Has Obamacare destroyed Obama?

This is a tragedy for all Americans, because the mechanics of health care in America, in desperate need of simplification and cost cutting, are now poised to become more byzantine, wasteful and cutthroat than ever— in plain English, more shortened and stunted lives. How this happened and what it means is worth some parsing.

When Obama became President in 2009, the immediate claim on his attention was a financial catastrophe that threatened the global economy with ruin. He also had to deal with two failed wars that, symbolized by Guantanamo Bay and Abu Ghraib, had reduced U.S. prestige to its lowest point in a century and left the Constitution in tatters.

So, naturally, Obama invested virtually the entire political capital of his first year in office on health care reform.

America’s unique model

To be sure, U.S. health care was in critical condition. Costs were prohibitively expensive even for those insured; and 50 million Americans— disproportionately children— had no coverage at all. In a quieter time, and with a president prepared to lead boldly, health care reform would certainly have commanded a principal place on the national agenda.

But with a White House fighting several major fires at once and unprepared to do more than offer general guidelines from which it would retreat time and again, health reform was bound to be done badly if at all, and certain to result in the entrenchment of the for-profit system that was the essence of the problem to begin with—a model at this point unique to the U.S. among developed countries, and repudiated or reduced to a regulated utility model everywhere else.

Why, then, did Obama bet the farm on health care reform? Here’s my guess: the Clintons. They, too, had been defined by a health reform debacle. Obama had had to give Hillary Clinton a plum appointment to neutralize her politically. When the memoirs are all written, we’ll know more about how and why Obamacare came about, but I would be greatly surprised if the desire—perhaps the need—to trump the Clinton dynasty were not at the heart of it.

Lesson of the Clintons

The larger question, though, is the process by which such a terribly compromised bill emerged— and avoided defeat altogether only through the resolve of House Speaker Nancy Pelosi.

When Obama declared a single-payer system off the table at the very beginning, he invited insurance lobbyists to come in for the kill, and indeed they wrote substantial portions of Obamacare. When— learning precisely the wrong lesson from the experience of the Clintons—Obama gave Republicans an equal share in drafting the bill, he made it hostage to a determined minority opposition that first eviscerated and then boycotted it. In the end, Obamacare was a Republican bill— Romneycare writ large— without a single Republican vote in its support.

Anyone involved American politics for the preceding 15 years should have known better. The modern Republican Party takes no prisoners. To believe that it was about to allow a Democratic president to remake nearly a fifth of the economy in a spirit of bipartisanship was simply naïve beyond belief— especially after Senate Minority Leader Mitch McConnell declared early on that his party’s objective was to make the Obama administration fail. The Republicans couldn’t defeat Obama in the 2012 election, although he gave them every opportunity. But in Obamacare they had a Trojan Horse that could destroy the second term.

Republican resistance

Obama himself did the rest. With three and a half years to prepare for the rollout of Obamacare, there was much to be done, with exchange centers to be coordinated in all 50 states. There were also the lessons of the Romney program in Massachusetts— the nearest analogue to Obamacare— to be learned. That program was most successful in extending coverage, but least so in controlling costs.

Of course, Obamacare was infinitely more complex than Romneycare. As a program based on private purchase of insurance, it was subject to 50 different sets of laws and regulations. In 34 states, Republican governors refused to cooperate on implementing exchanges. As a result, even where the website was navigable, consumers often found themselves with nothing to log on to.

Given that Republicans had attempted to have the Act declared unconstitutional and then made its repeal the centerpiece of the 2012 campaign, such obstruction was inevitable. Yet the Obama administration apparently never factored in the disparity between exchange-friendly and unfriendly states in calculating its enrollment projections.

Shifting the blame

Obama himself was hoist on the petard of his own oft-repeated pledge that no one would find his or her existing coverage altered for the worse under the new Act. The barest familiarity with its provisions would have shown this not to be the case for a substantial population. One was left to conclude that either the president had promised falsely or he hadn’t read his own act. The latter possibility should by no means be dismissed.

As the political firestorm over the website grew, Obama reacted first as a bystander, assuring the public that he was as frustrated by the fiasco as anyone else. Then he blamed his staff for not having forewarned him of design flaws and test failures. These serial postures powerfully suggested a president essentially disengaged from the success or failure of the most complex piece of legislation in the history of the Republic. It’s also the one that will likely define his place in it.

Detachment has been Obama’s hallmark. He seems to think that to imagine a thing is to make it real, and that to make a speech is to pass a bill.

Bay of Pigs, or Waterloo?

Joe Nocera of the New York Times has suggested that the Affordable Health Care Act is Obama’s Bay of Pigs. But John F. Kennedy made his blunder early and was able to recover from it. In addition, he took full responsibility for it, which Obama has not done for his fiasco and I believe cannot do, since in his world a bad outcome always appears to be someone else’s fault. The more probable analogy, I think, is Waterloo.

John F. Kennedy had another advantage with history: He died young, so we cannot know what his second term might have been like. But in an interview shortly before his assassination he spoke of his frustrations in office and the limitations of the presidency. He did not sound like a man in charge.

Barack Obama did get a second term. It still has three years to run, and it’s not inconceivable that Obamacare can be made to function, particularly if someone competent is finally put in charge. But this has been a year of disasters for the president, from gun control to the Snowden revelations to the aborted attack on Syria, with a new fiscal showdown in the offing. Obamacare may just be too much.