Topics: Obamacare

On health care, all that matters to Obama is planting the first stake

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In “The Power Broker,” Robert Caro’s epic biography of urban planner Robert Moses, the author details the hardball tactics Moses utilized to achieve his vision for the New York park and highway system.

One strategy was to simply get a project started with whatever money was available, knowing that politicians wouldn’t simply allow, say, a short stretch of highway to sit idle or for parks to wind up partially completed.

In one example, Moses spent all the money allocated for bathhouses at his Jones Beach development project just building the foundation. That challenged the politicians to give him more money, or just allow the foundation to sit in the sand, without a building on top.

“Once you sink that first stake,” he was fond of saying, according to Caro, “they’ll never make you pull it up.” It has always been clear that a similar line of thinking has driven President Obama’s strategy on health care and is governing his decision-making process on implementation.

Obama, it should be remembered, has long considered a government-run single-payer health care system to be his ideal. He said so in a 2003 speech to the Illinois AFL-CIO, cautioning the crowd, however, that “we may not get there immediately.”

During an Aug. 2008 town hall meeting, he told a questioner that, “If I were designing a system from scratch, then I’d probably set up a single-payer system.” He went on to explain that currently a lot of people get their insurance through their employers, making an “immediate transition” difficult.

What Democrats ended up doing by pushing Obamacare was what Senate Finance Committee Chair Max Baucus described as laying a “cornerstone.” At every point during the health care debate, when passage was in doubt, when Obama had to cede to dropping elements such as a “public option,” his focus was always on getting as much as he could passed.

As liberal New York Times columnist Paul Krugman recently described the law, “it basically relies on a combination of regulations and subsidies to rope, coddle, and nudge us into a rough approximation of a single-payer system.”

In my weekly column, I provided a number of examples in which critics of Obamacare have been vindicated by the law’s failures. But ultimately, Obama is willing to accept some egg in his face. He can deal with scrapping the unworkable long-term care program known as the CLASS Act.

He can suck up a delay in the employer mandate or weaker verification requirements for individuals to obtain government subsidies. He can live with all of the howls that this elicits from conservatives, because all of these provisions are ancillary to his primary goal, which is to get as many people dependent on government for their health insurance as possible so as to make it impossible for Republicans to ever fully repeal the law.

Just as Social Security, Medicare and Medicaid are not going anywhere, Obama assumes, once in place, a new health care entitlement will not only survive, but grow over time. This will be true, he’s concluded, no matter how disastrous its initial rollout is, no matter how deleterious to the nation’s finances, no matter how rife with fraud.

As health care law professor and Obamacare supporter Timothy Jost recently told the Washington Post’s Ezra Klein regarding the elements of the law that have been delayed, “Implementation just got easier rather than harder.”

Yes, in the sense that a workout would become easier if you decided to run one mile instead of five, or cleaning your home would become easier if you decided to skip the kitchen and bathrooms, implementing Obamacare became easier by ignoring parts of the law that were hard to implement.

But Jost’s point is an important insight into the thinking of the law’s supporters. Delaying provisions that would have limited the number of people on the new government-run insurance exchanges actually facilitates Obama’s ultimate goal.

So, before conservatives get too cocky about ongoing reports of problems with Obamacare, it’s worth keeping in mind that Obama just wants to plant that first stake. Like Robert Moses, Obama is betting that once he sinks in that first stake, they’ll never pull it up.

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