Even though he left the Obama administration for Citigroup in 2010, Peter Orszag has kept up his media appearances. In his peak years as an object of inside-the-Beltway obsession, sites like the now-defunct orszagasm.com and Wonkette discussed him with a zeal that budget wonks rarely inspire, and he made frequent appearances on radio and political talk shows. In more recent years, Orszag has been a columnist at Bloomberg and contributor to The New York Times, the Council on Foreign Relations, and, as it happens, The Atlantic – he’ll be speaking in an interview with Editor-at-Large Steve Clemons on Wednesday.
As a respected economist and one of the main architects of the Affordable Care Act, Orszag represents a faction of the Obama administration that hasn’t been very popular with the public lately: the centrist wonks. Following this fall’s botched rollout of the insurance marketplaces created by the ACA, public opinion of the law hit its lowest point since March of 2010, and the president’s approval ratings hit an all-time low in November. Meanwhile, political analysts have pointed to the recent election of Democrats like Elizabeth Warren and Bill de Blasio as evidence that the more progressive wing of the party is growing in power. During the fight to get the ACA passed in 2009 and 2010, the administration seemed eager to emphasize its willingness to compromise; now, as more populist voices on the left gain popularity, Obama’s team seems to see that as less of a solid strategy.
For his part, Orszag remains dedicated to defending the ACA in the same technocratic terms, emphasizing its potential for creating efficiency and reducing spending. “The cost story is better than I expected,” he said during a recent interview. "Whether [the cost curve] continues to be bent remains to be seen, but we're now going on five-plus years in which cost growth has been much lower than historical levels."
Industry analysts remain conflicted on how to interpret the “bending of the cost curve,” or wide-scale reductions in health care costs seen since the law passed in 2010. The Kaiser Family Foundation estimates that around three-quarters of those reductions should be attributed to the overall lag in the economy – the prices of health care services have gone down with inflation, and people just aren’t using as much health care, they say. On the other side, Princeton economist Paul Krugman has argued that the economic downturn is a weak explanation – it’s more likely that cost reductions have come from the elimination of Medicare “overpayments,” or reimbursements to some providers, as well as penalties imposed on hospitals that admit patients. It’s unclear how these numbers will look over the next five to ten years, but among all of Washington’s wonks, there seems to be a consensus: The law’s long-term affect on health care costs will be a major test of its success.
In public opinion, however, the law’s success might not be measured so clinically, especially as it affects perceptions of Obama’s broader legacy. Perhaps that’s why the White House team has decided to start framing health care as an issue of right versus wrong. “We’re on the right side of history,” the president said during a speech about the law in Texas in November. On this and other issues, the administration looks like it’s going to ditch Orszag’s style of pragmatic rhetoric for a more moralistic message as the president tries to win back popular support.
As Obama shifts toward a more populist posture, it’s worth wondering what this change will mean for the more moderate, technocratic voices of the Democratic Party. So many of the ACA’s original creators are no longer at the White House: Nancy-Ann DeParle, Ezekiel Emanuel, David Culter, and Orszag are among the former Obama administration officials who left after playing a large role in crafting the legislation. Emanuel and Cutler, like Orszag, have taken to defending the technocratic virtues of the law in op-eds. Although Orszag says he envisions staying in the private sector for a significant period of time, it seems clear that he and others who worked on the ACA are working to remain influential in the public sphere – why else keep up all the media appearances?
There is probably a place for technocrats in all administrations, no matter how Republican or Democrat they may be. But at least for Democrats, the rhetoric seems to be shifting out of Orszag’s favor. In a time of Warrens and de Blasios, policy proficiency might not be as persuasive as it was just a few years ago.