The Health Care Spectator

The Audacity of Rope-a-Dope

Obama promised a different kind of health care reform.

By From the May 2010 issue

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Supporters of obamacare claim the president simply delivered what he promised during the campaign, so the American people should stop demanding the law's repeal. But that isn't true. As a candidate, Obama actually campaigned against many of the law's most important provisions.

Obama's biggest policy switch came on the mandate that all Americans buy health insurance coverage. The health care plan Obama unveiled to great fanfare in 2007 and henceforth campaigned on contained no mandate. Hillary Clinton's plan did. Obama attacked Clinton's mandate relentlessly. He said the right reform was not to pass a mandate, but to lower costs.

"The reason Americans don't have health insurance isn't because they don't want it, it's because they can't afford it, which is why my plan doesn't have a mandate and goes further in cutting costs..." he said in Iowa in November of 2007.

"Hillary's idea is that we should force everyone to buy insurance," Obama went on. "But this is yet another issue where she is not being straight with the American people because she refuses to tell us how much she would fine people if they couldn't afford insurance."

Throughout the primaries, Clinton and John Edwards kept attacking Obama for not having a mandate. They said his refusal to impose one meant he wasn't offering truly universal coverage. Obama's response was to hit back with more attacks on the very idea of a mandate. He said it simply wasn't realistic.

"When Senator Clinton or Senator Edwards say they're going to mandate health care, but they haven't talked about either how to enforce it, or how to make it affordable to people, then it's not really a mandate. Anymore than if we mandate that people get car insurance. But [if] they can't afford it, they just don't get it," he said on November 21, 2007.

Obama then tried to link Clinton's and Edwards's plans to Romneycare.

The Associated Press reported on November 26, 2007, "The Obama campaign circulated a memo to reporters yesterday demanding to know how Clinton would enforce the mandate, noting that one state -- Massachusetts -- has taken that route and consumers that do not get coverage lose their personal tax exemption, a $219 cost."

On November 30, 2007, when the Clinton campaign attacked Obama for running a television ad in Iowa that claimed his plan insured everyone when it obviously did not, Obama spokesman Reid Cherlin released a statement that said, "Rather than spending their time attacking Barack Obama, the Clinton campaign should explain how exactly they plan to force every American to buy health insurance even if they can't afford it."

One of Obama's TV ads during the primary said, "Hillary Clinton's attacking, but what's she not telling you about her health care plan? It forces everyone to buy insurance, even if you can't afford it, and you pay a penalty if you don't."

Hmmm. What does that sound like?

Obama didn't fail to include an individual coverage mandate in his plan. He intentionally excluded a coverage mandate, and he campaigned aggressively against one on the grounds that it would be a significant financial burden on many Americans. That isn't just my interpretation. Here is New York Times columnist Paul Krugman's assessment from Feb. 4, 2008:

"You see, the Obama campaign has demonized the idea of mandates -- most recently in a scare-tactics mailer sent to voters that bears a striking resemblance to the ‘Harry and Louise' ads run by the insurance lobby in 1993, ads that helped undermine our last chance at getting universal health care."

Yet despite "demonizing the idea of mandates" during the campaign, Obama reversed himself and embraced mandates only six months after being sworn in as president.

On July 17, 2009, Obama told CBS News, "During the campaign I was opposed to this idea because my general attitude was the reason people don't have health insurance is not because they don't want it, it's because they can't afford it. And if you make it affordable, then they'll come. I am now in favor of some sort of individual mandate as long as there's a hardship exemption."

Obama took months to craft a health care plan for his campaign. Then he spent more than a year defending it. In all that time, he never doubted that an individual mandate was a horrible idea, but in his first six months in the White House he suddenly had enough free time to stop and realize that, hey, Hillary was right after all? That's less believable than John Edwards saying he cares about poor people.

Candidate Obama said his plan would lower insurance costs. The Associated Press reported in March that the legislation won't. It will simply subsidize premiums. And speaking of costs, the health care plan Obama campaigned on projected annual costs of between $50 billion and $65 billion a year. The bill he signed on March 23 costs much more than that by the administration's own low-ball estimates. It is likely to cost more than twice what Obama campaigned on once all the costs, such as the "doc fix," are factored in and Congress fails to follow through with the alleged cost-cutting measures.

Another huge piece of the law that Obama campaigned against in 2008 is its tax on employer-provided health insurance. When John McCain proposed removing the tax break for employer-provided plans for the purpose of decoupling health insurance from employment, Obama called it "the largest middle-class tax increase in history." But on March 14, 2009, less than two months after Obama was inaugurated, the New York Times reported, "The Obama administration is signaling to Congress that the president could support taxing some employee health benefits."

Obama later endorsed taxing "Cadillac" health plans as a means of both funding his expansion of health care subsidies and discouraging employers from offering generous coverage. That contradicted probably his most-often repeated talking point: that you'll get to keep the coverage you have if his reform passes. You won't, and that is by design. The legislation was written to encourage employers to shift to less generous plans.

When Obama said in Dover, New Hampshire, on September 12, 2008, "I pledge to you that under my plan, no one making less than $250,000 a year will see any form of tax increase. Not income tax, not capital gains taxes, not any kind of tax," he followed that line by pointing out that McCain "can't make that pledge" because he would tax employer-provided insurance.

Obamacare not only taxes employer-provided insurance, but taxes medical devices people of all income levels use and fines anyone of any income level who doesn't buy health insurance.

But of all the president's health care reform reversals, his most important is arguably one of process, not policy. One of the greatest appeals of Obama the candidate, and one that seems to have drawn independents to him, was his self-proclaimed bipartisanship. He positioned himself as the centrist candidate in part by repeatedly opposing what he called a "50+1 strategy" of winning political battles. He would seek broader consensus, he said.

In 2005, he said, "What I worry about would be that you essentially have still two chambers, the House and the Senate, but you have simply majoritarian absolute power on either side. And that's just not what the Founders intended. You know, the Founders designed this system, as frustrating it is, to make sure that there's a broad consensus before the country moves forward."

Two years later, he told the Concord Monitor while campaigning in New Hampshire, "We're not going to pass universal health care with a, with a 50-plus-one strategy."

We are not. But he did.

So although Obama campaigned against an individual mandate, taxing employer-provided health insurance, making people change coverage they like, letting premiums continue to rise, raising taxes on the middle class, spending more than $65 billion a year on reform, and passing health care reform by a simple majority, once in office he pushed hard for and ultimately accomplished all of these things.

You might call that the audacity of rope-a-dope. And the American people are the dopes.

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About the Author

Andrew Cline is editorial page editor of the New Hampshire Union Leader. You can follow him on Twitter at @Drewhampshire.