Jonathan Gruber is a policy wonk after my own heart. Detailed, relentless, fact-based, and possessed of a sly sense of humor as evidenced by his new oeuvre: Health Care Reform: the comic book. Gruber, an MIT economist, was a chief architect of RomneyCare in Massachusetts and served as an advisor to the Obama administration on the Affordable Care Act. So where does he stand on Romney’s stand on health care reform? It is “disingenuous” in Gruber’s words. And that’s just word one.
Gruber’s perspective is the smoking gun that the Mitt Romney of 2005 was serious about health care reform, knew its permutations and reasons for being, and his shrill disavowals of 2011 are a canard. The reason? Gruber, who know both bills intimately, says the federal bill is the same bill. It is simply more aggressive on cost controls, an aspect the state-based plan did not have the leverage to address. And yes, the Affordable Care Act does incorporate rudimentary elements of systemic cost control, especially for subscribers, which the Massachusetts plan did not include.
What does this say about Romney? The term “intellectually dishonest” comes to mind.
In an interview with online magazine Capital in November, Gruber got real when asked about Romney’s disavowal of the Affordable Care Act:
"The problem is there is no way to say that," Gruber said. "Because they're the same f***ing bill. He just can't have his cake and eat it too. Basically, you know, it's the same bill. He can try to draw distinctions and stuff, but he's just lying. The only big difference is he didn't have to pay for his. Because the federal government paid for it. Where at the federal level, we have to pay for it, so we have to raise taxes."
Gruber, who was interviewed on The Bob Edwards Show on Sirius XM on Monday, is a cheerleader for the Affordable Care Act. He says that the only way to look at the bill is to compare it against the status quo, rather than to critique it for not going far enough. That strikes me as reasonable. Too much is at stake with 45 million uninsured and rapacious industry tricks as a status quo benchmark. When the Affordable Care Act is phased in beginning in 2014, insurance companies will no longer be able to refuse you coverage due to pre-existing conditions. Nor will they be able to charge you more for that coverage. Nor will they be able to drop you if you get sick. These, says Gruber, are real benefits that we should fight to retain.
He points out that the number of people under the age of 26 who are covered by health insurance has already risen as a result of the clause that they must be covered under parental work policies. He points out that little-known nondiscriminatory high-risk pools known as the Pre-Existing Condition Insurance Plan (PCIP) —a program I wrote about here—have already been phased in nationwide. In addition, the annual well visit allowed under Medicare is now free. Baby steps, I know, but Gruber is begging us to accept that major reform is in the pipeline.
While Affordable Care Act systemic cost controls are baby steps, at best, I am inclined to agree with him that we should make the best of what we have. We need to overcome Supreme Court challenges with commerce clause arguments. (Really, as if the federal government has no history in mandating the need for indemnification to avoid liability to taxpayers!) Then we need to get health care exchanges up and running so they begin to make difference in people’s lives.
Of course the real test to the law comes with the election of 2012. Gruber feels, and I tend to agree, that if the Republicans to win the trifecta—the White House, Senate, and House of Representatives, they will either repeal the bill, or, if they can’t surmount a 60-vote threshold in the Senate (remember that?) they will bleed it to death by crippling or eliminating key provisions. A damaged bill, without, say, a universal mandate, will lurch toward failure and lose the public support it would never had had time to win were it to be allowed good-faith implementation.
If the act dies through electoral execution, we should make no mistake, says Gruber, nothing will replace it. So what’s it gonna be? Four more years and hold the Senate, win some seats in the House, or a weak, collapsing, shell of a plan that will lose all public support and usher in an era of profound pessimism and inaction. I know. Many readers argue we are already there. But, believe me, it can get worse, really, really worse, when it comes to health care.
The central issue, as Gruber puts it, is do you want to continue the regime of untrammeled insurance company discrimination against people in need? Having written long and often about health care reform, I believe the term I used to characterize my support for the Affordable Care Act was “tepid.” But that doesn’t mean it isn’t better than nothing. It is better than nothing. And those who say half-measures are worse than nothing at all should tell us their solution for assisting the unfortunate people who are facing lack of care, medical bankruptcy, or death, in the interim. And I’m thinking it may be a long, long interim.
As I have argued before, we should look at the birth of Social Security to fully appreciate the story of an unformed, toothless, tiny, program that grew to meet the needs of multiple generations, and still can, if we play our cards right and don’t kill it with abuse and cynicism. But that’s a story for another day.
So, about “ObamaCare,” if you can’t remember anything but the buzzword, check out Health Care Reform: the comic book. If politics is the art of half a loaf, we’ve got ours in the oven, and it beats starving.