Architect of Obama’s health care plan fears a ‘political’ decision by the Supreme Court, says Romney’s lying

Jonathan Gruber. (econ-www.mit.edu)
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Jonathan Gruber, a key intellectual architect of President Obama's overhaul of the American health care system, is a little frustrated.

"I'm frustrated that the future of the American health care system rests in the hands of one or two of these unelected people who might make the decision based on political grounds," Gruber, an M.I.T. professor, told me in a phone interview on Monday, a few hours after the Supreme Court granted a writ of certiorari to hear challenges to the Affordable Care Act. "It's very disturbing."

The court consolidated several different challenges and will hear a host of issues related to the Patient Protection and Affordable Care Act, which became law in March 2010, granting a full five-and-a-half hours for oral argument. But the central question is whether Congress can require people to buy health insurance, and, if not, whether that mandate can be severed from the rest of the bill.

Gruber, whose ideas also made up the landmark overhaul of health care in Massachusetts that was overseen by then-governor Mitt Romney, thinks that the Obama health care package would still be better than nothing if the mandate were removed, but said that it wouldn't be nearly as effective. He explained that the requirement to buy insurance puts more healthy people into the overall pool, and that if companies are not allowed to screen for pre-existing conditions, which is one of the more popular aspects of the bill, consumers would simply buy health care once they're sick, which would in turn drive up premiums.

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Without the mandate, Gruber said, the bill would only cover a third to half as many people, and that premiums go up 20 to 30 percent.

"The mandate is really the glue that holds this act together," Gruber said.

"I still think it's good policy," he said. "I still think that it's a better use of public dollars than the alternative. I still think that the totality of the package is deficit-reducing. It will be even more deficit-reducing because you only spend three-quarters as much instead of 100 percent as much.

"So I still think it's worth doing, but it goes from a good idea to better than nothing. I guess that's how I'd summarize it. You know, I think basically, what they've constructed, the Affordable Health Act, is the best possible private-sector solution to our problem of the uninsured that we have available, you know, short of single-payer. And I think it's not that anymore.

"You get rid of the mandate, it just becomes a big government expenditure, which will cover a bunch of people, and that's great, and I'm all for spending money to do that. Then it just becomes standard old, 'expand health care with the public money,' nothing really innovative anymore."

Gruber said he understands the political motivation for Republicans to be trying to dismantle the bill.

"Look, if this succeeds, then Obama becomes F.D.R. This is the most important social policy accomplishment since the 1960s. And if this succeeds, this could be the kind of benefit to the Democratic Party that Social Security was. So if I was the Republicans, I'd be screaming and kicking and scratching to kill it too, on purely political grounds," he said.

He also said, "On politics, this is your Waterloo. You've got to fight this tooth and nail. And so they're fighting it tooth and nail. It's not just the mandate, they're picking on everything."

Gruber was also frustrated with Democrats, who still express ambivalence about the bill and the mandate, with one recent Kaiser poll showing only 52 percent of Democrats currently support it.

"I really honestly feel in my soul that if I sat down and could talk to Democratic voters and explain what's in the bill, that would go from 52 to 75 percent," he said. "I really do believe that. It's so consistent with Democratic ideals in so many ways that it's just a matter of misunderstanding and misinformation."

To that end, he's writing a graphic novel explaining the bill, which will be published by Farrar, Strauss & Giroux in December. He said the opponents were mostly to blame for the bill's bad press, and only sort of entertained a question about whether the Obama administration could have done a better job of selling it.

"I guess I would like to think so, but at the same time, these are smart guys,"  he said. "It's kind of like criticizing the manager of a baseball team. I can criticize all I want but at the end of the day these guys are more qualified to do it than I am. So, you know, I wish they could have sold it better but it's not like I have some brilliant idea for how they could have done that."

Gruber said Republicans were actually less opposed to the mandate, which is going to be under scrutiny by the court, than they were to other provisions of the health care bill, given that the mandate was an essentially conservative idea that had currency with conservative intellectuals in the early 1990s. I asked about the difference between this plan and the kind that was espoused by former House speaker Newt Gingrich back then (and, briefly, in May of this year).

"Zero difference," he said. "This is, to my mind, the most blatantly obvious case of politics trumping policy I've ever seen in my life. Because this is an idea, that four or five years ago, Republicans were touting. A guy from the Heritage Foundation spoke at the bill signing in Massachusetts about how good this bill was."

He credited Mitt Romney for not totally disavowing the Massachusetts bill during his presidential campaign, but said Romney's attempt to distinguish between Obama's bill and his own is disingenuous.

"The problem is there is no way to say that," Gruber said. "Because they're the same fucking bill. He just can't have his cake and eat it too. Basically, you know, it's the same bill. He can try to draw distinctions and stuff, but he's just lying. The only big difference is he didn't have to pay for his. Because the federal government paid for it. Where at the federal level, we have to pay for it, so we have to raise taxes."

To Gruber, the stakes for the court's decision couldn't be higher.

"Basically, this is the last hope for a free-market solution for covering the uninsured. If this fails, then you either give up on the uninsured or you go to single-payer. Those are the only two options left. And the Republicans, if they're willing to stand up and say, 'We give up on the uninsured,' then great, let them say that and let the voters come to the polls and decide, but they won't say that.

"Anyway, I'm just ranting because I'm upset."

UPDATE: Romney responds, sort of.