Obama's assumptions about healthcare reform, in 2009 and today

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Jonathan Cohn today published an adapted excerpt from his book about the Affordable Care Act, The Ten Year War, coming out on Tuesday. The article's centerpiece is Obama's own assessment of what went right and wrong in the design, passage, and enactment of the ACA.  Of the ACA's basic design, which had become a consensus Democratic by the time Obama was elected, Cohn notes, "It was a far cry from the government-run insurance plan that Harry Truman once championed, but Democratic leaders embraced it as the best they could get..."

 ― and so did Obama, who repeated in our interview his belief that something like a government-run, “single-payer” system would probably work best, but creating one right away would be too difficult. 

“We have a legacy system that is one-sixth of the economy,” Obama said. “The idea that you could, in some way, dismantle that entire system ― or even transition it entirely ― to a single payer system looked politically impractical and probably really disruptive. ... The best chance to actually get people healthier was going to be to design a system that acknowledged 85% of the American people have health insurance and that plugged the gap for those 15% who don’t.”

Obama's neat foreclosure of other possibilities here reminds me of the technique deployed throughout his memoir, A Promised Land, of showcasing his undeniable rationality within a framework bound by self-imposed limits, or limits imposed by his choice of advisers, or -- sometimes -- by what was politically possible.  I see two fallacies here.

Obama's bid to bend the arc back toward justice

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In 2013, I marveled as pundits expressed surprise when Obama said what he'd always said about the economic case for a fairer distribution of wealth. It seemed that the connection Obama constantly asserted between fairness and prosperity hadn't registered. I wondered, Will we hear Obama in retrospect?

The answer now appears to be yes, evident in the outpouring of love and longing in reaction to his virtual commencement speeches for graduates of historical black colleges and universities and all high school graduates. But not in the way I'd anticipated.

Obama's core pitch, as candidate and president, was for a recommitment to shared prosperity -- public investment, income redistribution -- after decades of steadily encroaching plutocracy. He encased this pitch in a seductive narrative of American history in which this commitment to the common good was renewed and extended at intervals: the nation might err, but its long-term course was to approach ever nearer to fulfilling its founding principles of equal rights and shared opportunity. Democracy, embodied in bottom-up demand for justice, enabled periodic course correction: American history followed the arc that bends toward justice.

Hey America, let's go through the Obamagate

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Trump, displeased by U.S. law enforcement and intelligence agencies' investigations of the criminals and traitors who staffed his 2016 campaign and early administration, is deploying Barr (and his own deranged rhetoric) to smear and criminalize those efforts and tie them to the past administration under the rubric of "Obamagate."

In Trump parlance, "Obamagate" is a mass of trumped-up charges and projections advancing the fiction that Obama, like Trump himself, deployed law enforcement and intelligence to pursue his personal enemies and protect his personal friends. Obamagate is a moral looking glass through which Trump's face is imposed on Obama's.

I'll give Trump this: The term does have a certain resonance. Would that this country could pass through an equally fantastic Obamagate to various norms and benefits we took for granted when Obama was president.

If only we could..

• Pass through an Obamagate to a time when the president put the national interest above his personal interests, and worked as hard to advance prosperity and opportunity in states run by his political rivals as in states run by his political allies.

Obama's ACA sabotage claims: Checking the AP fact-checkers

Today Associated Press fact checkers Calvin Woodward and Christopher Rugaber spank Obama for claiming that Republican sabotage of the ACA "has already cost more than 3 million Americans their health insurance.' Okay, the claim is debatable, but the fact checkers need a fact check. Or at least some qualification.

Woodward and Rugaber allege that "Obama is cherry picking survey results" and blaming Republicans for all the ACA marketplace's problems, which had begun before the Trump administration took over. Both true to a degree. But...

The dueling surveys are Gallup-Sharecare, which found that the uninsured rate among adults had upticked 1.3% by the end of 2017, which translates to 3.2 million fewer insured, and the CDC's Nation Health Interview Survey (NHIS), which found the uninsured population essentially unchanged from Q1 2017 to Q1 2018. Obama was relying on Gallup. For sure, that suited his purposes. But there is some corroborating evidence as to the effects of turmoil in the ACA marketplace -- largely though not entirely as a result Republican sabotage.

