Michael Gerson: Health care alternative, co-sponsored by Orrin Hatch, represents what Americans need
Jacquelyn Martin, AP
WASHINGTON — For President Obama, the state of the political union ... could be better.
It is not only that the president's political support is diminished; it is diminished, in large part, because of his main political achievement, the Affordable Care Act. Because of the way the law was sold — "you can keep your plan" — Americans have questions about Obama's credibility. Because of the way it has been implemented — "the system is down at the moment" — they have questions about his competence. In a recent Quinnipiac poll, a plurality of American voters doubt Obama is "honest and trustworthy" and a majority believes the Obama administration is not competent at running the government.
Add to this an economy recovering so weakly and inequitably that 77 percent of voters call it "not so good" or "poor" and you have a serious possibility that the president's party will lose control of the Senate in November — leaving Obama isolated and legislatively irrelevant.
The great rhetorical problem for Obama is that these are not primarily rhetorical problems. It is neither fair nor realistic to ask speechwriters to succeed where legislators, bureaucrats and health economists have made a botch of it.
This political situation would be interesting if it were not so boring. A second-term president faces declining public standing and a tough midterm election. Not much news there.
It is the ideological state of the union that is less typical and more alarming.
The unraveling of Obamacare is also an unfolding crisis for liberalism. It was the universal liberal assumption that offering fairly generous health benefits — funded in a transfer program — to the uninsured would result in many more of them actually becoming insured, thus creating a social expectation that Republicans could never repeal. (This was also the expectation and fear of tea party conservatives, who described such benefits as crack-like in their addictive power.)
But the early returns are in. A large majority of the 2.2 million people who had purchased insurance on the exchanges by year-end — 65 percent to 90 percent, according to reporting by The Wall Street Journal — already had insurance. Economic writer Megan McArdle does the math, estimating that just 15 percent (750,000) of the 5 million uninsured that the Congressional Budget Office expected to sign up in the first year have actually done so. Meanwhile, administration claims about increases in coverage for the uninsured under Medicaid are badly, even deceptively, inflated.
Economists debate the reasons for this failure of uptake. But, as it stands, Obamacare is largely a health insurance replacement system, not so much an expansion. And the replacement is often less generous, more expensive and more restricted in options than promised. Yet, as McArdle points out, "the worst is yet to come": small-business policy cancellations, expensive government subsidies to insurance companies for excess losses, higher premiums in the exchanges, the IRS collection of individual mandate penalties, cuts in Medicare Advantage, the "Cadillac tax" on expensive policies, the possibility that some insurers will exit the public market entirely.
As the defining legislative promise of modern liberalism is implemented, trust in government is near record lows — a correlation that is not purely a coincidence. And this complicates every other element of the progressive agenda.
Meanwhile, Republicans argue internally — not only about what policy alternatives they might offer but about whether federal policy on most issues is legitimate. And the ideological position generally taken to be more authentically conservative is also unresponsive to public needs and alienating to public opinion. The tea party argument in favor of narrowly interpreted, specifically enumerated constitutional powers is not only a criticism of Obamacare but calls into question the legitimacy of the Great Society and New Deal as well. (It is also a criticism of anyone, including Republicans, who offers an alternative to Obamacare.)
This is not, in fact, the more "authentic" conservative tradition, which has stronger ties to the Federalists and Lincoln than to the anti-Federalists. But this view has come to characterize a significant portion of conservative activists. And given the choice between incompetent liberalism and tea party populism, Americas are, well, in deep trouble.
The alternative is a reform-oriented conservatism that makes peace with the safety net, while empowering individuals and rejecting bureaucratic centralization — the spirit, for example, of the Patient CARE Act, an alternative to Obamacare recently introduced by Republican Sens. Tom Coburn, Richard Burr and Orrin Hatch. It represents what the union needs most right now: another ideological option.
Michael Gerson's email address is firstname.lastname@example.org.
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