Let me tell you again how Obamacare works.

Photographer: Win McNamee/Getty Images

Simple Policies Win Elections

Megan McArdle is a Bloomberg View columnist. She wrote for the Daily Beast, Newsweek, the Atlantic and the Economist and founded the blog Asymmetrical Information. She is the author of "“The Up Side of Down: Why Failing Well Is the Key to Success.”
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Michael Kinsley once famously defined a gaffe as when a politician says what he or she truly believes (i.e., "a gaffe occurs not when a politician lies, but when he tells the truth"), a formulation so iconic that it is now known in the trade as a "Kinsley Gaffe." A special subcategory of Kinsley Gaffe is becoming more common in these days of ubiquitous personal electronics: "accidentally telling the truth without knowing a camera or a tape recorder was running." This is the category where we'd put Obama's remarks about "bitter" working-class voters who "cling to guns or religion or antipathy to people who aren't like them"  and Mitt Romney's complaint about "the 47 percent."

Jonathan Gruber, one of the architects of Obamacare, has now made two such gaffes: once, when he insisted it was ridiculous to think that anyone could ever have thought that subsidies would only be available on state exchanges, only to be confronted with one audio and one video clip of himself saying that very thing in 2012. And again yesterday, when footage surfaced of Gruber making some awkward remarks about the design of Obamacare at a  an event a year ago in Philadelphia:

This bill was written in a tortured way to make sure CBO did not score the mandate as taxes. If CBO scored the mandate as taxes, the bill dies. Okay, so it’s written to do that. In terms of risk rated subsidies, if you had a law which said that healthy people are going to pay in -- you made explicit healthy people pay in and sick people get money, it would not have passed … Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter or whatever, but basically that was really really critical for the thing to pass … Look, I wish Mark was right that we could make it all transparent, but I’d rather have this law than not.

This is undoubtedly true, and critics of the law have been saying as much for years. Nor is it only true of Obamacare. As Steve Teles of Johns Hopkins has been arguing for a while, the American system increasingly favors byzantine laws that do things in complicated, opaque ways rather than better, simpler, more transparent ways. We prefer 1,000 tax credits to a few direct subsidies, mandates rather than government provision, hidden costs rather than direct ones. Teles calls this "kludgeocracy," and not in an affectionate way.

A good argument can be made that Obama has gone further down this road than most, in part because he favored big technocratic bills that aimed to do a lot of everything that experts and the party base wanted done, rather than simpler and more targeted initiatives. But you need only look at the bizarre "donut hole" in Medicare Part D coverage created under President George W. Bush to dispel the notion that this is somehow unique to Obama's administration.

As I was discussing last week with one of my colleagues here at the University of Chicago's Institute for Politics, the fetish for opacity and complexity may have come back to bite Obama this election. Giant bills with a lot of moving parts were harder for critics to target with concerted attacks.  On the other hand, they were also really hard to sell on the campaign trail.  

To see what I mean, try this exercise: Name the five most important things about the stimulus. If my informal survey is any guide, then you probably stalled out after the $800 billion pricetag, and the federal highway money.  In fact, the stimulus did a lot of things, from providing funds to install electronic medical records in physician offices, to cutting payroll taxes. That was the problem: It did too many things for anyone to remember. What they remembered was the price tag, and the signs on the highway that heralded another hour stuck in traffic.

So too, with Obamacare.  They wanted a massive overhaul of the whole system, but they couldn't do that cleanly, so they jammed a bunch of complicated mechanisms into one sort-of-working bill.  You may like the goal of Obamacare, or you may not. Either way, you probably wouldn't choose this particular method of implementation, which is simultaneously less comprehensive, more expensive and more annoying than many other methods they could have chosen. Even its supporters don't really think of it as a second-best solution; more like eighth-best. This made it very difficult to communicate to people what Obamacare was going to do, and in fact many of the things they ended up communicating instead, like "If you like your doctor, you can keep your doctor" turned out to be false. This probably didn't help Democrats in the midterm elections.

It also made the administration's job harder in the legal cases. Most notably, in the first round of lawsuits that ultimately reached the Supreme Court, the solicitor general attempted to argue that the individual mandate was like a tax, for legal purposes, but also not a tax. This got him some laughs from the bench, and some questions about why the people who wrote the law had repeatedly insisted that it wasn't a tax.  

This is a good lesson for Republicans, should they get back into the White House, and for Democrats, if they should earn another round: Keep It Simple, Stupid. The temptations of Rube Goldberg Policy should be shunned. It is bad policy, for one thing: vulnerable to breakdown, hard to fix and full of unintended consequences. But it isn't even good politics in the long run. You end up with a landmark bill that has to be pitched to voters in graphic novel format. Presumably, the next round of health-care policy making will have its own YA series, with the movies to star Jennifer Lawrence and Justin Bieber.

I know this is going to sound crazy -- heck, it sounds crazy even to me -- but what if our next president stood up and announced what she wanted to do, explained why she wanted to do it, and explained exactly what -- and who -- it would cost? Then if people seemed to like it, they would do it, and if they didn't like it, after all due consideration, the president would say, "I hear you," and go do something else, rather than attempting to camouflage the unpopular bits as something else? We'd have better policy, for sure. We might even have better elections. And for sure, there wouldn't be so much shock and awe when someone actually tells us the truth about our laws.

This column does not necessarily reflect the opinion of Bloomberg View's editorial board or Bloomberg LP, its owners and investors.

To contact the author on this story:
Megan McArdle at mmcardle3@bloomberg.net

To contact the editor on this story:
James Gibney at jgibney5@bloomberg.net