A Different World

Why Obama must continue taking it on the chin for the poor and vulnerable

President Barack Obama
President Barack Obama

Facebook Post, Nov. 16, 2013, while I was a Nieman Fellow at Harvard and not officially working for The Sun News:

It was only a few months ago I was seriously considering supporting Sen. Marco Rubio in his likely 2016 quest to become the next president of the United States. But that was a few months ago – a lifetime in the political world.

Months ago, he had shown real political courage, which is in too short supply. He stood up to the hard right of his own party to champion a comprehensive immigration reform bill that eventually passed the U.S. Senate, the kind of reform that has for too long been mocked by the hard right as amnesty, the kind of reform that could bring great relief to millions of our most vulnerable fellow human beings. Rubio took on the likes of Rush Limbaugh – on Limbaugh’s show, even – in a smooth, concerted, sustained effort that helped assure a super majority in the U.S. Senate would vote for the bill.

And it worked.

That’s why I was seriously considering supporting his run in 2016 – even though he is a Tea Party champion, even though I think Tea Party tactics overall have been an awful addition to our democracy. (The Tea Party has been trying to sell superficial, overwrought political machismo as though it is indispensable principle.) Too often in this country, political courage is punished rather than encouraged. I’ve long believed encouraging political courage is more important than a particular ideology or a particular party, which is why my voting record seems odd to most people.

I voted for Democrat Bill Clinton. And Republican George W. Bush. And a third-party presidential candidate. And Democrat Barack Obama. (Twice.) And Republican Mark Sanford. (Twice.) And Republican Lindsey Graham. (Twice.) And Democrat Gloria Tinubu against Republican Tom Rice in the newly created 7th District in South Carolina. I have no plans to vote for Republican Tim Scott, who is similar to Republican Jim DeMint, a man I voted against twice. I would consider supporting either Democrat Hillary Clinton or Republican Chris Christie, though the dynasty problem makes me balk at Clinton a little and Christie’s continued pronouncements against marriage equality (despite his hand being forced in New Jersey by the courts) makes me balk at him a lot.

In other words, voting for or supporting Rubio would not have been out of the ordinary for me. I am actually one of those independent voters who can be swayed between parties, depending on the political environment in Washington, the top issues at hand and the quality of the candidate. But the initial political courage Rubio showed has evaporated. He has begun to speak out against the bill he helped to craft and pass through the U.S. Senate in an attempt to get back into the good graces of his most ardent supporters. I expected he would have to do some of that, play politics. After all, he is a politician who needs support from base supporters to win. That is understandable. But to walk all the way back from what seemed a principled stand only a few months ago takes him too far in the other direction, making null and void the political courage he briefly showed.

And that’s why so far I am encouraged by what President Obama has been doing in the face of misleading media coverage, hyperventilating by political pundits and distress among his base of supporters concerning the Affordable Care and Patient Protection Act. He is doing two important things: Standing firm in the face of the latest “this will end his presidency” trope; and he is eating shit for the poor and vulnerable. Let me explain.

Remember when the unemployment rate was going to be the undoing of his presidency? Or the morass of Afghanistan? Or Libya before he launched what was a super no-fly zone? Or Libya after the tragedy in Benghazi that his critics tried to turn into a conspiracy? Or the IRS scandal that turned out not to be a scandal? Or “Fast and Furious,” another tragedy his critics tried to turn into a conspiracy? Or the awful debt ceiling talks during the summer of 2011 which dropped his approval ratings to an all-time-low? Or his performance during the first debate against Mitt Romney? Or his “red line” on Syria just a few weeks ago? I’m sure I’m forgetting other things, each of which was presented at the time as the unraveling of the Obama administration.

Oh, how could I forget the election of Scott Brown in a special election to replace Ted Kennedy. Brown’s victory, pundits and straight-news reporters declared at the time, meant the Affordable Care Act would never become law, meaning Obama’s No. 1 domestic priority would never see the light of day. In our Twitter/cable news obsessed world, every twist of the screw is seen as the end-all-be-all and is frequently blown out of proportion. I get why hard core activists do it, because they are always looking for something – anything – that could mean a hard-fought victory on their priorities. It doesn’t make it right, but understandable.

What’s unfortunate is when even hard-nosed, veteran reporters and pundits fall for this trap again and again and again and again, and not only that, help fuel the illogical of it all with over-hyped pronouncements, lazy reporting and a lack of awareness about all the times their manic reactions had been proven wrong.

It’s one of the reasons I cautioned people before the launch of the state health care exchanges to neither prematurely declare the ACA a success nor a failure because with something this big, it takes time to know what its real impact will be. We can know about individual stories and glitches and bad or good rollouts and a few other more important indicators early in the process, but not much beyond that. And it’s also why I cautioned people, liberals in particular, to not gloat about the outcome of the government shutdown, because it was bad for the country, and it was just the scandal du jour.

This is what we know about the ACA so far: The rollout was awful, primarily because of a dysfunctional Website that was designed to make insurance shopping easier, not harder, for people who really needed it. The president’s pledge about keeping your health care plan – even though it was true for more than 95 percent of Americans – was wrong primarily because it left no room to explain the complexity of the health care system and that the reality of reform means change, and that the law itself, as comprehensive as it is, could not have possibly been designed to foresee every single scenario in advance. The men and women in Washington who culled it together are politicians, not all-knowing gods.

