspiracy theories make for attractive explanations, because they allow one to identify scheming villains with nefarious master plans. In reality, politics, which must account for the converging and diverging interests of many people and parties with very different interests, is far more complex. Indeed, the complexity that results from the interaction of those interests is often the source of policy problems.

Barke is right that Democrats did not all get exactly the law they hoped for in Obamacare; the bill was designed as a series of concessions and payoffs to various interest groups and stakeholders and elected officials.

Not only did the law have to pass in the House, it had to find 60 votes in the Senate, which, in the absence of Republican support, meant securing the support of wavering centrist Democrats. The law's designers—fearing the sort of industry backlash that had helped kill a health care overhaul under Bill Clinton in the 1990s—had to ensure that it would not upset industry groups, like drug makers or insurance companies or hospitals, too much, and that doctors, an influential and widely admited constituency, would be on board too.The law's architects also had to design a system that did not radically upset the existing mixed public-private structure of the American health care system too much, and, in particular, would allow the majority of Americans who already had coverage and liked it to keep their existing insurance coverage and providers (this front was so important that they ended up misleading the public). Parts of the law were delayed in order to keep its ten-year price tag artificially low. Other elements were delayed in order to appease unions.

As a result of all this and more, Obamacare was a deeply compromised piece of legislation. Those compromises and concessions were made in order to ensure that the Affordable Care Act could secure enough votes to become law, and without them, it is unlikely that the bill would have become law. But those same compromises have also contributed to some of the particulars of its current struggles by rendering its already inherently complex policy scheme even more awkward and unwieldy. In other words, the problem with Obamacare isn't that it was designed to fail—it's that it was designed to pass.

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73 responses to “The Problem With Obamacare Isn't That It Was Designed to Fail—It's That It Was Designed to Pass

  1. So, it was a case of “Something must be done! This is something, we must do this!”?

    1. As many folks who are no longer speaking with me will tell you, i pointed out exactly that when the ACA first reared its misshapen head.

      1. Cry me a river. Anyone with any smarts has known that mantra for ages.

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      2. The ACA is much like the Iraq War. Anyone with any sense was against it from the beginning.

    2. Something had to be done, but the Republicans refused to help. Any failure is their fault.

  2. Either it was designed to fail or the people designing it didn’t understand basic human (economic) behavior.

    1. Have you seen this country’s current crop of politicians? That may not need to be an either/or statement.

      1. Sure have…. The Socialists/Communist/Fascist Democrats think that centralizing power and letting the Elite/Government have control of everything is the answer.

    2. The second.
      The first presumes an intelligence not in evidence.

    3. Those are not mutually exclusive.

    4. Ha, I knew some people would say that both are possible. But to know the former means they understand at least some (not necessarily all) of the latter…

  3. Agreed.
    This was no false-flag operation by some 4-D chess wizard; this was a mash-up put together by proggie ignoramuses hoping that this time the New Soviet Man would arrive, or that it could be hooked to the money-printing presses.
    They almost got the NSM; that pajama-boy looked dumb enough to qualify.

    1. Odd way to see it. I’ve been harboring the suspicion since the legislation first started to lose traction and ended up being passed in a way that seemed doomed to failure.

      I don’t think it takes a “4-D chess wizard” as you’ve so poetically put it. I think any dummy can actually work it out that if a government program succeeds, it asks for more money. If it fails, it asks for an overhaul and more money. Very, very rarely does any program simply get ended years after it was instituted. If a program is going to die, it’s going to do it fast (usually if it is immensely unpopular, costly, or going to wreck reelection chances in an election year).

      Absence of evidence that this happened on purpose is not evidence of absence of what is ultimately a simple plan. It seems equally plausible that progs really do drink the Kool-Aid and were so economically illiterate that they thought it would work. That’s why it is not out of the question that a few slightly more clever ones could have hatched it and gotten a legion of useful idiots to evangelize it. That trick worked well enough for the soviets.

  4. Someone once said that Forseeable Consequences Are Not Unexpected.

    1. That presumes the intelligence to foresee them.

    2. … are not unintended.

