There’s a recent footprint of commentary on whether or if the initial introduction of the federally-administered insurance exchanges established by the Affordable Care Act threatens the ‘promise’ of modern liberalism. This almost (but not quite) off-handed premise is a result of the rotten rollout of the ACA exchanges. To summarize briefly an excellent New York Times report, as well as Timothy Lee’s piece, a confluence of events — technical incompetence, bureaucratic ineptitude, insufficient funding, intransigent politics — have produced a woefully inadequate portal for shopping and purchasing health insurance in those states that declined to operate marketplaces. This is, undeniably, a completely unacceptable situation by any standards.
Now the notion that a bungled implementation will delegitimize future liberal goals is presumably derived from a possible future where the exchanges are so unworkable that it’s entirely unfair to expect folks to comply with the requirement to have health insurance or pay a tax penalty next year. Then a delay of some form would be passed, which would embolden Republican chances in 2014 to regain the Senate, and the ACA would become an example for why non-conservative ideas are inherently deficient for dealing with the country’s problems. Leaving aside the intrinsic subjectivity in defining ‘liberalism,’ this seems little more than fanciful rhetoric for several reasons.
First, it’s been 17 days — really, it’s too soon to start musing about the downfall of an entire contemporary political ideology. More pragmatically, could a truly catastrophic failure of the 36 federally-administered marketplaces lower the possibility of future efforts by the Obama administration to successfully tackle immigration, climate change, or inequality? Probably. But let’s not pretend the status quo of “not gonna happen” on these other initiatives doesn’t already exist with the House of Representatives controlled by Republicans.
Next, it may be entirely legitimate to wonder whether a counter-factual world with a repealed-in-disgrace liberal health law would hinder future reform efforts. Yet even here it should be asked what the valid difference would be between that hypothetical future and the 45 years of failed attempts before the ACA. If we’re being honest with ourselves it’s worth considering that it would be a return to the status quo. This would be a defeat for liberals, sure, but in so many ways it’d be a familiar environment. More importantly, it wouldn’t actually prevent sustained organizing for change.
Moreover, a failure to establish functional exchanges interpreted as ‘proof’ that liberal policies can’t work effectively disregards that politics is already primarily an exercise in confirming one’s priors. For many on the right, and for those on the left trying to spin the exchange rollout, this is an especially self-deluding activity (okay, especially on the activist right). People all along the political spectrum already judge the efficacy of the ACA in an alternate reality of death-panels and public options. Also, for a not-insignificant amount of Americans the law will be seen as an abject failure for some time, irrespective of whether it ultimately provides health insurance for millions of their fellow citizens.
Furthermore, it’s worth reminding that this discussion is only centered on one part of one half of the effort to expand health care coverage. In states that are operating their own marketplaces things seem to be running smoothly, with tens of thousands of applications processed so far. Some of these folks will be purchasing private insurance just as the law intended, but a sizable portion will also be gaining coverage through an expanded Medicaid program. Assuming the absence of a wholesale repeal, such an outcome necessarily discounts in-part the question of whether ACA-style health care liberalism can work. If anything this thought-process could be flipped on it’s head: a failure of the federal marketplace coupled with success of an expanded Medicaid could just as easily justify a more liberal interpretation for the proper course for health care reform. Which is to say that it would be equally as valid to infer the apparent superiority of a truly government-run, price-negotiated, system of providing health coverage.
Nevertheless, what can appear to be high-minded reflections on the trajectory of political ideology in action is often so much pretense to mystifying plain-speaking practical politics. Before October 1st the likelihood of legislative fixes for the inevitable complications in the ACA was pretty abysmal. Even though a dysfunctional federal marketplace would raise the challenge to making the law work, it’s difficult to see how that lowers the possibility for congressional adjustments to a level that is meaningfully distinguishable from present reality. There are optimistic reasons for why this conjecture may be irrelevant a year from now. Yet for now it can serve as a useful excuse to advocate, at once, focusing on the laws current problems while taking a step back to breath and absorb the broader context.
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