Irony – the tendency to underscore a point by stating the opposite of what is meant – has been the downfall of many an advocate. It’s an often powerful technique. In political speech, though, it is prone to backfire, because it can easily be taken out of context. It’s more dangerous than ever in the age of YouTube and opposition research. Accept that “oppo” has greatly damaged the effectiveness of Jonathan Gruber, of the Massachusetts Institute of Technology, the economist who in 2004 framed the financial strategy that, over a twisted course, led to the adoption of the Affordable Care Act, in 2010. Gruber is a leading healthcare expert, much in demand. For two weeks he’s been at the center of a firestorm because of three video clips in which he seems to give comfort to enemies of Obamacare.
The story of how investment adviser Rich Weinstein, angered because he was forced to search for a new policy under terms of the ACA (he found one), turned amateur sleuth, searching through hundreds of online videos, radio interviews and podcasts to find three damaging ones, makes interesting reading. We owe it to reporter David Weigel, of Bloomberg Politics.
The ACA requires those who don’t receive health insurance benefits from their employer or from the government to buy their own insurance, much as licensed drivers must purchase automobile insurance, with government subsidies for health insurance for those who earn less than a certain amount.
According to Gruber, the bill was written in a “tortured” way to avoid describing its mandates as taxes. He told a health care conference at the University of Pennsylvania last year that ''Lack of transparency is a huge political advantage, Call it the stupidity of the American voter or whatever, but basically that was really, really critical to getting the thing to pass.''
Gruber was being ironic. Addressing an audience of healthcare professionals, he meant that, for good reasons or bad, in extending insurance to those who couldn’t afford it or even obtain it, that Americans had done the right thing. Sleuth Weinstein found two other clips in which Gruber seemed to buttress Republican argument that insurance obtained on a federal exchange is not eligible for subsidies because the legislation anticipated that all states would form exchanges of their own. Twenty-four states, all with Republican governors, refused to form such exchanges. The federal government formulated a marketplace in their stead.
“Health Adviser Logged White House Visits,” headlined The Wall Street Journal. “Fallout From Gruber’s Remarks Spreads: Economist’s Comments on Affordable Care Act’s Passage Prompt Vermont to Cut Ties, Michigan Lawmakers to Seek Probe.” .
In an editorial, “The Impolitic Jonathan Gruber,” The New York Times came to the ACA’s defense:
''Republicans are crowing over Mr. Gruber’s remarks because he has been portrayed as a major architect of the health reform. In truth, his role was limited. He had a big contract with the White House to use his econometric model to calculate the financial and coverage effects of proposed measures. And he was one of thirteen experts who advised the Senate Finance Committee. His comments should not be taken as evidence that the reform law was hatched in secrecy and foisted on the public by trickery.''
It depends, I guess, on what is meant by “truth.” In truth, Gruber’s role in devising the mandate strategy of the ACA was absolutely fundamental. The idea had originally been proposed in the early 1990s by the conservative Heritage Foundation as an alternative to Hillary Clinton’s much farther-reaching plans. Gruber dusted it off and broached it in 2004, at the request of then-Massachusetts Gov. Mitt Romney. Romney was in the early stages of preparing a presidential bid. His plan was adopted by Massachusetts’ s heavily Democratic legislature, with apparent success.
The mandate idea was taken over by the Democrats in the campaign for the 2008 presidential election. By now a leading expert on its operation, Gruber first advised John Edwards, then Hillary Clinton, and finally Barack Obama on the details of the plan. In early 2010, President Obama relied on Democratic majorities in both the House and Senate to pass the measure into law.
Was it a good idea? Some Democrats have begun to voice their doubts. Sen. Charles Schumer (D.-N.Y.) said, last week: “It wasn’t the change we were hired to make.” The party should have found a way to raise wages and create jobs, instead of focusing on the uninsured, he continued, whom he described as “a small percentage of the electorate.”
David Axelrod, a close adviser to President Obama in both campaigns countered (in a another story in the WSJ ), “If your calculus is solely on how to win elections, and that is your abiding principle, it leads you to Sen. Schumer’s position. But that’s precisely why big difficult problems often don’t get addressed in Washington, and why people have become cynical about that town and its politics.”
The ACA will continue on its perilous course in the courts, this time in King vs. Burwell, a challenge to subsidies for those policies obtained from the federal exchange. The 2016 elections come after that.
With much rule-changing still to be done before the huge medical sector becomes stable, U.S. healthcare reform is like global warming: Further measures are not a matter of if but when.
David Warsh, a longtime financial journalist and economic historian, is proprietor of economicprincipals.com