      Your phrasing makes it kind of a tautology. The implication of the statement is supposed to be that no one can get away with “we didn’t intend for X to happen!” when people were pointing out that X was a predictable result of their actions.

      1. I shouldn’t comment before I drink my caffeine.

    3. Someone once said that Forseeable Consequences Are Not Unexpected.

      Yogi Berra?

  5. The grain of truth in “designed to fail” is that the Dems didn’t care if it failed or not, because they figured plan B was single-payer.

    If it worked somehow, great! If it didn’t, still great!

    1. If it worked they would have control government controlled healthcare through the Medicare expansion and the expandable list of what is required for qualified plans (not to mention the reimbursement mechanisms for added unlisted benefits). If it didn’t work then Plan B as you say.

  6. It was a massive vote buying operation for the sole purpose of producing a photo opportunity for the raging narcissist that occupies the Oval Office.

  7. It was explicitly a half way step on the way to full chavez style nationalization (a.k.a. single payer).

    And it was completely foreseeable how and why it would fail.

    If that doesn’t mean it was “designed to fail” then, oh well, we are in semantic territory I don’t really give a shit about anymore.

    1. Sort of. you have to remember how stupid these people are. It was supposed to have a public option. The plan was to make private insurance suck while setting up a public option that would over time swallow private insurance making the transition to single payer seamless and virtually unnoticeable.

      The problem was they didn’t get a public option. So plan B was to pass it without the public option and then after they won a big victory from a grateful public in the midterms, pass the pubic option then. That is why they put off implementing the thing. They wanted some time to pass the public option. Of course they didn’t win a victory in the midterms. They got killed. So the public option was not happening. so they wound up with a bill that destroyed the private insurance market and replaced it with nothing. Since they don’t have the glories of the public option to sell or any public option no matter how bad to force people into, I don’t think they are getting single payer out of this.

      You really can’t overstate how stupid these people were.

      1. That’s because the “public option” was going to end up snowballing as it was designed to. It would begin to fail almost immediately because nobody offers medical services of high quality at low price. Med school’s not cheap. Years of time invested isn’t easy. Then you’ve got a sue-crazy public that threatens your future prosperity and the uncertainty that it won’t get nationalized and all your time and effort will earn you squat.

        Thus, the government would have to prop it up with tax money. That would make it competitive in a market where it otherwise could not be and erode the whole private market until creeping socialism rotted the whole system until it collapsed. They were hoping to build yet another edifice that wouldn’t be touched by conservatives either. Who is proposing to get rid of any of the edifice that already exists (excepting us, of course)?

        1. “That’s because the “public option” was going to end up snowballing as it was designed to.”

          Cite missing.

  8. “…doctors, an influential and widely admited constituency…”

    “admited”? “Admitted” doesn’t make much sense there either. Are other constituencies denied?

    Otherwise we seem to be rediscovering the concept of regulatory capture here.

    1. Try “admired” instead.

      The admiration may not be justified, but it probably does exist. There’s a reason the Surgeon General gets to wear a really elaborate uniform.

  9. The problem was not political reality. If anything political reality helped by keeping these idiots from getting everything they wanted. The problem was the people who wrote this bill were criminally stupid. The bill is failing because it is an insanely crafted bill written by unbelievably stupid people.

    1. The law’s architects also had to design a system that did not radically upset the existing mixed public-private structure of the American health care system too much, and, in particular, would allow the majority of Americans who already had coverage and liked it to keep their existing insurance coverage and providers (this front was so important that they ended up misleading the public)

      They obviously didn’t have to do this because they didn’t fucking do this at all. Who has the same plan they had 5 years ago, let alone 10?

      Many of the provisions of the ACA were specifically designed to upend the health insurance market to get outcomes that the bill’s writers wanted. Not a single one of those outcomes aligned with the interests of people who were satisfied with the system as it was.

      1. … this was not meant as a reply to John

      2. This is correct. They lied to our faces about that knowing full well the law was designed so that you could not keep your doctor if you liked your doctor.

