How Obamacare Lost Its Soul
The president has replaced the moral case for reform with a transactional one. That's a mistake.
For supporters of the Affordable Care Act, President Obama’s new push to "sell" the law is a welcome sign that Healthcare.gov is on the mend, but it also risks devolving into transactionalism—a narrative of “Democrats delivering benefits on one side, and Republicans trying to deny them on the other,” as Politico puts it. To make the case, Obama needs to strike the sustained, emotional moral clarity—consistent claims that go beyond economic benefits—that helped bring him to the Washington in the first place.
The president took a valuable first step at the Center for American Progress on Wednesday, delivering a cogent, thoughtful address on declining economic mobility in America. The speech showed flashes of Campaign Trail Obama’s moral fire. He appealed to our shared obligations, citing last week’s apostolic exhortation from Pope Francis (“How can it be that it is not a news item when an elderly homeless person dies of exposure, but it is news when the stock market loses two points?”) and, on healthcare, Martin Luther King (“Of all the forms of inequality, injustice in health care is the most shocking and inhumane”). What remains to be seen is whether Obama will keep it up.
I worked for the president’s campaign in 2008, running a small field office in the heart of Ohio’s Rust Belt. One of my favorite members of our team was a high-school senior named Anoop Bal who, despite being on the varsity basketball team and student council and having to apply for college, somehow found six hours each afternoon and evening to spend organizing volunteers in his hometown of Canfield, a bucolic (if somewhat conservative) Youngstown suburb.
One the campaign’s most inspiring moments for me was paradoxically also one of its most distressing. One Sunday evening, Anoop—an observant Sikh who wears a turban—was out canvassing, only to find himself detained by police officers called by a worried neighbor. A fellow resident of the Ohio town where Anoop was born and raised had found his appearance alarming. I’d later learn that this happened multiple times.
What was inspiring was that no matter what got in Anoop’s way, he persisted in devoting every minute he had to the promise he saw in then-Sen. Obama’s campaign. And he didn’t do so out of self-interest—it was the result of emotional resonance with a cause. “I definitely identified with him on the moral and idealistic side of things,” he told me over the phone on Tuesday. “[Obama’s message] wasn’t so much of a ‘here’s this specific benefit to you’—it was on more of a moral level.”
Somewhere along the way, the political operation that recruited Anoop—and whose candidate transfixed the nation with the story of a nine-year-old girl who started eating mustard-and-relish sandwiches because her mom had cancer but no health insurance—turned to more transactional rhetoric. By mid-2009, Vice President Biden was cutting videos telling voters how “you'll be surprised at how much you'll get out of this health-insurance reform we're proposing”; then-budget chief Peter Orszag was explaining that the real reason to pursue healthcare reform was because it would help reduce the deficit. As Marshall Ganz, who helped pioneer Obama’s 2008 field-organizing model, put it in 2010, “Obama entered office wrapped in a mantle of moral leadership,” but, after taking office, “abandoned the bully pulpit of moral argument.”
In the intervening years, Obama has claimed that bully pulpit only occasionally—in Strongsville, Ohio, in the days leading up to the ACA’s passage, for example, where he connected healthcare to “what’s right and what’s wrong” by telling the story of Natoma Canfield, a woman stricken with cancer who could no longer afford her insurance premiums; at George Washington University, in April 2011, when he challenged Republicans on the morality of their vision for “changing the basic social compact in America.” These sparks of righteous fire have been encouraging, but they’ve also been disjointed—too often, the president’s light stays hidden under a bushel for long stretches, or only appears elegiacally, after national tragedies.
Now the White House is, according to Politico, “kicking off a three-week drive to refocus the public on the law’s benefits,” including decreased costs for preventative care and prescription medicines, protections for preexisting conditions, increased access to affordable plans.
These are real deliverables, and Obama is right to reaffirm and clarify them for voters, especially after so many of the law’s virtues have been obscured, both by Republican demagoguery and the implementation fiascos. As Ganz put it in an email: “One of the big ‘values’ in health care provision is reliability, security, being there—which is exactly what this whole debacle has undermined. [In this case] ‘making it work’ actually has moral content.”
But the program that Obama and his team are desperately trying to make work is also based on moral claims about human dignity and distributive justice—many of which, until recently, were pretty bipartisan. If Obama recognizes that “the basic social compact in America” is now under attack, why can’t the basic social compact in America get its own three-week messaging calendar at some point? The vast inequalities and decreasing mobility in our society got their day in court Wednesday. Can he focus on how our common humanity and the advantages many Americans receive through the dumb luck of birth should inform their obligations to one another on a Thursday and a Friday?
The main argument against launching such an effort is that it would be politically hazardous—that any overt set of moral claims defending a program like the ACA would be tantamount to confirming one conservative thinker’s charge that it’s just “a massive, massive income redistribution.”
For supporters of progressive taxation, the social safety net, and the responsibility to heal the sick, that rationale for shying away from moral claims is misguided to the point of self-sabotage. Adding a set of bold moral arguments for healthcare reform to a recitation of the program’s transactional benefits is a winning strategy for three main reasons.
First, the risk is not that high. What does the worst-case scenario look like? Republicans assail his rhetoric, refuse to work with him on any part of his legislative agenda, and call him a socialist? Right.
Second, it’s better than being ignored. Voters were already tuning Obama out before the Healthcare.gov woes. Now, with tanking approval ratings, he’s in danger of becoming a lame duck. In this climate, a series of cautious, policy-heavy speeches about the ACA’s benefits is unlikely to break through. Neuroscience research shows that emotions are key to engaging voters, and Pope Francis is a testament to how that a sustained moral critique can turn heads. Obama is more likely to enjoy the benefits of the bully pulpit if he continues to treat it a bit like an actual pulpit—a place more for making moral claims than listing goodies.
Third, Obama is the standard-bearer of a party in the midst of a fight over the validity of its philosophical underpinning. (The administration’s Healthcare.gov incompetence has not helped.) With 2014 looming and many of his supporters in retreat (or at least feeling that way), Obama needs to fight the progressive corner. If the country has really come to a point at which a Democratic president won’t defend the basic ideas behind “income redistribution”—something we’ve been doing for over 150 years now—Democrats are soon going to have much bigger problems than a malfunctioning website. Obama’s opponents certainly aren’t shying away from making their own moral claims.
In her new book Political Emotions, political philosopher Martha Nussbaum cautions that “ceding the terrain of emotion-shaping to antiliberal forces gives them a huge advantage in the people’s hearts and risks making people think of liberal values as tepid and boring”; she rejects as bound for failure a liberal politics that is “morally ‘neutral’” or lacks “a certain definite moral content.” None of our greatest leaders—Nussbaum focuses on Abraham Lincoln and King from the American tradition—made these mistakes.
On Wednesday, discussing America’s “economic and civic foundation,” Obama promised that “over the course of the next year, and for the rest of my presidency, that’s where you should expect my administration to focus all our efforts.” Let’s hope that’s true, and that president relies on more than just economic arguments in proving it so.