AP notes that marketplace enrollment dropped by "only" about 900,000 in 2018, the year that Republican-induced disruptions* took full effect. That's true -- but those disruptions triggered a massive premium spike in 2018 that devastated off-exchange enrollment in ACA-compliant plans -- that is, among those who don't qualify for ACA subsidies and so bore the full brunt of the premium increases.

According to the Kaiser Family Foundation, off-exchange enrollment dropped by 2.3 million, or 38%, from the first quarter of 2017 to the first quarter of 2018. On-exchange enrollment was also down by a couple of hundred thousand (here I take mild issue with Kaiser, which chose not to correct a CMS reporting error in 2017). Enrollment would have been depressed still further -- by several hundred thousand -- if not for the paradoxical effect of Trump's cutoff of direct federal funding for Cost Sharing Reduction (CSR).  When insurers priced CSR mostly into silver plan premiums, that move alone drove premiums up by double digits for unsubsidized enrollees, but also created discounts  in bronze and gold plans for the subsidy-eligible that boosted enrollment among the more affluent subsidized.

Melt like wax into God or be born into her womb?

Continuing vacation posting of old non-political bits...

Kierkegaard, Julian, Obama

(5/5/13) -- Who knows what governs how a moderately engaged undergraduate makes sense of abstruse philosophic texts? As a sophomore, my mind settled on a basic dichotomy: Hegel bad, Kierkegaard good. This was probably what you might call a gendered thought. Hegel's basic How-Things-Work was to my mind aggressive, imperialist, male: thesis absorbs antithesis in new synthesis. Man slays dragon, eats its heart, becomes (relative) superman. Kierkegaard, by contrast, kept apparently irreconcilable opposites in eternal balance, on an eternal toggle switch whereby they could be seen alternately as part of a unity and eternally distinct.

I can't tell you at this distance whether my abstract caricature is accurate, but it has stayed with me all my life, and I tend to class thinkers on one side or the other of this divide. In retrospect, I'm sure that I placed the subject of my dissertation, the medieval mystic Julian of Norwich (an achoress, i.e. a nun in self-imposed solitary confinement) on the Kierkeaardian side of the ledger, though I never zoomed up the centuries to probe the association. *

Julian had a brilliant trick of subordinating the harsh elements of Catholic dogma that she didn't like (the damned are damned forever) to those that she felt by force of direct revelation to be true (all will be well, and all will be well, and all manner of things will be well).  Her basic dynamic was that God-as-man maintains two "cheres," or points of view: the human, limited one, whereby we must see and condemn our own sin, and the "inward, more ghostly" and more strictly divine one, whereby no one does anything except by God's will, and God is delighted with all, and sin is merely an instrument of human self-education.

There's Martin Luther King's dream. Then there's his American reality principle

Martin Luther King's finest hour may have come when he took a stand against the Vietnam War, breaking with the president with whom he'd partnered to pass epochal civil rights legislation.

Returning to the speech in which King took that stand, I find myself taking a weird kind of solace in his clearheaded denunciation of the violence that tore at two societies. It's a reminder, in the Trump era, that American betrayal of American ideals is continual, that backlash is continual, that mass violence inflicted on foreign populations is continual, and systemic injustice inflicted on minorities at home is continuous.

Why does that reminder offer solace?  Because along with the failure, success has also been continual: we have recovered from, and partially redressed, so many past self-inflicted wounds. Somehow, this account of how the triumphs of the civil rights movement turned to ashes reminds also that there was a residue of progress -- and also some lessons learned from Vietnam that held in some measure for 20-30 years.

Here is the core indictment in King's speech against the war delivered at Ebenezer Baptist Church on April 30, 1967:

"X" is for ten: An anniversary for xpostfactoid

Over the weekend, it dawned on me that xpostfactoid's tenth anniversary was coming up. I checked, and indeed, I started blogging continuously on October 10, 2007, after a couple of false starts.

