President Obama speaks about the Affordable Care Act on Wednesday in Boston.
The Affordable Care Act's early travails are yielding some lessons for future presidents and lawmakers. Here are three:
1) Presidents can't be too careful about making high-profile promises.
President Obama dented his credibility significantly by repeatedly promising that the Affordable Care Act would allow Americans with insurance they liked to keep those policies.
That turns out not to be true in many cases for those in the individual insurance market, leading to the conclusion that the president didn't understand the legislation's effects, that he intentionally misled, or that he way oversimplified his message for broad consumption.
None of those put him in a particularly good light. And the hit to his credibility as he closes in on the end of his fifth year in office could very likely wind up harming other parts of his agenda, like immigration, as opponents repeatedly ask: "How can we trust him?"
Health care experts have said they were surprised when they first heard the president's vow, since they knew Obamacare would invariably result in many private insurance plans being dropped — and thus people not being able to keep those plans. An obvious question is how the president's senior aides allowed him to keep making the promise.
2) Someone needs to tell the president bad news.
It's a truism that aides are loath to bring presidents bad news. But even worse than telling a president bad news is allowing him to be surprised by it. Health and Human Services Secretary Kathleen Sebelius testified this week, however, that the president was caught off-guard by the health care exchange website's meltdown.
That was despite the failure of HealthCare.gov when it was tested before its Oct. 1 launch and couldn't handle a minuscule fraction of the traffic it was expecting. There were plenty of warnings that the site was troubled. According to the administration, they just never flowed to Sebelius' level or to the president's.
Future presidents might want to have a trusted, top-level White House aide whose sole job is to sniff out the bad news in the administration.
3) Democrats can forget about Republicans helping them fix Obamacare.
Democrats have argued that the GOP should take a page from how Democrats acted after Republicans passed the Medicare drug benefit program in 2003.
In recent congressional hearings about the ACA, Democrats have reminded Republicans that even though Democrats voted against the drug-benefit program because of the hole in its coverage, its ballooning of the deficit and its failure to rein in pharmaceutical company profits, they helped fix it. Democrats by and large didn't threaten to undo the Medicare program once it became law.
But the dynamics were totally different. When Karl Rove, President George W. Bush's political strategist, persuaded Republicans to create a new entitlement program, he argued that it would help Republicans capture ground from Democrats on the health issue. It also put Democrats in a trick bag since, as a party, they tend to support entitlements, not oppose them.
By contrast, the central premise of the health care law — the federal government mandating the purchase of a product and penalizing people who don't buy it — is anathema to many conservatives. It's why the repeal and defund argument appeals to so many Republicans.