Birenbaum: The Day the President Struck Out
Baseball, the pundits tell us, is the metaphor for everything in American life. I won’t go through all of them, but there are many. For example, if a patient with advanced prostate cancer chooses radiotactic radiosurgery, offered by a prostate radiologist to destroy a cancerous lesion rather than the anti-hormonal hormonal therapy that is directed at extending life, the skeptical prostate oncologist might say, “You’re going for the home run.”
The roll-out of the Affordable Care Act (ACA), also known as Obama Care, was clearly a strikeout for the President. However, it was only the beginning of what promised to be a long process of rebuilding the team during the course of the season and thereby saving the season. The length of a major-league season was often compared by Joe Torre, the great Yankee manager, to a marathon rather than a sprint. A team could start off poorly and still become division champions when October rolled around because there was plenty of time to catch up after a dismal start. A new season, as in the case of a team like the Boston Red Sox that went from worst in 2012 to first in 2013, reminds us that starting over is soothing. However, a “do over”, as we called it in my Bronx childhood, will not happen with regard to Obama Care even as tweaking will occur.
Can we apply the Torre metaphor regarding the lengthy season to the start of the implementation of the ACA? Yes, we can! The October 1st, 2013 disaster of a rollout of the ACA will always make me uncomfortable when it comes up in conversation, but It will not produce rage like December 7th, 1941 or September 11th, 2001. For most Americans, it will be greeted with disbelief if not ridicule.
There is, as an aside, a unique American contempt for our first black president, with an African father and a funny set of names, making him appear to an elite and a non-elite white population, as the epitome of the “other,” an alien figure who cannot be trusted to do things right and clearly does not deserve to hold high office.
Again to invoke baseball history, this contempt reminds me of the way Jackie Robinson, old number 42, was greeted by racist white fans in St. Louis. There were also black cats released from the stands to distract this great player from performing at his best. Wasn’t he told to go back to the Negro League or to play basketball with a black five team? Robinson, also an All-American college football player, didn’t break, and opened the big leagues to the countless African-American players who followed in his footsteps, but also those of Latino backgrounds as well.
The pioneers in the majors still had to put up with segregation off the field, despite the fact that they brought out thousands if not millions of fans from these diverse ethnic and racial backgrounds. Despite the hatred displayed by white-superiority oriented fans in 1947, there were now new participants in American life. This point was not lost on President Obama in his interview with David Remnick in The New Yorker last week, when Obama observed that losing some white supporters was balanced by the gains among other ethnic and racial voters.
Rebalancing also started to take place in response to the opportunity to sign up for coverage under the Affordable Care Act. The machinery found in Healthcare.gov, the federal website, didn’t work that day or for many days thereafter, and public opinion and commentators on news programs to the President to task. There was, it should be noted, comparable levels of complexity in signing up large numbers of people were found in the federal insurance drug program for seniors and people with disabilities, Part D of Medicare; it furnished a useful model for dealing with large numbers of potentially qualified members. In addition, Medicare determines how much to charge recipients for Part B based on data from the Internal Revenue Service. Finally, states have been determining eligibility for Medicaid and Child Health Plus for years, using websites to collect information from the applicant and verifying income information from state tax agencies.
We can now agree with Hall of Fame member Yogi Berra that nobody goes to that restaurant anymore because it is too crowded. At the awful start, Healthcare.gov didn’t do nearly as well as some of the state-run websites, such as California and New York. Happily for those who needed coverage, the Empire State website and navigators, the people who guided people seeking coverage, through December 2013, a three month period, defied the odds and registered 50 percent more than was forecast. Coming from behind during that ninety-day period, the federal website overtook the state-run sites as far as registration was concerned.
President Obama delivered the State of the Union Address on January 28th, 2014 and he both lightly took the blame for the bad start and correctly took credit for applying various corrections to the website to make it work. Like a manager of a new franchise, e.g., the Mets, the Diamondbacks, or the Rays, he explained that the ACA was working like a changed pitching rotation. To date, there are nine million Americans covered by policies purchased on the exchanges or via Medicaid.
As with all recent holders of the Presidency, there was a story to tell that went along with the numbers. A person in the galleries, who via an exchange, signed up for coverage, perhaps with a subsidy, and is now protected against financial disaster as well as having access to health-care providers. Unsurprisingly, it turned out, that this was a wise decision. With her health insurance coverage starting on January 1st, she was able to get indemnified for emergency surgery a few days later. The President pointed her out , he briefly told her story, and a new narrative was unveiled that spoke to the underlying strength of the plan to extend health care coverage to all Americans at a reasonable cost and to the team that steers this complex program, one with many moving parts.
Yes, I agree that universal coverage through expanding Medicare for all makes more sense and I have written extensively about that quest, but that would be a grand slam in a country that needs to use the willingness of our powerful insurance industry to cooperate. Think of what is happening as the start of a two-out rally and we are not leaving players on base.
This is only the first quarter of the season for Obama’s team, and yes, the ACA, like all other efforts to cover more people so they can access care and not go bankrupt doing it has some unintended errors in the field. As required when there are more patients seeking services there is a need for more care givers. Thus it is also the beginning of training more primary care providers to extend care to the newly enrolled via the exchanges and by the expansion of Medicaid. So let’s see who is in first place next October 1st and who will say “wait 'til next year.”