Political Animal


June 14, 2012 1:31 PM False Choice Redux

By Ed Kilgore

One of the hoariest debates in recent politics, revived by Mitt Romney’s highly selective quotations from Noam Scheiber’s recent book, is whether the Obama administration lost an opportunity to further stimulate the economy when it decides to devote so much attention and political capital to the enactment of the Patient Protection and Affordable Care Act of 2010.

This argument remains ridiculous coming from Republicans, since they opposed Obama’s economic policies as violently as they did his health care policies. But it’s a claim you also hear often on the Left, including, as a matter of fact, from Noam Scheiber.

But as Harold Pollack explains at Ten Miles Square, the “false choice” of health care versus the economy is particularly suspect if you look at the stimulative effect health reform might have produced had it been designed a bit differently:

The real missed opportunity was the failure-forced by fiscal conservatives at both ends of Pennsylvania Avenue-to embed more effective and immediate help for states, localities, and ordinary people in the nuts and bolts of the final bill. Health reform included many opportunities for a second stimulus. Many of these opportunities were missed, due to the tentative back-loading of the Senate bill that became the core of the Affordable Care Act.
Suppose ACA had included a five-year extension to the COBRA subsidies embedded in the 2009 stimulus. Imagine if ACA had abolished the mandatory Medicare waiting period for individuals who qualify for federal disability programs. Imagine if the bill had allowed each state the option to begin health insurance exchanges as soon as these could possibly be implemented. Imagine if ACA had continued the 2009 stimulus’s highly-favorable federal matching rates for hard-pressed state Medicaid programs.
Each of these measures would have been sound health policy. Each would have accelerated the on-the-ground implementation of health care reform for ordinary people. The Affordable Care Act’s original sin, tentative back-loading of its main pillars, left health reform more politically vulnerable than it needed to be. It also left on the table needed opportunities to provide immediate help to a weak national economy.

When the final accounting of the Obama administration is written, Harold’s what-might-have-been should become more than a footnote.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.


  • TCinLA on June 14, 2012 1:42 PM:

    Pollack's indictment of the Obama Administration is absolutely right. Watching those fools blow the opportunity for real reform with their timidity and their Rockefeller Republican policies, I thought "why can't they at least get this thing going before they have to stand for re-election?"

    God I hate the the choice of a crew of idiots (Dems) vs. a crew of fascists (Republicans).

  • c u n d gulag on June 14, 2012 1:48 PM:

    Between the Republicans, and the Red Dog Democrats (I don't call 'em "blue," 'cause there ain't nothin' blue 'bout 'em) in the House and Senate, it's a minor miracle ACA got passed at all.

    What the Democrats failed to do, was to defend what WAS passed!

    Instead, when the R's and their Teabagging sycophants, started shrieking like it was a national 'Force-feed Poisoned Cod Liver Oil Program To Kill The Old And Young," the Democrats ran away and took cover from it like it was a nuclear IUD.

    They had a chance to explain what was in it, and why people had to wait for almost 4 years before most of took effect *cough* Republicans *cough*, but instead, took defeat from the jaws of victory, and made people wonder, "Well, how feckin' good can this feckin' thing be if the very feckin' people who passed it are feckin' running away from it like they're being chased by a rabid feckin' Pit Bull?"


  • gus on June 14, 2012 1:55 PM:


    You think someone in charge of including anything related to COBRA in the ACA would have thought that making it actually affordable would have been a boon to people who may consider buying it. But, noooooooo.

    Also, Since 1992, the GOP candidate for president has, barely won, the popular vote once, and that was just in 2004.

    Just saying...

  • T2 on June 14, 2012 2:17 PM:

    "just saying"
    so from 92 til now we've had 12 years of Dem prez, 8 years of GOP....which should have legally been at least 4 more years of Dems. But the 8 years of GOP were horribly ruinous for the nation and so here we sit. Had Gore simply run on the Prosperity of Clinton instead of "I'm so ashamed of Clinton"....he'd have had a landslide instead of a cheat-able win for Jeb and George. And we'd be a really different nation.

    just saying....

  • sue RN on June 14, 2012 3:03 PM:

    not only did our Dems refuse to implement REAL reform-medicare for all- they failed to explain how big a chunk of our economy healthcare is and why freeing up a bunch of money being wasted on paperwork-30% of your insurance dollar!!!-would stimulate the economy-and how disentangling healthcare insurance from employment would improve the labor market and the competitiveness of companies.

    It's the clueless vs. the heartless...

  • Citizen Alan on June 14, 2012 3:11 PM:

    I will say this much. Obama staked his entire presidency on the ACA,a Rube Goldberg collection of warmed-over Republican ideas that now hangs by the thread of a single vote on the Supreme Court, when he could have spent the last three years moving heaven and earth to improve the economy and demagoguing the treasonous GOP over their obstruction. And now, he's going into reelection with a tepid, possibly failing recovery, a landmark health care bill that may be struck down any day now, and a cabal of insane, anti-democratic billionaires who will be spendthrift in their desire to destroy him.

  • Rick B on June 14, 2012 3:40 PM:

    Gulag, as usual you've got it right. My bet is that the conservatives, both Republican and Democrat, saw that the bill was going to pass even though they didn't want it to. So they built into the bill the political vulnerabilities and a period of delay for them to become effective.

    Ben Nelson was an insurance executive. He probably knew enough to dream that strategy up all by himself before he tried to hold up the administration for additional goodies when it did pass. If he didn't dream it up himself the insurance industry very likely prompted him. That's exactly the kind of crap the lobbyists buy from Congress.

  • Rick B on June 14, 2012 3:48 PM:

    Citizen, face it. Obama saw himself as doing long term things the country really needed instead of putting more patches on a rotten tire. A new health care policy on a national basis was without doubt the single most needed long term policy possible for the government, and Obama essentially had a year to get it or nothing.

    If it survives the conservative insanity, the ACA will structure health care financing so that providers can predictably get paid for providing needed care. That means they can start planning instead of doing everything off the cuff and then scrambling to replace lost funds somehow when the patients don't come with rational payment plans behind them.

    That will lower long term health costs as Massachusetts is already proving, which lowers the long term deficit substantially. (Getting out of unneeded wars is a lot less long term. He's also doing that.)

  • gus on June 14, 2012 4:14 PM:

    Yeah, I wasnt born yesterday. I recall 01-08.
    Im just saying that theres never been this huge Republican majority we should think it gonna crush everything.

    Its always about the margins and there are relatively thin margins in the two most recent GOP presidential victories.

    I still feel strongly that Mitt will not become the next president, this year or four years from now.

  • GUCCI ؔ on June 15, 2012 2:58 AM:

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