Is the ACA’s Failure the Fault of Michael Cannon?

Alec MacGillis of The New Republic has named Michael Cannon of the Cato Institute the Affordable Care Act’s “single most relentless antagonist.” (Cannon says that, though he’d prefer to be known as freedom’s single most relentless protagonist, he’ll take the title). If you recognize Cannon’s name, it’s because I frequently cite his blog posts, columns, and policy reports here at Hamsterdam Economics. He is one of my first as well as last stops for commentary on any issue related to health policy or the Affordable Care Act, and his work is remarkably reliable and, at least in my opinion, fair-minded.

I don’t think anyone would dispute that Cannon has been extremely influential in pushing back against the ACA. MacGillis elaborates on Cannon’s ideas, and how he has managed to get his message out to others.

Cannon’s argument has made its way into several lawsuits against the Affordable Care Act, two of which recently surmounted their first hurdle in the courts . But his crusade may have done damage regardless of whether those long-shot lawsuits prevail. To build the legal case, Cannon spent a lot of time traveling around the country during the past few years—with visits to more than a dozen states and calls to far more—explaining to state officials opposed to the law that, if they simply refused to set up exchanges of their own and thereby shunted their citizens onto the federal exchange, they would greatly raise the odds of the law’s total collapse if and when the courts agreed with him that the federal exchange couldn’t award subsidies.

This isn’t a “takedown” piece. MacGillis isn’t trying to slam Cannon and, although he does refer to Cannon’s work as part of a “crusade,” he seems to try to see both sides of the ACA debate without injecting too much bias into it. (He grants, for example, that readers will give Cannon either credit or blame for his outsized role in opposing the ACA). That being said, I’ve got a feeling I know which way MacGillis and The New Republic are leaning on the ACA, and I doubt that this article was commissioned as a means of celebrating Mr. Cannon for all of his hard work and scholarship.

Maybe it’s just me, but the implication here seems to be that one man has pursued a large role in opposing the ACA, and that there’s something negative about all of that. At least, when I read MacGillis’ article, it seems like it was written so as to leave a bad taste in the mouths of The New Republic readers. (Even if it wasn’t, I really don’t think anyone would object to me saying that many readers of The New Republic will probably feel negatively toward Cannon after reading the piece). To me, though, this entire saga reveals more of a problem with the Affordable Care Act than it does with anything (or anyone) else.

If one man, armed with nothing more than the wording of the Affordable Care Act itself , is capable of going around the country and drumming up support for a particular reading of the legislation, doesn’t that point us toward something problematic in that particular piece of legislation? Either the ACA clearly means what it says, and federal subsidies are not permissible in federal exchanges, or it doesn’t mean what it says, in which case we’ll need the court’s interpretation of the enumerated powers. I could go on and on here and say that the bill’s too big and sprawling, no one really read it or understood it before they passed it, etc. etc., but I think we’ve all heard that before so I’ll abstain.

Instead, the point I’ll make is this: a piece of legislation that is rammed through Congress without a single vote from the opposition party will almost by definition be one that has not taken into account that the opposition party exists. What do I mean by that? I think that Cannon himself has said it best in the past.

The industry has way too much influence when the government gets involved, and it’s nice to think that we could have this wonderful universal coverage plan, and we could just get the industry out of it. We could just have the industry not be a part of it. We could cut off their influence. But we know the industry is always going to be around, we know that there will always be drug companies and greedy private health insurance companies, and Republicans! Who will mess things up, like they messed up FEMA and they mess up everything else.

So you can’t say that universal coverage is a wonderful idea and we can separate out this part–this is an inherent part…all the rent-seeking from the industry, and all the buffoonery from the Republicans– unless you’ve got a plan to abolish the Republicans, they’re part of your plan.

Cannon was debating a proposition for universal health coverage and not the ACA there, but I’ve always liked the point that he’s making. The fact that the ACA was passed without broad support means that the Republicans, tea partiers, and libertarians who make up an implicit part of the plan aren’t really accounted for within it. I have a feeling that there’s an inverse relationship between the number of bones a measure throws to an opposition party and the amount of push-back the originating party eventually receives. Considering that the ACA was passed without a single Republican vote , should we really be surprised and indignant when they dig their heels in and push back against it?

There will always be people who oppose any measure, so it’s not a reasonable standard to suggest that a good plan would always take account of everyone and try to appease them in some way. But Michael Cannon isn’t just some ill-informed, unreasonable stand-still determined to stand in the way of anything and everything just for the sake of some bias that he’s held all his life. He is an informed and influential health policy scholar, and the fact that the ACA has motivated him to devote this much time and energy to stopping it dead in its tracks should cause us to reflect more on the ACA than we do on Cannon.

President Obama often invites columnists he likes to the White House to join him for a private chat on his administration and policies. Although he reportedly recently sat down with conservatives like Charles Krauthammer and Paul Gigot, some of his favorite liberal guests apparently include writers like E.J. Dionne and Ezra Klein. I’m not saying it would be enjoyable, but the President may consider talking more closely with men like Cannon the next time he prepares to embark on such a largely unpopular measure.

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