Obama, Pure Bullshit

September 9, 2009, speech to Congress. Four promises. The caption adds the fifth: it wasn't just “if you like your doctor.”

The $4 trillion. He said that if health costs slowed by a tenth of a percent a year, the plan would cut the deficit by $4 trillion over the long term. The reel drops the “if.” CBO never scored the law at $4 trillion. In March 2010 it scored the bill, as written, at a $124 billion deficit cut over 2010–2019. About $70 billion of that window was the CLASS long-term-care program. Health and Human Services said in 2011 it could not be run. Congress repealed it in January 2013. The $4 trillion never showed up in the budget.

“Waste and inefficiency” did not pay for it. The money on the score was Medicare payment cuts, new taxes, and that CLASS line. Medicare’s actuary said the same cuts were being used twice: once to pay for the new coverage, and once to say the hospital trust fund would last longer. You do not get to spend the cut and also save it.

Costs did not slow for the people paying them. Kaiser’s employer survey put the average family premium at $13,375 in 2009. The worker’s share was $3,515. In 2024 the family premium was $25,572, and the worker’s share was $6,296. That is not a tenth of a percent a year.

The fail-safe was the Independent Payment Advisory Board. If Medicare spending beat a target, the board was supposed to send Congress cuts. Obama never appointed a member. The board never met. Congress repealed it on February 9, 2018, before it could be triggered. The taxes that were supposed to hold the math together went the same way. The 2017 tax law set the individual-mandate penalty to zero. The Cadillac tax never took effect and was repealed in 2019. The medical-device tax was suspended, then repealed the same year. When the savings did not show up, nobody came forward with more cuts. They took the pay-fors off the books.

The plan line is the one with the paperwork. He said “if you like your health care plan, you can keep it” at least 37 times, with no caveat. In the fall of 2013, insurers sent cancellation notices to about 4 million people. PolitiFact named the line its Lie of the Year. He then said he had meant you could keep it only if the plan had not changed since the law passed. That was not what he had said. In November 2013 he apologized. Keeping the doctor was the same promise with a narrower network on the other end of it.