Why is the ACA (Obamacare) so complicated?

With the ACA (“Obamacare”) so much in the news, I thought I’d answer the obvious question — why is it so complicated?

I could offer a number of my own explanations, but there’s none better than Ari Berman’s. Writing at The Nation in the summer prior to the 2012 election, Berman profiles Jim Messina, Obama’s then-campaign manager.

It turns out that Messina was also the architect of Obama’s ACA legislative strategy. In a piece called “Jim Messina, Obama’s Enforcer” Berman writes about the passage of the ACA. It explains all you need to know, about the ACA, Jim Messina, and yes, his boss (Obama) as well. (If you want to jump to fixing Obamacare, go here.)

Let’s start with some context on Messina. Berman opens (my paragraphing and some emphasis below):

Jim Messina, Obama’s Enforcer

In March 2009 the Campaign for America’s Future, a top progressive group in Washington, launched a campaign called “Dog The (Blue) Dogs” to pressure conservative Blue Dog Democrats to support President Obama’s budget. When he heard about the effort, White House deputy chief of staff Jim Messina, who was regarded as the Obama administration’s designated “fixer,” called CAF’s leaders into the White House for a dressing down, according to a CAF official.

If the group wanted to join the Common Purpose Project, an exclusive weekly strategy meeting between progressive groups and administration officials, CAF had to drop the campaign. We know how to handle the Blue Dogs better than you do, Messina said.

Not wanting to sour its relationship with the White House at this early date, CAF complied, and the campaign quickly disappeared from its website. Despite Messina’s assurance, however, the Blue Dogs would remain a major obstacle to the realization of the president’s legislative agenda.

The hardball tactics used by Messina against CAF exemplified how the Obama administration would operate going forward—insistent on demanding total control, hostile to any public pressure from progressives on dissident Democrats or administration allies, committed to working the system inside Washington rather than changing it. … “It was a major harbinger to me, when Obama hired him, that we were not going to get ‘change we can believe in,’” says Ken Toole, a former Democratic state senator and public service commissioner in Montana [Messina’s home state, where he worked for Senator Max Baucus].

That sets the stage and tells you a lot about Obama’s relationship with progressives, and Messina’s as well. As Berman elsewhere notes, the “Common Purpose Project” was what Jane Hamsher called the “veal pen,” a weekly meeting in which progressive organizations were wrangled (or bullied) to support administration policy goals instead of their own.

Now about the ACA:

At the beginning of the healthcare debate in 2009, many Democrats were justifiably concerned about the role that [Max] Baucus, chair of the powerful Finance Committee, would play in shepherding the Obama administration’s domestic policy priority through the Senate. Baucus had brokered the passage of George W. Bush’s 2001 tax cuts and 2003 Medicare prescription drug plan, and had spent the better part of the Bush presidency cutting deals with Republicans and infuriating fellow Democrats. …

Among Senate Democrats, only Nebraska’s Ben Nelson had a more conservative voting record on economic issues than Baucus. Moreover, Baucus accepted the most special-interest money of any senator between 1999 and 2005, and had at least two dozen staffers working as lobbyists on K Street, including for healthcare companies adamantly opposed to reform.

Despite these obvious warning signs, Messina emerged as the leading advocate for his old boss during the healthcare debate and the top administration conduit to his office. … Messina told the Washington Post he regarded Baucus as a father figure.

The administration deputized Messina as the top liaison to the Common Purpose Project. … During the healthcare fight, Messina used his influence to try to stifle any criticism of Baucus or lobbying by progressive groups that was out of sync with the administration’s agenda, according to Common Purpose participants.

“Messina wouldn’t tolerate us trying to lobby to improve the bill,” says Richard Kirsch, former national campaign manager for Health Care for America Now (HCAN), the major coalition of progressive groups backing reform. Kirsch recalled being told by a White House insider that when asked what the administration’s “inside/outside strategy” was for passing healthcare reform, Messina replied, “There is no outside strategy.”

The inside strategy pursued by Messina, relying on industry lobbyists and senior legislators to advance the bill, was directly counter to the promise of the 2008 Obama campaign, which talked endlessly about mobilizing grassroots support to bring fundamental change to Washington.

But that wasn’t Messina’s style—instead, he spearheaded the administration’s deals with doctors, hospitals and drug companies, particularly the Pharmaceutical Research and Manufacturers of America (PhRMA), one of the most egregious aspects of the bill. “They cared more about their relationship with the healthcare industry than anyone else,” says one former HCAN staffer. “It was shocking to see. To me, that was the scariest part of it, because this White House had ridden in on a white horse and said, ‘We’re not going to do this anymore.’”

When they were negotiating special deals with industry, Messina and Baucus chief of staff Jon Selib were also pushing major healthcare companies and trade associations to pour millions of dollars into TV ads defending the bill. …

I’ve cut liberally from that section so as not to quote too much, and there’s much more there. The whole piece is worth your time, but the ACA part starting with the phrase “At the beginning of the healthcare debate” is especially timely. Please do click through.

The new message: It’s Health INSURANCE reform. Yes, it is.So why is the ACA is so complicated? Because the only customers that Obama, Messina and Max Baucus listened to during the entire process were “doctors, hospitals and drug companies, particularly the Pharmaceutical Research and Manufacturers of America (PhRMA),” not to mention the for-profit health insurance industry itself. Not progressives, including House progressives, and not the grassroots base. Just the industries.

A public program that serves mainly private interests has to be complicated, if it wants to appear to be a public program. Once you decide on a Clintonian privatized plan, the only way to obscure your goal is complication. Otherwise, it’s just private insurance.

Fixing the ACA (“Obamacare”) from the left

This also explains why we have to fix the ACA from the left. What does “fix it from the left mean”? In my mind it starts with at least these two initiatives:

■ Offer Medicare as an option to ACA (Obamacare) customers.

 ■ End the health insurance industry’s exemption from anti-trust laws (yes, they’re exempt, and it’s the source of many of their abuses, like being able to lie in advertising).

At the moment, ACA and Medicare are competitors for the same people — U.S. health insurance customers. At some point one will encroach on the other’s territory and take over the other’s market. The for-profit health insurance industry would love to get at Medicare recipients. What greedy CEO (sorry, shareholder-minded job-creator) wouldn’t?

Whose side of that equation do you think Obama is on, yours or the industry’s? I’m guessing the industry’s. Whose side are you on? I’m guessing your own.

Care to help? Care to help today? Call your congressperson, while this is still news, and ask for a “Medicare option” now. Believe me, this is being discussed in many congressional offices. Senate phone numbers here. House phone numbers here. And thanks.


To follow or send links: @Gaius_Publius

Gaius Publius is a professional writer living on the West Coast of the United States.

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