MIT economist Jonathan Gruber has distinguished himself in recent weeks by his astonishingly candid comments about President Obama's health care legislation, "The Affordable Care Act": reliance on the "stupidity" of the American public to secure enactment, the overall intent and scope of the law, and the extent to which federal subsidies were not intended for low-income people who secured coverage on the federal government exchanges (as opposed to state-sponsored exchanges where the law is clear that such individual subsidies are in order).
Then he took it all back and issued a major "mea culpa" during his testimony before the House Oversight and Government Reform Committee. In his earlier video appearances, however, Professor Gruber had depicted himself as a major architect of Obamacare. Now he tries to come off as a petit fonctionnaire -- albeit one who reportedly (he won't disclose the full sum) received hundreds of thousands of dollars in consulting fees for his work.
Professor Gruber's earlier candor is decidedly welcome -- not only among the policy experts and the lawyers challenging Obamacare's federal-exchange subsidies in the U.S. Supreme Court, but also, I suspect, among the stable of TV and online comedians whose living depends on reality being stranger than fiction.
But what I had not appreciated until I revisited Professor Gruber's videos is the extent to which he also appears to have played a major behind-the-scenes role in Senator Barack Obama's 2008 presidential election. Professor Gruber told his audience that "quite frankly" when Senator Obama was running for president, he knew that the "American public doesn't actually care that much about the uninsured." What Americans really care about first and foremost, he averred, is cost -- namely, the cost of their own insurance. So all that campaign talk about extending coverage to 40 million or so uninsured Americans was just feel-good pabulum to motivate what people like Rush Limbaugh like to call "low-information voters." It's the stupidity, stupid.
Professor Gruber's video remarks reminded me of one of President Barack Obama's first public events to promote health-care-reform legislation. On March 5, 2009, the President hosted a White House health-care summit. I was privileged to be among the invited guests and was impressed by what Barack Obama said on that occasion, not even seven weeks into his first term. The president launched the event with remarks in the East Room, and his opening statement made clear his priorities: he said that we had to get health-care costs under control first before we could expand access to the uninsured.
As a lifelong Republican who supported Senator John McCain in the 2008 election, I thought: this new president has it exactly correct. I can support enthusiastically what he is saying. I know very few people who do not favor expanding Americans' access to health care -- especially when it comes to the millions of uninsured Americans -- but if you expand access on top of a structurally flawed system, you will only make matters much worse. Costs will continue to rise, thereby creating additional budgetary havoc that will only jeopardize the overall viability and long-term sustainability of the entire system. Better to fix the structure first, change the incentives away from costlier fee-for-service, volume-over-value reimbursements, and then expand access once the entire system is financially secure.
But that's not what happened.
Shortly after his March 5 opening salvo, President Obama outsourced the legislation to Congressional Democrats Harry Reid, Nancy Pelosi and Max Baucus. What has never been explained is why the president did not work in a bipartisan way with Senators Ron Wyden (D-OR) and Bob Bennett (R-UT) who, months before Obama was elected, had already drafted and scored a comprehensive health-care bill, "The Healthy Americans Act," that also enjoyed more than a dozen Democratic and Republican co-sponsors. After all, during his 2008 campaign, Senator Obama had pledged to transform Washington's hyper-partisanship. An excellent way to make good on this commitment would have been to launch his signature domestic-policy initiative with genuine, pre-existing bipartisan support.
Now we learn from Professor Gruber's candid disclosures that the Obamacare legislation was mostly about expanding access to the uninsured and really not about trying to restructure the system to reduce costs. Here's what Professor Gruber actually said:
"What the American public cares about is costs. And that's why even though the bill that they [sic] made is 90 percent health insurance coverage and 10 percent about cost control, all you hear people talk about is cost control."
It turns out that all of the talk about restructuring the system to control costs was simply a dodge. Tell the American public (they're "stupid," don't forget, with a maximum attention span of 140 keystrokes) what they want to hear, and then do whatever the hell you bloody well want.
Americans tend to appreciate candor. Being too clever by half is not an established American trait. It is not terribly surprising, therefore, that the president's current approval rating is exceptionally low, and that his credibility in international matters has been questioned around the globe -- by friends as well as foes.
The American people, after all, may not be as stupid as some people think.
Charles Kolb served as Deputy Assistant to the President for Domestic Policy from 1990-1992 in the George H.W. Bush White House. He was president of the French-American Foundation--United States from 2012-2014 and president of the Committee for Economic Development from 1997-2012.