The Secretary of Explaining Stuff is back on the job. On Wednesday, former President Bill Clinton gave a speech about Obamacare—why it was necessary, how it will work, and what it will do in the future. The speech itself was typical Clinton: It started about 25 minutes late, ran for nearly an hour, and was full of policy detail. Yes, he cited the Rand Corporation and the Commonwealth Fund. Most important, though, Clinton explained why those details mattered—to the taxpaying public, to businesses, and to individual Americans.
It’s safe to assume it’s not the last time Clinton will have something to say on the subject. And lord knows he’s earned the right. Twenty years ago, Clinton was attempting to get his own health care reform proposal through Congress. The plan was better than most people now remember, and the launch Clinton gave it, in a nationally televised address to Congress, was actually among the more widely praised speeches in recent memory. And still it wasn’t enough to win congressional support. Partly that was because Clinton made strategic errors, and partly that was because allies hadn’t laid a strong political foundation for reform. But another big factor was the brutally effective opposition, which overwhelmed every argument Clinton made with two or three counterarguments of its own. Some were true, some weren’t, but together they helped to obscure the big picture—making it even more difficult for Clinton and his allies to succeed.
With help from Nancy Pelosi, Harry Reid, and outside advocates of reform, Obama was able to do what Clinton could not: Sign a comprehensive health care bill into law. But the political environment, if anything, has deteriorated. These days, the focus is on implementing reform, not passing it. But every day Obamacare critics go on the attack, warning about negative consequences they say the law will have or is already having—and agitating for its repeal or at least its defunding. As in 1993 and 1994, some of the claims critics make are true. Some are not. But the deluge of stories about glitches and delays and side-effects make it nearly impossible to have a broader argument—about the basic trade-offs of the law and whether they are worthwhile. As surely as advocates focus on its upsides, critics focus on the downsides—and almost nobody puts the two together.
It should be one conversation, starting with very real costs Obamacare imposes. Wealthy people are paying higher taxes. Most of the health care industry is dealing with declining reimbursements from government. Insurers and employers face tighter regulations. Starting next year, some individuals and small businesses that already have insurance will have to pay substantially higher premiums. These things are given. Other effects are just materializing: It appears, for example, that some employers really are limiting the hours of part-time workers, in order to avoid paying for employee health insurance. It's a tiny percentage of the workforce, but in such a large country even a small percentage equals a lot of people. Just today, Investor Daily’s Jed Graham had a new article on the reports so far.
But it’s simply not possible to fix a dysfunctional health care system without some adverse effects. The best you can do is limit the disruptions, undo or repair the damage, and maximize the benefits. According to Clinton, Obamacare is doing just that. And he makes a good case.
In the speech, Clinton acknowledged some of Obamacare's flaws—most notably, an "affordability" standard that will leave dependents of some low-income workers without a new way to get insurance. And he urged Republicans to join Democrats in trying to fix them. "There are always drafting errors, unintended consequences, unanticipated issues," Clinton said. "We’re going to do better working together and learning together than we will trying over and over to repeal the law or rooting for reform to fail and refusing to fix relatively simple matters." (As Greg Sargent keeps pointing out, that position—supporting the law with fixes—tracks closely to public opinion.)
But Clinton also pointed out the benefits Obamacare has already produced. Young adults are getting insurance through their parents. The insured have new consumer protections, like those eliminating lifetime limits on benefits. Seniors have more coverage of prescription drugs and preventative services. The list goes on: In all, many millions of Americans are better off because of these provisions. Meanwhile, the year-to-year increases in health care spending have been lower than usual, which means government is saving money and premiums for the privately insured aren’t rising as fast as they would be otherwise. Obamacare isn’t the only reason for this change and it probably isn’t the primary reason, either. But most experts think it has played a role.
Those savings are likely to grow with time. Health improvement might follow, since the changes underway—like a reduction in hospital readmisisons—save lives as well as money. And that’s not all—not by a longshot. Starting next year, millions of people without insurance today will get coverage via expanded state Medicaid programs or through the new insurance exchanges. Thanks to generous federal subsidies, many people will pay less for their insurance than they pay now. And those who do pay more will at least have more comprehensive and stable coverage, while paying premiums that are pretty much comparable to what employer-sponsored insurance costs. Oh, and if the Congressional Budget Office is right, the deficit will be lower than it might otherwise be.
Are these benefits certain enough—and big enough—to outweigh the likely costs? Is the new system clearly better than the dysfunctional status quo? Those are judgment calls, obviously. But they are best made by stepping back from day-to-day news and thinking about the big picture. Among contemporary politicians, few can do that with the knowledge and authority of Bill Clinton.
Jonathan Cohn is a senior editor of the New Republic. Follow him on twitter @CitizenCohn
Note: This item has been updated. Among other things, I mistakenly referred to the 1990s as "ten years ago," rather than twenty. Yikes.