        What was that smarmy little cocksucker’s name? Was it Johnathan Gruber?

        1. Yes it was. I hope the bastard gets pancreatic cancer.

          https://www.youtube.com/watch?v=Adrdmmh7bMo

          1. Too quick. Some form of muscular dystrophy .

            1. Nah.

              Amyotrophic lateral sclerosis. Since he ain’t no Stephen Hawking, I suspect it would be a gloriously inglorious way to go ? downright humiliating, in fact.

      3. The truth that the media never would tell was that the vast majority of the country was happy with their health insurance. They didn’t tell that truth because doing so meant admitting that any change to the system, let alone the radical ones these half wits wanted, screwed most of the country.

        Everyone associated with this bill, the drafters, the people in Congress who voted for it, and the media who shilled for it, deserve to be shot for the good of mankind.

  10. Given the results of this law, a troop of demented chimpanzees could have come up with something better.

    Come to think of it…

    1. +1 joe flouncing off.

  11. One the one hand he argues that the law’s scope was limited due to public opposition; on the other hand he argues that it was rushed through with little debate.

    In accordance with President Obama’s “Sunlight before Signing” pledge, the public got five full days to view and comment on PPACA before it was signed into legislation.

    1. Well phrased, “Signed into legislation.” The big fucking moment it was signed however disguised the fact that it was never “passed by the legislature,” as is required by the Constitution.

      This pile of shit is not a law, has never been a law and is being illegally enforced by what has become an illegitimate government. I truly wish some of the lawsuits on the “law” had focused more on the convoluted, clear unconstitutional process used to bring it to this point.

  12. I wish Obama had said….

    We’re starting a new branch of the US military called “The Good Guys”. It will consist entirely of trained medical caregivers, emergency response, crisis intervention, aid workers, etc. We will be doing away with the VA, Medicaid, Medicare, FEMA, the DEA, and other healthcare subsidies in order to fund it. We’re declaring war on sickness, injury, disease, and other health issues.

    I’d almost be OK with it… Because I can at least reconcile it in my head.

    But as it is, we now have a legal obligation to obtain, and tax funded subsidies to pay for private insurance. We haven’t just legalized gambling, we’ve made it compulsory.

    It’s hard to argue with crazy.

  13. I recently saw a reference to ACORN’s support for minimum wage laws and their arguing that MW laws do not increase unemployment. They asked to be exempted from the minimum wage law because if they had to abide by the law they would be forced to hire fewer outreach workers.

    The left is nothing if not insane.

    In the end it doesnt matter to me if it is dishonesty or cognitive dissonance. I treat them the same.

    No Suderman, the problem with Obumblecare is that it DID pass. I could almost read ‘Top Men just needed more power’ into that last paragraph.

    1. I want to amend that. It did not pass. It was forced on us by hook and by crook unconstitutionally. The method and the law itself are wildly unconstitutional.

  14. Not only did the law have to pass in the House, it had to find 60 votes in the Senate, which, in the absence of Republican support, meant securing the support of wavering centrist Democrats.

    And it didn’t even do that much.

  15. Not that I disagree with the author but this line is misleading…. ” to make the public upset with them by passing a failed law in hopes that the public would give Democrats another chance to pass something even more sweeping later.”

    That is not what people usually say….They say that the failure will be the Private Insurance Companies pulling out making the law non-viable that will have to be fixed.

    Since democrats always SPIN things it will be BIG Insurance’s Fault or the Republicans who are to blame.

  16. The Problem With Obamacare Isn’t That It Was Designed to Fail?It’s That It Was Designed to Pass

    But then I think of what the law would be like if it’s architects could’ve gotten everything they wanted and I shudder at the thought.

  17. BTW, I notice our resident apologists for O-care never bother to try anymore. Even *they* see the colossal fuck-up which is O-care and for that matter, Obo himself.
    The SF Chron, OTOH, still keeps pitching some ‘minor changes’ that will somehow bring all those insurers back to the market. But then the Chron still keeps pitching rent-control as a fix for high rents. Stupid can’t be fixed.

