The Obama Watch

Who Killed Obamacare?

Mr. President, thou art the man.

By 2.5.10

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Obamacare is dead. The politicians, journalists and bloggers who continue to talk about passing "reform" via reconciliation or some other procedural skullduggery are like those characters in the comedy, Weekend at Bernie's, who lug a corpse around pretending it's still alive. It is, of course, possible -- even likely -- that the Democrats will pass some anemic health care bill that will allow the President to declare victory and give his congressional accomplices a talking point for the midterms. It will not, however, be the grandiose program that everyone expected Obama to sign into law. So, it's worth considering how a piece of legislation whose passage seemed all but inevitable less than a year ago met with such an ignominious fate. What, or rather who brought about the very timely demise of this nanny-state abomination?

Searching for telltale signs of the "real killer" amidst the scattered debris of last year's tumultuous health reform debate, it is difficult to miss the trail of blood that leads to 1600 Pennsylvania Avenue. As counterintuitive as it may seem, a preponderance of the evidence suggests that Obamacare met its unexpected end at the hands of the President himself. Obama killed his signature initiative by creating what he referred to in his State of the Union address, with no apparent sense of irony, as a "deficit of trust." He has broken virtually every campaign promise he made concerning reform, presided over a series of shady back room deals, and treated the voters like an irritating group of poorly behaved and dull-witted children.

At the beginning of his presidency, Obama famously enjoyed a "surplus" of trust. Shortly after his inauguration, however, significant shortfalls began appearing between his rhetoric and his behavior. Having promised that his reforms would not force Americans to give up insurance plans they liked, the President signed off on a congressional proposal to kick millions of seniors off Medicare Advantage (MA). He then reversed his position on the individual mandate, suddenly endorsing a bad idea he had rejected during the 2008 presidential campaign. Next came his brazen flip-flop on the "Cadillac tax." Despite running a series of campaign ads denouncing John McCain for a similar proposal, Obama made it clear that he favored taxing "high-value" health benefits.

These broken pledges added to the trust deficit, but they didn't bust the budget. Complex issues like MA funding and the individual insurance mandate are susceptible to nuanced rationalizations. Even the Cadillac tax can be justified, with some plausibility, by sophisticated advocates. A much larger problem than any of these policy pirouettes was Obama's failure to honor, or even acknowledge, his C-SPAN promise. Obama's pledge to negotiate the details of health care reform in front of Brian Lamb's television cameras could not be finessed. In one of the more delicious ironies of the reform debate, the voters spent the holiday season watching innumerable YouTube videos of Obama making his C-SPAN promise while they noted with increasing dudgeon the conspicuous absence of similar footage of the actual negotiations.

When the sordid character of those closed-door negotiations became generally known, the deficit of trust skyrocketed. Obama's implausible claim that he "didn't make a bunch of deals" notwithstanding, it was blindingly obvious that his people were in on the wheeling and dealing from the very beginning. The administration was, for example, intimately involved in the negotiations that led to Ben Nelson's infamous "Cornhusker Kickback." The Washington Post reported at the time that two administration aides, Jim Messina and Peter Rouse, worked on the deal and "relayed their intelligence to White House Chief of Staff Rahm Emanuel, who monitored the talks from a dinner in Georgetown." There can be little doubt that the President and his people were also involved in the "Louisiana Purchase."

And there is no doubt whatsoever that Obama himself participated in the backroom deal that produced the union exemption from the Cadillac tax. The various labor unions began grumbling about this 40% tax on some health insurance plans when it first surfaced in the Senate Finance Committee last fall, and continued to so when it remained in the bill passed by the full Senate. Big labor is, of course, an indispensable source of campaign contributions for the Democrats, so Nostradamian prescience wasn't required to predict a special dispensation. Sure enough, less than 72 hours after a gang of union bosses descended on the White House to vent their displeasure about the President's support of the offending tax, a "Labor Loophole" was announced.

That sleazy deal destroyed what remained of the public's trust in the President's leadership on health reform. Less than a week later, Scott Brown pulled off his "Massachusetts Miracle" by promising to use his vote to kill Obamacare. Shortly thereafter, a CNN poll found that 70% of Americans were glad the Democrats had lost their supermajority. Incredibly, Obama responded to this rebuke by talking down to the voters. His patronizing attitude was neatly summed up in his State of the Union address. Commenting on the failure of reform, he looked straight into the camera and offered the following mea culpa: "This is a complex issue… I take my share of the blame for not explaining it more clearly to the American people." In other words, he didn't speak slowly enough for the knuckle-draggers out in flyover country to get it.

The President's health reform project might yet have a pulse if he possessed the wisdom of Senator-elect Brown. Brown pointed out, in an interview conducted the day after Obama's speech, "People aren't stupid … leaders should figure out they're better informed now than ever." They are indeed. Yet Obama still insists on treating the American people like idiots. Just this week, he answered a question about the C-SPAN ban by claiming his administration was the most transparent in modern times. It was such insults to our intelligence, combined with broken promises and shady deals, that did in his pet program. The "real killer" of Obamacare wasn't the "party of no," Sarah Palin, Rush Limbaugh, the Tea Party movement, insurance lobbyists or even Scott Brown. Obamacare was killed by Barack Obama.

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About the Author

David Catron is a health care revenue cycle expert who has spent more than twenty years working for and consulting with hospitals and medical practices. He has an MBA from the University of Georgia and blogs at Health Care BS.