There’s a brute test of a policy: If you knew then what you know now, would you do it? I will never forget a conversation in 2006 or thereabouts with a passionate and eloquent supporter of the decision to go into Iraq. We had been having this conversation for years, he a stalwart who would highlight every optimistic sign, every good glimmering. He argued always for the rightness of the administration’s decision. I would share my disquiet, my doubts, finally my skepticism. One night over dinner I asked him, in passing, “If we had it to do over again, should we have gone in? would you support it?”
And he said, “Of course not!”
Which told me everything.
There are very, very few Democrats who would do ObamaCare over again. Some would do something different, but they wouldn’t do this. The cost of the blunder has been too high in terms of policy and politics.
During the darkest days of the website meltdown, Obama made it clear to those who asked that it was crucial for him not to fire any high-ranking administration officials. Sebelius and McDonough both reasonably feared they would be shown the door.
Numerous business executives, even those who wish Obama well, criticized Obama publicly and privately for failing to “hold someone accountable” and using the power of a bureaucratic beheading to demonstrate his fury. Whether this is a sign of strength or weakness, it is characteristically Obama…
In ways they’ve never discussed before, senior administration officials now admit they feared late last fall that the entire law might collapse under the weight of Democratic defections and aggressive Republican calls for repeal.
Sebelius brought two main assets to her job. She had experience regulating insurers and, as a successful Democrat in Kansas, she knew how to work with Republicans. But what Obamacare needed more was a deft, aggressive manager. Case in point: By all accounts, Sebelius did not grasp the severity of tech problems at healthcare.gov until the day it went live and crashed. If she got the warnings, then she should have heeded them. If she didn’t get the warnings, then she should have appointed people who would have kept her better informed. Either way, that’s a serious management failure.
Still, it’s not as if Obamacare’s implementation difficulties are entirely, or even mostly, the fault of HHS. It’s a typical, if predictable, failure of Washington to demand a fall guy when things go wrong. But responsibility rarely lies with just one person. (That’s one reason Obama resisted calls to fire her.) And this case is no exception.
Implementing Obamacare was never going to be easy. The law is full of compromises that, however politically necessary, weakened regulations and depleted funding that would have made introducing the new insurance system a lot easier. And Sebelius never had the kind of control a chief executive officer would. She was always dealing with a host of other players—from superiors at the White House to underlings at the Center for Medicare and Medicaid Services (CMS) to Democrats on Capitol Hill to lobbyists for the health care industry. And that’s to say nothing of her war with the congressional Republicans, who were trying actively to sabotage the law through repeal votes, funding cuts, and intimidation of would-be allies.
But I will say this. Behind the scenes, they did get to work. I could tell just from the way people talked, the things they said were happening there, that it really was getting better. They were (and I guess still are) sitting on this battery of IT stats about response times and how long a person had to wait to be logged in and so on and so forth, and those were being cut quickly. So Sebelius and the rescue team really did do their jobs once they were up against the wall.
Think of it this way. Did you think, last fall, that they’d actually hit the 7 million? Did you think they’d even come close? In a year-end column I wrote with my 2014 predictions, I said they’d make 5.8 million. And I thought that would be respectable. The latest report is that they’re approaching 7.5 million. So yes, there was utter failure. But there was one hell of a nice recovery. As time goes on, I think Sebelius will start getting less blame for the former, and more credit for the latter.
In a sense, the development of the Obamacare website offered a window into the thinking behind the program as a whole. The federal government spent three years building a system in an intensely centralized and consolidated way (refusing even to hand over the basic project management tasks) that is characteristic of the technocratic mindset of Obamacare’s larger approach to American health care. That system failed on launch and turned out to have been ill-designed, retrograde, and sclerotic. It seemed almost beyond repair, but a group of private sector engineers from Silicon Valley firms were able to come in at the lowest point in the crisis and essentially do in six weeks what the government couldn’t do in three years (and was probably never going to be able to do). And yet somehow, the president and others are trying to have people draw from this the lesson that the government actually can handle huge, complicated projects well after all…
Now, as the new insurance arrangements created by the law begin their real-world trials, Democrats argue that the fact that the system survived its earliest self-inflicted wounds should end all debate about its prospects.
The pressure for further health care reform to “fix” Obamacare’s mess is already rising, and that political pressure will actually increase given the number of people enrolled in either plans they view as too expensive or in Medicaid programs which strain state budgets and fail to deliver access to care. The more those costs burden states and working families with higher costs, worse coverage, and restricted access, the louder the clamor to pass further reforms. Every candidate in 2016 is going to have a health care plan, and the people will decide which direction they want to go.
Why on earth do some on the left think Obamacare ended the health care reform process? There is no end zone in which to spike this football. And when the 2014 election is through, we can really start talking about what big health care reform is going to come next.
From the outside, then, Sebelius mostly seemed to play the role of a glorified flack for the president’s health care policies, dutifully making the rounds and mouthing talking points as necessary. And she wasn’t even good at this. Her responses at congressional hearings were so canned that they might have come from a phone-mail system, and they occasionally revealed that she didn’t quite know what she was talking about. Her speeches were ho-hum pablum, when they weren’t being quietly edited after the fact due to unverifiable claims.When she went on offense during the 2012 campaign, she was often wrong or misleading. She engaged in ethically dubious fundraising for outside groups that support Obamacare.
In the last few months, as a spokesperson for the health law, she’s made a fool of herself and the administration. She kicked off the launch of the exchanges with a disastrous, embarrassing interview on The Daily Show, hosted insurance sign-up events where no one could sign up for insurance, and responded to basic questions about Obamacare’s continued poor poll numbers with blank silence. Fitting, I suppose, given that Sebelius has never been one for worthwhile answers.
Maybe—probably—Sebelius doesn’t deserve all or even the majority of the blame for the administration’s health law screw-ups. But regardless of her impact, as the most visible official associated with the law aside from President Obama, she deserved to be shown the door—or at least be given the opportunity to show herself out.
Supporters of The Affordable Care Act are quick to brush aside the early problems with implementing the president’s “signature legislative achievement” as old news. “Kathleen Sebelius is resigning because Obamacare has won,” crows Ezra Klein at Vox, the new “deep journalism” website that is supposed to be beyond ideology. But, in fact, Sebelius is hustling out of town before any of the most important questions about Obamacare have been answered.
Among them: Of the 7.1 million people who reportedly signed up for health care in the individual market, how many were previously uninsured? How many have actually paid for coverage? Are they the right mix of young and old, healthy and sick? We know none of this information, which is not simply incidental to whether Obamacare is “winning.”
Sebelius’s abrupt resignation, then, is the fitting capstone of a cabinet tenure that did nothing to inspire feelings of competency and trust in government in a century that is so far replete with revelations of bipartisan secret surveillance, financial mismanagement of the nation, and failed foreign policy.