I’m probably not alone among journalists writing about the Affordable Care Act in finding that the lowest-information emails landing in my inbox lately come from people who have learned one thing about the act, and one thing alone: that some guy named Jonathan Gruber, its ostensible “architect,” said some insulting things about American voters’ stupidity and how they had to be gulled into supporting the bill.
So this is how low the debate over the most far-reaching social insurance program of our time has fallen. Never mind that the act has brought health coverage to at least 10 million Americans who didn’t have it before. Or that it has eradicated medical underwriting — that process by which insurance coverage denied policies to people with pre-existing conditions or jacked up their rates to unaffordable levels. Or that it has wiped out a broad range of traditional health insurance abuses.
While we’re arguing over whether a working law should be invalidated by a health economist’s casual description of the legislative process of 2009 and 2010 — the inaccuracy of which can be documented — here’s what we should be be noticing: The healthcare consultancy Avalere Health just reported that 2015 premiums for benchmark silver plans rose only 3% on average compared with 2014 among the 34 states using the federal insurance website to enroll their citizens in the ACA.
That’s well below historical cost growth. In 24 of the states, premiums rose by 5% or less; in 12, the change is zero or negative.
So tell me again why we should be fixated on Jonathan Gruber. I know — didn’t the MIT economist create the law?
The right's elevation of Gruber to the status of "Obamacare's architect" is a familiar strategy. It's known to football coaches, college debating teams and military commanders alike: overinflate your opponent’s strength or importance so you can look better when you take him down.
By calling Gruber the “architect,” the right wants you to think that he all but cooked up the law, wrote the language, supervised its legislative strategy and political PR, whipped up all 279 votes for it in the House and Senate (or maybe cast them himself), then signed the bill as president.
Here's the truth: Gruber was a consultant to the Democrats during the ACA’s formative period. He outlined the economic rationale for some of its elements, based in part on his role as, sure, “architect” of the Massachusetts healthcare reform known as Romneycare. Yet we kept hearing from Gov. Romney during the 2012 presidential campaign that Romneycare was nothing like Obamacare; now, apparently, they’re supposed to be identical. (Does Mitt Romney now agree?) He played an important role in the creation of the ACA, but he had nothing to do with the strategy he seems to have been describing.
As for Gruber’s remarks about the stupidity of the voters, pundits and politicos have lined up to denounce them as utterly wrong, unfair, offensive, etc., etc., etc. That they may be, but who would dare bet that exactly the same sentiment hasn’t been heard at one time or another in every one of the 535 House and Senate offices on Capitol Hill? Anyone?
ACA critic Avik Roy of Forbes, grasping for a rationale to make Gruber’s remarks relevant to the ACA today, snarks that Gruber has revealed something that Roy himself always has maintained: that Obamacare is a “redistribution of wealth from the young and healthy to the old and unhealthy.”
Congratulations, Avik: You’ve just defined health insurance, which distributes funds from policyholders who don’t need medical care just now to people who do. The reason this is useful, of course, is that one can go from “healthy” to “unhealthy” in the blink of an eye — the screech of an upcoming truck, the sudden pain of a heart attack, the call from the doctor with your cancer diagnosis.
And by the way, nobody on Earth is in a permanent state of youth. Sooner or later, the young become the old. When Avik Roy gets to that point, he may well benefit from the premium payments of the young. By the way, how does he think the health insurance he carries now works? (How does he think his home or auto insurance works, for that matter?)
The dudgeon on the right about the supposed subterfuges identified by Gruber in getting the ACA analyzed by the Congressional Budget Office and marketed to the public is doubly cynical. For one thing, every major bill is manipulated this way, by Republicans and Democrats alike. House Budget Chairman Paul D. Ryan has put his successive budget plans though this same wringer to extract favorable fiscal scoring from the CBO. Does anyone really believe that no bill in history before the ACA wasn’t simplified and subjected to legislative code to win passage?
Second, if you want lies about the ACA, just look at the roster of lies its critics have foisted on the public to kill it. “Death panels.” That it’s a “government takeover” of healthcare (a neat trick, since it strengthened the role of private insurers). Premiums will “skyrocket.” (See the Avalere survey above.) And so on.
Ezra Klein of Vox wrote recently that Gruber’s remarks are important because “they confirm everything [the right] already believed about Obamacare: it’s an unconstitutional law jammed through Congress on false pretenses by elitist technocrats who dismiss the intelligence of the American people.”
Klein is much too charitable here about the ACA’s foes. They know it’s constitutional, because the Supreme Court has ruled it so. They know it was passed by Congress in an open vote. They know it’s working exactly as it’s supposed to — bringing affordable health insurance to 28 million Americans in 2014, of whom about 10 million didn’t have insurance previously.
And because they know this, they’re trying to shift the battle from facts and figures to a manufactured controversy over videotaped remarks by Jonathan Gruber.
As for the voters’ intelligence, Gruber’s remarks threaten to become a self-fulfilling prophesy. To treat them as important really is stupid. If anyone’s counting on the stupidity of the American voters, it’s the ACA’s opponents, who have turned an academic’s dumb remarks before some open mikes into a much dumber controversy.