Too Big To Fail, Because We Might Need Their Help: The Obama administration has pioneered a new path to corporatism**: Screw up a government initiative so much you have to call in the big boys from the industry to fix it. … You think the White House owes the large insurers now that they’ve dispatched their experts to save healthcare.gov? It’s easy to think of dozens of situations in the next three years–assuming Obamacare survives–where Obama’s regulators will have to choose between more competition and cozier big-firm oligopolies. The first benefits consumers. The second benefits insurance company profits. They now have a big reason to favor approach #2.. ..
**–That’s in addition to the four or five paths he’s already mapped out. …
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How the King of Quotes Lost His Crown: Bill Keller calls on Obama to “nationalize the midterm elections” in a campaign to end divided government:
“Norman Ornstein, the veteran Congress-watcher, points out that the last time someone succeeded in nationalizing a midterm election was 1994, when Newt Gingrich led a Republican uprising …”
That chestnut of Beltway wisdom isn’t really necessary for Keller’s argument, but it’s still BS. Name a recent midterm election that hasn’t been nationalized. You can’t. Here’s a list, followed by the national issue at stake:
1998: Lewinsky, impeachment, GOP overreach
2002: War on terrorism
2006: Unpopularity of Iraq War
2010: Tea Party revolt against Obama programs
A truer bit of punditry would be that all midterms are now nationalized. This makes sense–we live in a national media market with national obsessions and a powerful national government. Everything moves faster (except government procurement). It seems like an eternity between elections. Why shouldn’t voters seize on whatever opportunity they have to shift the national debate?
Obama won’t have any problem nationalizing the midterms! The problem (for him, and Keller) is that the balance of national issues–specifically Obamacare–seem likely to run against him and his party. On the one hand, Democrats righteously reorganized a sixth of the economy, affecting nearly everyone’s lives, and screwed it up! But hey, on the other hand if we had less partisanship and division Congress might pass the immigration amnesty that K Street and newspaper editorial boards want. Doesn’t really seem close. …
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Jon Kingsdale, who led the successful start-up of Romneycare in Massachusetts–but who turned down the Obama administration’s attempts to hire him in a role with less authority–outlines two challenges facing Obamacare, even if healthcare.gov gets fixed:
1. Actually tracking and collecting accurate premiums from millions of people, many of whom may not even have checking accounts.
2. Avoiding an adverse pool (disproportionately composed of the old and sick) which would “cause premiums to soar in 2015”–the first step in the fabled Death Spiral.
But there are really at least three “challenges” beyond those, no?
3. Rate Shock, if premiums–especially for the unsubsidized 40%–turn out to be considerably higher than premiums in the old individual insurance market (including for those who’ve had their old policies cancelled).
4. Doc Shock–when it turns out that many of the allegedly superior insurance plans on the web achieve their lower rates by restricting choice of doctors and hospitals, including pushing people to use doctors who may not be very good.
5. Access Shock/Price Shock–When the sheer increased demand for medical services (thanks to more universal coverage) collides with a relatively fixed supply of doctors and nurses.
What are the odds that the A.C.A. survives all five? I’m glad I’m not a betting man. …
P.S.: Note that none of these problems seems insoluble, given enough time, flexibility and competence. If Obamacare fails and gets repealed it will be an avoidable debacle. …There are other, broader critiques–that the structure of Obamacare inhibits the development of new technologies, for example, or that the competition it sets up won’t produce sufficient savings. But these ain’t those.
Backfill: Ed Rogers’ not quite identical list. …
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Not too early to think about … :What happens when/if it becomes clear to the White House that not only is most of their agenda stuck in Congress, but the 2014 election will give them no relief–and therefore no domestic second term legacy? You’d expect a) lots of executive orders and unilateral actions (pushing the constitutional envelope) b) bold foreign policy moves; c) some kind of meta-panic around, say, March of next year …
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