White House reporter Major Garrett asked the president two tough, pointed, biting – fair - questions during the press conference on Thursday (you should go watch the exchange) and the president gave a full answer as to why he got that so wrong – the kind of answer he should have been giving long ago, but the kind of answer that can’t fit as neatly on a bumper sticker as “death panels” and “government takeover” and “socialized medicine” and “repeal and replace,” the kinds of falsehoods often leveled by his critics that could easily fit on said bumper sticker. His “you can keep your plan, period” line was a wrong-headed attempt to beat back bumper sticker falsehoods.

It hardly matters that insurance companies sent out misleading cancellations notices or didn’t tell customers the plans they were buying after 2010 would be discontinued by 2014 because of the ACA or that most customers on the individual market switch plans almost annually any way – only 17 percent keep the same plan for as long as two years – because of changes the insurance companies had been making annually long before the ACA passed. All that mattered is that a tiny portion of the public was frightened and angry because of misleading cancellation notices, and by worse and even more misleading coverage of those notices.

Those stories made it seem as though the ACA was making millions of people lose health insurance, when what the ACA was doing was reordering the market and that most of those receiving those notices will get better, more comprehensive, reliable coverage at a cost about 15 percent lower than the Congressional Budget Office projected a few years ago. Yes, some of them will have to pay more for better plans, while a smaller segment will have to pay more for plans that are just about the same as what they had. But it is expected that most of the people receiving those cancellation notices will receive better plans at a better cost. What’s more is that everyone getting those notices will still be getting health insurance – something the media seems to ignore as well. (Again, please explain to me just what a ‘liberal’ media is?)

But we also know this about the ACA: It has been a factor in the slowest health care inflation rate in half a century. It is projected to reduce the deficit – including by about $50 billion this year alone – by more than a trillion dollars over the next two decades. It has helped millions of children remain on their parents plan until the age of 26. (I reported last year how that helped a college student from Aynor better cope with a diagnosis of a rare cancer before she died, because it gave her peace of mind that her parents wouldn’t go bankrupt trying to pay for all of her costly treatments.) It has already identified billions of dollars of waste and fraud and returned that money back to the taxpayer. It has filled the donut hole left by Medicare Part D, making life easier for millions of seniors. It has extended the life of Medicare by about a decade. It has shown that you can cut $700 billion from a part of Medicare and not only not undermine the program, but strengthen it. The ACA has begun to change the pay-for-procedure medical culture that has been driving up health care costs for years.

And even during the first month of a botched rollout, the ACA has provided coverage, through the exchanges, to about 106,000 Americans who had long been locked out of the system, as well as to about 400,000 other Americans through Medicaid. During that botched rollout, about 1 million other Americans completed their applications (they represent 1.5 million Americans) and they are now waiting on the process to be complete before it can be determined what kind of help and policies they qualify for.

Just imagine if the Website had actually been working, or the opposition hadn’t been doing everything in its power to sabotage the law at the state and federal level at every single return. When the Medicare Part D rollout under Bush was even worse than this, Democrats openly said they hated the law – but then did everything they could to make it work, because that was best for the majority of Americans. They, too, could have chosen the sabotage route; instead, they decided to legislate and lead.

And here is something else a short-sighted media is overlooking: The open enrollment period for the exchanges began on Oct. 1 – not even two months ago – and extends through March 31. Given that reality and context, it makes no sense to make definitive statements about enrollment numbers. But that gets lost in the day-to-day hyper world of politics and media.

That’s why the political courage of President Obama is being tested like it never has. The groups that will receive the most help from the ACA – mainly the poor and vulnerable – don’t have major sway on Wall Street or Capitol Hill. The people who are getting the most attention because of cancellation notices are those who had long benefited from a system weighted against the poor and vulnerable, even though they did not know they were benefiting in that way. And most of them are relatively wealthy. They get heard all the time, in the media and by politicians eager to cull their votes. Some of their premiums might be going up - but is not on the same level as vulnerable people who have been dying and living less-than-ideal lives because they have long been shut out of the system. As Paul Farmer, a professor at the medical school here at Harvard once said, “all suffering is not equal.”

Farmer also remarked that “serving the poor … is more important than soothing your own ego. It’s called eating shit for the poor.”

That’s where President Obama is. He has to decide if he is going to hold firm and eat shit for the poor or give into momentary hysterics that could undermine the kind of help the poor has literally been waiting decades to receive. So far, he has held firm, even while showing contrition. Marco Rubio, the man I considered as a potential replacement for President Obama, couldn’t stand eating shit for the poor for more than a few months.

President Obama is going to have to eat it for much longer than that. If he does, it will be better not only for the poor, but the rest of us as well. Big important changes cannot be sustained in this type of political environment without a large dose of political courage.

While many people are losing sight of that today on health care, it will take the same type of courage to get rid of our debt and rein in the out-of-control entitlement spending that is darkening our fiscal future and making it more difficult to invest in our children’s future. Giddy conservatives and nervous liberals need to be careful what they wish or stand for. Happily encouraging hyper-partisanship to thwart health reform or running away from imperfect yet needed solutions to complex problems today will only make it that much harder to convince our leaders that it is worth the effort to make other necessary, long-overdue changes.

If you never understood why kicking the can down the road has long been the preferable option for our top political leaders, you should now. Doing the right thing is hard; complaining about other’s imperfect attempts to make things better is easy.