As best as I can judge from monitoring Twitter for about 20 hours out of every 24, which is my habit these days, few of this country’s big-time journalists are keeping a close eye on the Obamacare crisis in the United States. We are all caught, like flies in a spiderweb, in the evolving stories of Rob Ford and the Senate multi-scandal. Both are news files quite unusual in Canada, delivering little bomblets of fresh weirdness for months on end and on a basis that could be characterized as “daily, gusting to hourly.”
Or maybe these stories aren’t unusual; maybe it is just a matter of social media turning our existences as pundits into a sweaty, crowded hearth in which we all sit in a big circle and echo each other all day. I quite enjoy it, but a mind-pummelling stream of “FordSenateFordFordSenateFordNigelWrightFordFord” may not be healthy.
Is anyone, for example, looking for the international or even the Canadian angle on Obamacare? It is a disaster of such magnitude that it is easy to imagine it influencing politics in countries that take cues from America, which, the last time I checked, was about all of them, bar North Korea. It is one of Canada’s major national afflictions that most of us remain blazingly ignorant of health care policy and provision in any country but the U.S. Already one senses that the appetite for reform of physician care and health budgets in Canada has dwindled since, say, the 1990s.
Obamacare isn’t going to make major systemic change in either direction look more appetizing to Canadians. That’s an important Canadian angle right there. Not long ago it looked as though national pharmacare was likely to become an election issue here, quarterbacked by the NDP and perhaps the Liberals, too. The concept has plenty of support among economists and other health policy experts—the same class of kindly boffins that, in the U.S., lined up almost unanimously behind the Affordable Care Act.
For better or worse, nationalizing prescription-drug insurance seems likely to be a much tougher sell here in the immediate future. Any large, complex health care experiment will be. The more wise heads support it, the easier it will be for supporters of the status quo to shout, “Unintended consequences! Ivory-tower tomfoolery!” Indeed, political strategists may already be saying it to themselves.
American commentators are already starting to wonder if Obamacare’s difficult start and increasingly troubled prospects may end up as a victory for small-government conservatism. The problems for the program do not end with the calamitous state of the federal insurance-exchange website, or even with the nasty surprises handed to the self-employed and freelancers in the “individual market” who were falsely promised: “If you like your plan you can keep your plan.” Some Obamacare buyers are finding themselves shut out from their preferred doctors and hospitals; employers are junking non-compliant health plans; and many in the middle class who liked the Obamacare concept are facing sticker shock.
The U.S. is having some success in slowing the growth in its health spending thanks to some “cost-curve bending” measures already undertaken. (Penalizing hospitals under Medicare for repeat patient visits is a big one.) And Obamacare may end up being good for the country’s solvency even as it leaves millions angry. But the damage done to the prestige of “evidence-based” social engineering may already be permanent, especially given the impression of a calculated bait-and-switch on the part of planners.
The redistributive aspects of Obamacare were undersold, and possible pitfalls obviously not foreseen. The neoliberal Democrat Walter Russell Mead put it neatly the other day: “President Obama may be the Democrat who ends up convincing millions of American millennials that Ronald Reagan was right, and that the progressive administrative state is neither honest nor competent enough to solve the problems of the American people.” If that is the case, the effects cannot be confined to the U.S.
Barack Obama is a charismatic president who lacked executive experience but was, partly for reasons related to his ancestry, an attractive blank slate onto which young voters could project their dreams. He compensated for his shortcomings in political dues-paying by building a team of high-profile brainiacs like Steven Chu, Peter Orszag, and Austan Goolsbee. Am I wrong to detect resemblances with the Liberals’ Justin Trudeau victory plan? If Obama goes down as a failure, someone who peddled Hope and got in over his head, will our millennials think twice about casting a feel-good vote for an unknown quantity who fast-forwarded past the usual leadership training?
On the web: For more Colby Cosh, visit his blog at macleans.ca/colbycosh