The Clintons Were Right: Where Obamacare (Maybe) Went Wrong

Watching all the fuss and muss surrounding the launch of Obamacare these last few weeks, I’ve been struck by an unwelcome thought:

Maybe the Clintons were right.

The Clintons — Bill and Hillary both, back when Bill was president — emerged from the last fight for universal health care pretty wounded, politically. The Democrats lost control of Congress for the first time in a generation. The president was reduced to asserting his Constitutional relevance to the press. And the pair seemed to lose the courage of their liberal convictions.

Bill Clinton declared that “the age of big government is over.” His presidency retreated from big policy initiatives to “small ball” efforts — school uniforms, more police — that offered incremental change. The exception? Welfare reform, which was a massive remaking (and to many liberals, undoing) of the safety net that Democrats had once labored so hard to build.

By the time 2000 rolled around, lots of liberals were tired of Clinton Liberalism, felt it too entangled with corporate interests — still a problem, by the way — too timid, as though Bill and Hillary secretly believed in their hearts that Republicans were right about America. Some of them (including, mea culpa, me) voted for Ralph Nader. We got George W. Bush for president. The rest is history.

Though Barack Obama’s victory over Hillary Clinton in the 2008 primaries is often traced to his anti-war stance, you can argue that the liberals who voted in those primaries still had some Clinton Fatigue — saw in Obama the promise of Big Things Like Liberals Used to Do, but only more school uniforms from Hillary. And sure enough, he got the Affordable Care Act passed.

The Affordable Care Act, you may have noticed, is in a bit of trouble these days.

It is far too early to declare the law a failure. It is not too early to notice the danger. The launch of HealthCare.gov was … a mess. President Obama’s promise that “if you like your health insurance, you will get to keep it” turned out to be not entirely true (and even if the exceptions were relatively small in number, they were magnified in the press to the point they did real political damage). Some middle class folks — who tend to be the linchpin of whether the public will accept a policy or not — found their insurance rates going up dramatically, and then told to shut up about it.

Not good.

All of which led Robert Kuttner, co-editor of The American Prospect, to vent his anger this week — from the left. The Affordable Care Act has too many moving parts, he said. It leans too heavily on private insurance. It was “an accident waiting to happen.”

“As many of us wrote at the time, Medicare for All would be simpler to execute, easier to understand, and harder for Republicans to oppose,” Kuttner wrote. “If doing Medicare for All in a single stroke was too heavy a lift, start with 60-year-olds, then 55-year-olds, then young people under 25, and fill in the qualifying age brackets over a decade.”

Small ball, in other words. Just like the the Clintons used to do.

This isn’t just a political lesson, but a governing lesson as well. It’s easier to pass — and defend — smaller bills that advance liberal goals bit-by-bit than it is to drink down a whole keg in a single gulp. (Although Republicans would probably still denounce smaller bills as the victory of socialism.) Even if there weren’t political advantages, it’s probably also less complex to implement policy — and easier to find out what works and what doesn’t — when you pass a smaller law.

The Affordable Care Act, meanwhile,  ran more than a thousand pages long. Then-Speaker Nancy Pelosi famously said, “We have to pass the [health care] bill so that you can find out what’s in it,” and if Republicans manage to kill the law, that quote will surely be on its tombstone.

Small ball, though, can work. In the aftermath of their own health care failure back in the 1990s, it’s true that the Clintons retreated. Then they advanced, and passed the State Children’s Health Insurance Program. CHIP, it’s called today. It offered health insurance to many thousands of poor children for the first time ever. And nobody except the most Ayn Rand-addled Tea Party congressman would vote today for its repeal. For that matter, George W. Bush’s own effort to create Medicare Part D — while controversial at the time — is similarly ensconced in policy. Lots of people benefit from both programs.

As I say, it’s still too early to make final pronouncements about the Affordable Care Act. But if it fails, liberals will have to reconsider their approach to “small ball.” No, there isn’t much appetite for “half-a-loaf” liberalism, but it might be more effective, politically — and, maybe, it might just produce better results for the country.

 Follow @JoelMMathis on Twitter.