They'll never lay this demon to restby Jared Bernstein / April 10, 2017 / Leave a comment
Last November, progressives around the world collectively gasped when Donald Trump defeated Hillary Clinton. In Alexandria, Virginia, right outside Washington, my wife and I glared at the election returns, as if somehow our negative energy could flip the numbers. As she began to sob, my first thought was: “There goes Obamacare.”
But, at least so far, I was wrong. Team Trump has been unable to do more than generate chaos. America’s conservative bloc is beset with contradictions on healthcare—and pretty much every policy other than tax cuts. Under this administration, fecklessness is emerging as a feature, rather than a bug. That doesn’t mean they can’t or won’t break many important things, but they haven’t managed to repeal Obama’s Affordable Care Act, and probably won’t anytime soon.
Like every recent presidential candidate, Barack Obama ran for office in 2008 pledging to reform our healthcare system. We spend 18 per cent of our GDP on it, nearly twice as much per head as other advanced economies, but without universal coverage and without better health outcomes. I used to work for the president and I recall a conversation we had early in his first term. It was clear what a heavy lift health reform would be—which was why none of his predecessors had succeeded. But Obama explained that he was motivated by what I’ll call “fiscal space”—if 6-8 per cent of the country’s GDP is wasted on inefficient healthcare, responsible stewardship means squeezing those inefficiencies out of the system. He understood this wasn’t going to be easy: my inefficiency is your profit, and health industry lobbyists will spend large amounts fighting tooth and nail to maintain such “rents.” But to Obama’s credit, he made the play for it.
Remarkably, he succeeded. The Affordable Care Act became law in 2010. Even strong advocates like myself recognised it was far from perfect. But we thought it had a decent chance of accomplishing its two main goals: significantly reducing the numbers of those without health coverage and slowing the growth in costs. And we were right. The share of Americans without health insurance fell from around 15 per cent to about 9 per cent. And, while this part is harder to prove,…