The thought made me rather sad, in that the blog started as Obama came into full focus and is tied up with my hopes of political and national renewal that gained steam throughout 2008  -- as first the seeming miracle of Obama's nomination drive came to fulfillment and then the wonder of the United States electing an African American whose rhetoric and thought was imprinted with Lincoln's took hold. And look where we are now -- in danger of turning that legacy, if not the whole world, to ashes after electing a lifelong fraudster and vicious demagogue, someone an emotionally grounded six-year-old would run from screaming.

But the blog's first posts from fall 2007 feel strangely contemporary. Back then, in the Later Bush Era, I wondered whether American democracy had lost its ability to self-correct -- precisely the capability that Obama spent the next nine years spotlighting as the nation's defining virtue. If you'll indulge a pair of early snippets:

How to hand the keys to an unfit successor

How do you hand the keys to the Oval Office to a man you've declared in no uncertain terms to be unfit for the presidency?

Obama's handwritten note to Trump, placed before Inauguration Day in the top drawer of the president's desk, is a carefully calibrated document -- a muted "don't be evil" plea on behalf of the nation, with goals distilled to the most basic: justice, security, democracy. Stark in its simplicity, it's generous without warmth, avoiding the hypocrisy of any hint of confidence in the recipient.

It begins with a depersonalized wish:

Obama, dis-illusioner in chief

Obama's year-end press conference on Friday was preceded by breathless expectations, half-voiced, that he would, I don't know, call the election results illegitimate, suspend transition, call on electors not to cast their votes for Trump...the hopes were inchoate.  And the despair when Obama launched into his characteristic slow-talking, methodical, low-drama point-by-points was the Twitter equivalent of Lamentations.

Listening while watching Twitter (twistening?), at first I shared the disillusionment. But gradually I began to feel that Obama's performance was literally that -- dis-illusionment. Obama was telling us some hard truths about the degradation of our institutions. His meta-message was: Russia didn't do this to us - we did it to ourselves.

In fact he was explicit on that point. Here is where my own (wavering) reaction tipped from "he's explaining away his soft-touch response to Russian meddling" to "he's telling us the truth":

Obama calls Trump unfit for the presidency. Republican react in outrage, right?

Yesterday, Obama called Trump "unfit to serve" as president. In fact, he made the case at length.

Using the formal backdrop of a joint news conference with Prime Minister Lee Hsien Loong of Singapore, Mr. Obama suggested that Mr. Trump would not abide by “norms and rules and common sense” and questioned whether he would “observe basic decency” should he reach the Oval Office.

The president said he would have been disappointed to lose in 2008 or 2012, but added that he had never doubted whether his Republican rivals in those races, John McCain and Mitt Romney, could function as president or had the knowledge to make government work.

“That’s not the situation here,” Mr. Obama said.

Alarm bells went off for those familiar with basic political dynamics (or schooled, like me, by political scientists contributing to mainstream journalism in recent years).  Presidents polarize. When the president comes out in favor of something, the out-party turns agin it, by reflex. That goes triple in the Obama era, when the right wing scream machine has demonized the president's every move, including his birth.

When a democracy offers "one choice": Obama's haunted celebration

One of the enduring themes in  Obama's rhetoric is to embrace the messiness of democracy: to remind listeners that 'the other side may sometimes have a point,' to urge the necessity of compromise, to affirm that people on opposite ends of the ideological spectrum share some core values.  

It was all the more striking, then, that in his convention speech last night he placed Donald Trump outside the pale of this consensus allegedly underpinning all our battles over policy. In his 2008 convention speech, Obama praised John McCain's service to country and personal decency effusively while lambasting his polices; in fact the whole convention was structured to kill McCain with kindness. With Romney he was more caustic, suggesting in his 2012 convention speech that to vote Republican was to choose oligarchy. But oligarchy is on the democratic spectrum. The U.S. has always been an oligarchy to greater or less extent.

In this his valedictory paean to democracy, in contrast,, Obama asserted that there was only one choice. He ultimately placed the Republican nominee in the company of the destroyers of democracy, the nation's worst enemies: fascists, communists, jihadists. And the context in which he made that shocking but wholly appropriate charge is fascinating.

He began by evoking the "real America" as portrayed by Trump's precursor, Sarah Palin: the small town Bible belt heartland -- where ironically he, in a very real sense, came from. He then carried that "heartland" through space and time, to Hawaii and working class black Chicago and to the present -- and then to the entire world from which the U.S. draws its immigrants.

