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Health care debate has trust, politics themes, too

Wednesday - 12/11/2013, 11:08am  ET

FILE - In this Nov. 13, 2013 file photo, House Oversight Committee Chairman Rep. Darrell Issa, R-Calif., holds up a checklist related to the preparation for the implementation of the Obamacare healthcare program, and specifically, the HealthCare.gov website, on Capitol Hill in Washington. For two months, the talk was all about computer code. About response times. About glitches and bugs. Issa, who misses no opportunity to investigate perceived shortcomings in the health care program, devoted a full hearing to the "limitations of Big Government" when it comes to health care. (AP Photo/J. Scott Applewhite, File)

NANCY BENAC
Associated Press

WASHINGTON (AP) -- For months, the talk was all about computer code. About response times. About glitches and bugs.

People who didn't know a URL from an http were blithely expounding on software snags and web design, thanks to the clunky launch of healthcare.gov, the insurance marketplace for the government's big health care overhaul.

With the website improving and tech chatter settling down, the conversation about the Affordable Care Act, or "Obamacare," is turning in other directions.

It's about trust. It's about big government. It's about politics. And, oh yeah, it's about your health care, too.

WOULD YOU BUY A USED CAR FROM THIS MAN?

Or an agenda? The debate over President Barack Obama's health care law has gradually morphed into a broader discussion about whether he is to be trusted. It's a critical question for Obama, who could always rely on strong ratings on his leadership and personal qualities, even if people did not agree with his policies.

It turned out that the confidence he exuded prior to the disastrous launch of the health care exchanges was misplaced. Then came revelations that, despite Obama's assurances that people could keep their plans if they liked them, millions of Americans faced insurance policy cancellations. Now Republicans are highlighting questions about whether people will be able to keep their doctors.

Obama has tried to head off the cancellations by giving insurance companies more flexibility. But Republicans have been only too happy to pound him for broken promises, and to insist that he knew all along what would happen.

The debate has taken a toll on the president's credibility. A Quinnipiac University survey of registered voters last month found the share of Americans who thought Obama was honest and trustworthy had fallen 10 percentage points over the fall, to just 44 percent.

The health care launch "turned out to have moral dimensions as well as policy dimensions," says Robert Blendon, a Harvard professor of health policy and political analysis. Obama "really has to restore confidence in himself. He's got an agenda for the rest of his term here."

And Republicans will be sure to ask at every turn why Americans should take the president at his word on immigration reform or budget policy or any other big issue if he led them astray on health care.

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THE BIG G

The struggle over Obama's health care law has reinvigorated a debate that's been going on for centuries and never seems to get settled: the core question of what government should or shouldn't do for people, and how it should spend their money.

For years now, Republicans have displayed remarkable message discipline in zinging the Obama White House for creating a "government-centered health care delivery system," arguing that the matter would be better left largely to private forces. The failed website sign-up launch generated a whole new round of head shaking about government overreach.

Rep. Darrell Issa, the California Republican who misses no opportunity to investigate perceived shortcomings in the overhaul, devoted a hearing last week to the "limitations of Big Government" when it comes to health care.

"By its very design, the federal government may never be efficient or effective or innovative enough to carry out big initiatives like Obamacare, nor should it be," he says.

It's the antithesis of Obama's yes-we-can philosophy that government should step in to ensure all Americans have the opportunity to thrive and succeed.

White House chief of staff Denis McDonough sees "a strange case of nostalgia" breaking out among Republicans for the greater flexibility of the old health care system -- one that he says "covered too few people in a maddeningly inefficient and often heartbreaking and ultimately very expensive way."

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FULL-THROTTLE POLITICS

The law is more than three years old, but there's nothing past-tense about the politics. Both parties are expecting an epic dust-up over the law in next year's congressional elections and are already gearing up for it.

"Obamacare is the center of the universe as it relates to 2014 because so many Republicans believe it is the perfect vehicle to argue a whole host of issues," says GOP strategist Kevin Madden. Matters of trust, competence, big government and more will be framed by that one topic.

Whether Democratic candidates want to talk about the health care law or not, party strategists are preparing a full-throated case supporting it. They're talking up the benefits that Americans seem to like, or will, once they know them, and assembling examples of people helped by the changes to counter the tales of horror coming from the GOP.

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