    1. Who are the resident apologists for Obamacare? Aside from Tony, Shriek and Amsoc, (who don’t count as residents) I can’t think of a single name.

    2. Now that Obumbles is on his way out I rarely see them around at all anymore. I wonder what that means?

      If Cankles gets in in November we will soon have a new crop of trolls even more retarded and evil than the last batch.

  18. “In other words, the problem with Obamacare isn’t that it was designed to fail?it’s that it was designed to pass.”

    …and then fail.

    It’s possible for both to be true, and Obama is on video talking to a group stating that this was just a first politically necessary step toward single payer. It’s obvious fraud, and a very destructive one. Since Obamacare, my companie’s premiums have gone up by 70% while delivering plans that are practically like no insurance at all compared to what we had. My employees are now making huge sacrifices so that Dems could get their stupid hobby horse, and what they lost is gone forever. Selfish, arrogant, lying dicks!

  19. Shorter Suderman: MORE SMARTER TOP MEN

  20. They passed a LAW saying healthcare would be affordable. Hellooooo. LAWS DO STUFF. If it didn’t work it’s because of obstructionism. And probably racistism.

  21. What seemed apparent to me is that they didn’t really give a shit if worked or not. The key was to pass something, ANYTHING, just to get the ball rolling and fundamentally transform health care. Just getting something into law was the big hurdle. Once they did that, they figured, they could fix any problems down the line. That’s why the bill was such a hodge-podge monstrosity. It was continuously molded and remolded to make it more politically palatable as well as to maintain the illusion that the financial numbers worked out.

    Once it became the law, then nothing short of tactical nukes would get rid of this thing. That was the appeal for the Donks. How many times have you read even those pundits who ostensibly opposed this shitburger write something like “Well, at this point, to simply repeal the thing and root out the entire rotten structure would be disasterous” Congressional Democrats were counting on exactly that in 2009-10. This was their golden opportunity. Why else do you think so many of those supposed “Blue Dog conservative Dems” fell on their swords and voted for the turd? It was now or never. They got it passed, and if things went wrong they could always count on the lapdog press to blame the GOP for not cooperating with them in making it. In the long run, it was absolutely worth it for them.

    1. You are right that they wanted to pass something. What they didn’t count on was it being so unpopular. This thing has done untold damage to the Democratic party. And the fact that it is going to be so hard to get rid of is turning into a real downside for the Democrats. Because they passed this without a single Republican vote, they now own the entire health care system and are being blamed for all its failures. It has been a complete disaster for the Democrats. Without Obamacare, they likely still control the Congress.

      These people are retarded. You should never attribute any kind of evil master plan to them. They are just stupid.

  22. It wasn’t necessarily designed to fail but they didn’t give a damn whether it worked or not because they knew the remedy would be even more sweet governmental intrusion into healthcare.

    Sort of along the lines of “Hey, we’ll give this a shot but if it fails we’ll go the single payer route.”

    1. Sorry Chipwooder, I swear to God I didn’t rip you off-just read your comment.

    2. I recall many quotes alluding to how this would be the gateway to single payer. I believe this is how they play the game. What do I know, I’m just a conspiracy kook.

      1. quotes from both sides

  23. I don’t think that was the Dems goal; tehy were just glad to get whatever they could, because their goal was government control independent of any specific outcome. But I also think their plan all along, and not just with Obamacare but with everything they do, is geared towards increasing government control of society, and even the slightest toehold is better then nothing because it can be expanded upon. Witness how few government programs ever disappear.

  24. It seems to me that most comments are rightly pointing out the insane incompetence of the 2009 Democrats.But there is very little mention of the idea that nowhere does the Constitution give imbeciles the power or right to legislate that area. Justice Roberts notwithstanding.

  25. This ties back to the earlier article about why socialism is attractive.

    There is a substantial portion of humanity that believes the right top men can succeed at central planning.