As Democrats mull how change works, consider Obama

Bernie Sanders' light sketch of single-payer healthcare Utopia has got Democrats debating their theory of change. Generate mass support for fundamental restructurings -- of healthcare, banking, wage law --or take any step you can, by legislative compromise or executive order, to make current institutions more progressive?

Obama is often held up these days as a proto-Bernie who stoked the thirst for swift transformation in 2007-8 and then disappointed. But if  Hope and Change was the Obama trumpet call, his bass note was always slow, hard, pragmatic step-by-step progress.

Even at his most apparently messianic, Obama has always stressed the incremental nature of change for the better. As I've noted more than once, the key words here, on the night he clinched the Democratic nomination in 2008, are began to:

Obama on polarization: I failed, we will succeed

I found the first half or so of Obama's final SOTU pretty anodyne, and I did not like the scalp-waving -- 'just ask Osama,' etc.  But there were two points on which I thought he got intensely real -- both involving the dangers of what we as a country might do to ourselves.

The first was putting the threat from ISIS and other terrorist networks (current and future) in its place:

But as we focus on destroying ISIL, over-the-top claims that this is World War III just play into their hands.  Masses of fighters on the back of pickup trucks and twisted souls plotting in apartments or garages pose an enormous danger to civilians and must be stopped.  But they do not threaten our national existence.  That’s the story ISIL wants to tell; that’s the kind of propaganda they use to recruit.  We don’t need to build them up to show that we’re serious, nor do we need to push away vital allies in this fight by echoing the lie that ISIL is representative of one of the world’s largest religions.  We just need to call them what they are – killers and fanatics who have to be rooted out, hunted down, and destroyed.

In effect: this is the Barbary Pirates, not World War III.

The second was an extended warning about the road to oligarchy -- paved with polarization, campaign finance gone wild, voter suppression and demagoguery. There were two parts to it: the emotion of dysfunction, and the machinery of it. First, the emotion:

Obama to Inskeep: I'm not Eisenhower, ISIL is not the Soviet Union, the media is not the culprit, the country is not in crisis

NPR's Steve Inskeep began an interview with Obama by setting on a tee what might have looked to some like a giant softball:

STEVE INSKEEP: I have been reading a history of part of the Cold War. Dwight Eisenhower was president, he's meeting his cabinet sometimes in this room where we're sitting. The Soviet Union has emerged as a major nuclear threat. The country is very worried at this point in the 1950s. But Eisenhower is convinced that they are not that strong, that the United States is stronger, that the U.S. will win if we just avoid a huge war.

And he decides to try to reassure the public, gives a series of speeches, saying, keep your chin up, everything's fine, our strategy is working. It's a total failure. The public doesn't believe him. He is accused of a failure of leadership, and his approval rating goes down.

Are you going through the same experience now with regard to ISIS?

Obama took it for a ball:

The moment when the rise of the oceans began to slow

Not to minimize the dangers posed either by ISIS or Trumpism, but the odds are pretty good that both will fairly swiftly end up in the ashcan of history. Meanwhile, as we in the US obsess about both, a 195-nation climae accord has been negotiated in Paris that may lay the foundation for  continued human progress without catastrophic interruption.

While the US is maintaining a relatively low profile at the conclusion, the accord would not have been possible without forceful and effective climate action on the part of the Obama administration and the long, intensive efforts of John Kerry. Thank God we have a president who knows what's most important, knows how to prioritize and persist.

Obama was mocked for grandiosity when he laid out this hope on the night he secured the Democratic nomination in 2008 (my emphasis):

Obama overcompensates for winning

Obama's defense of the Iran deal in an interview with the Jewish Daily Forward's editor-in-chief Jane Eisner was marked by bulletproof logic and and impressive grasp of nuance. It was marred, however, by grotesque overcompensation for having beaten back Netanyahu's attempt to control U.S. policy on this front. Obama foreclosed on the the possibility of a fundamental divide in interests, not to say values, in terms inappropriate to relations between nations:

There are always going to be arguments within families and among friends. And Israel isn’t just an ally, it’s not just a friend — it’s family.