    I got into an online argument with a guy recently who claimed, on the one hand, that free enterprise has been tried and failed with healthcare. Then said one of the failures is insurance companies avoiding competition. When I asked how they do that, he pointed to their influence over the government. Pointing out that regulatory capture is not free enterprise was a big “whoosh”. over his head. He complained about the $600 epipen. I pointed out that again is gov’t squelching free enterprise. All to no avail. Nothing was going to dissuade him from the belief that only noble government can provide health care.

    We’re back to sarcasmic’s observation. They have good intentions. Failure must be due to bad intentions. The premise is never the problem.

    1. “He complained about the $600 epipen. I pointed out that again is gov’t squelching free enterprise. All to no avail. Nothing was going to dissuade him from the belief that only noble government can provide health care.”

      There was a commenter who came and went; judging by his/her grammar, teens. In support of the claim that ‘free trade is evil’, s/he pointed to the brutality of King Leopold in the Congo!
      There was no way that dimwit could or would understand that the actions and agency of a King was in no way ‘free enterprise’.

      1. But it was called the Congo Free State! Free is in the name! Surely it was run by libertarians, what with your constant talk of freedom!

  26. Good. I was worried Obama might be a maniacal evil genius, but it’s comforting to find out he’s actually just a smarmy Chicago wheeler dealer fuckface politician. Does Medicaid cover semen overdose?

  27. If King Obama likes your health plan you can keep it.
    Only King Obama knows what’s best for you
    He is pro-choice – He decides what’s best for you and you must comply.

  28. No, no, no, no. Mr. Obama (along with all the Progressives, and most of the Liberals) were all in favor of a single payer, and had been for decades. They knew there was no chance to go straight to it, and PPACA was a transition vehicle. These people know that the key to securing the big government they all long for requires control over healthcare spending and access. They know that it can be structured to reward the worthy and punish or manage the rest of us.

    The die for PPACA passage was cast when Rep. Bart Stupak caved on funding for abortion. after him (the last principled holdout) it was all over. Nobody thought much about the journey, all that mattered was crossing the river and burning the bridge to set out for the destination of single payer.

    It is more clear now that the insurance companies and hospitals are figuring out ways to be the single payer conduit, as few people really want the US equivalent of a National Health Service. It is also clear that there will soon be few other choices recognized as viable, especially in Red State (not densely populated or much covered by the MSM or Reason) America, and that is that.

    Suderman knows better, but he likes the free drinks at those cocktail parties in DC. Enjoy it while you can, Pete. You like those Progs… But they don’t like you, and they never will.

    1. “No, no, no, no. Mr. Obama (along with all the Progressives, and most of the Liberals) were all in favor of a single payer, and had been for decades. They knew there was no chance to go straight to it, and PPACA was a transition vehicle. These people know that the key to securing the big government they all long for requires control over healthcare spending and access. They know that it can be structured to reward the worthy and punish or manage the rest of us.
      The die for PPACA passage was cast when Rep. Bart Stupak caved on funding for abortion. after him (the last principled holdout) it was all over. Nobody thought much about the journey, all that mattered was crossing the river and burning the bridge to set out for the destination of single payer.”

      Sarc, right?

  29. Start working at home with Google! It’s by-far the best job I’ve had. Last Wednesday I got a brand new BMW since getting a check for $6474 this – 4 weeks past. I began this 8-months ago and immediately was bringing home at least $77 per hour. I work through this link, go to tech tab for work detail,,,,,,,
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  30. The law’s architects also had to design a system that did not radically upset the existing mixed public-private structure of the American health care system too much, and, in particular, would allow the majority of Americans who already had coverage and liked it to keep their existing insurance coverage and providers (this front was so important that they ended up misleading the public).

    That may be the most generous description of their “keep your doctor” promises I’ve heard. I’m not sure if you noticed, but they didn’t do anything like what you just said they “had” to do, they just promised it and then didn’t even attempt to do it.

    “Boy, making everyone happy is sure hard” is not an adequate excuse for dictating which perfectly safe commercial products can be voluntarily purchased by citizens.

  31. The real story: Why can’t reason find a different picture for their Obamacare articles?

  32. That’s really cool. I would be interested in seeing more graphs of different information you pull from these logs.
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