And then:

No man is an island -- but the GOP is

Yesterday, in a speech in Anchorage starkly laying out the current and future effects of climate change, Obama rhetorically placed his opposition on an island unto themselves, as besieged intellectually as Alaskan islanders now are physically. That reminded me of something. Here's the passage:

But if those trend lines continue the way they are, there’s not going to be a nation on this Earth that’s not impacted negatively.  People will suffer.  Economies will suffer.  Entire nations will find themselves under severe, severe problems.  More drought; more floods; rising sea levels; greater migration; more refugees; more scarcity; more conflict.

That’s one path we can take.  The other path is to embrace the human ingenuity that can do something about it.  This is within our power.  This is a solvable problem if we start now.

And we’re starting to see that enough consensus is being built internationally and within each of our own body politics that we may have the political will -- finally -- to get moving.

So the time to heed the critics and the cynics and the deniers is past.  The time to plead ignorance is surely past.  Those who want to ignore the science, they are increasingly alone.  They’re on their own shrinking island. 

Here's the association. Defending the Iran deal in early August, Obama similarly quarantined the opposition: 

What if Congress rejects the Iran deal? Ex-Mossad chief Halevy fills in the blanks

There's one incontrovertible point in the argument against the Congress rejecting and invalidating the nuclear agreement with Iran. Even if you think the deal was poorly negotiated, if the U.S. walks away the sanctions regime will immediately fall apart and Iran will gain everything it could ever gain either by cheating on the deal or stepping up its enrichment and weapons program when various constraints expire. 

Obama has made this point repeatedly, minus the "even if you think..." part. The shorthand is "what is your alternative?" -- and there is none. Implicitly recognizing this, Chuck Schumer, in the most self-negating policy statement I've ever read, could barely bring himself to sketch in (in the statement's last breath) an alleged alternative path:

Hillary's short history of inequality is too short

A few weeks ago, I contrasted Elizabeth Warren's critique of income inequality in America with Obama's. The critiques are substantively similar, laying primary responsibility for the widening wealth and income gaps on Republican tax, labor and regulatory policy and citing similar stats showing that virtually all productivity and output gains over the last several decades have gone to the wealthiest. But Warren is more laser-focused on Republican and Wall Street malfeasance: Obama acknowledges contributing causes as diverse as global competition and domestic racism. And interestingly, where Obama cites four stats to illustrate the growing gap, Warren concentrates her fire with one pair:

Since 1980, how much did the 90% get of income growth in this economy -- from 1980 to 2012, the 90% got zero. None. Nothing.

Zero. None. Nothing. You could hang a campaign on that, no?

Now what about Hillary Clinton, who officially kicked her campaign off with a speech on Roosevelt Island yesterday?

Molly Ball points out quite rightly that Clinton is being credited with a more full-throated populism than she voiced:

"Strong enough to be self-critical": Obama's handwritten additions to Selma speech

As I noted at the time of Obama's Selma speech,, the idea he expressed there that riveted respondents -- that America's greatest strength is its capacity to self-correct, in a never-finished drive to fulfill the promise embedded in its founding documents --  -- was not only not new, but was the same story that Obama's been telling continually since he first appeared on the national stage, and probably before. He did take that message to a new level of clarity at Selma, while expanding the circle of those he credited with fighting that fight and advancing the "always perfecting, never perfected" narrative.

Today the Washington Post is out with a hand-edited draft of the speech. It turns out that Obama handwrote-in the most direct expression of its core idea. And he pointed it directly at his most recent critics -- e.g., Giuliani, who had recently charged that Obama doesn't love America -- contrasting his brand of patriotism with a cardboard boosterism "based stock photos or airbrushed history."

Here is that passage with the handwritten addition bolded, an omitted portion in strike-through, and a later addition in red type:

...Selma is not some outlier in the American experience. Even today, we continue have debate about what it means to love this country, to be a true patriot. But what greater expression of faith in the American idea, what greater form of patriotism is there, than to believe that America is not yet finished, that it is strong enough to be self-critical, that each generation can look upon its imperfection and say we can do better.  That’s why it’s not a museum or static monument to behold from a distance. It is instead the manifestation of a creed written into our founding documents: "We, the People....in order to form a more perfect union."