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First Thoughts: The Four Years War

The health-care political fight has become a Four Years War, and that hasn’t been good for either side… Sebelius on the hot seat as she testifies before House Energy and Commerce Committee beginning at 9:00 am ET… Obama speaks in Boston at 3:55 pm ET to make two health-care arguments: 1) implementation got off to a slow start there, too; and 2) the experience shows that reform can work… Misleading rhetoric on health care all around… New national NBC/WSJ poll comes at 6:30 pm ET… National Review vs. Erick Erickson and how it illustrates the divide inside the GOP… And new Quinnipiac poll shows McAuliffe up by just four points, 45%-41%.

*** The Four Years War: Health and Human Services Secretary Kathleen Sebelius testifies on Capitol Hill today about the health-care website’s rocky rollout, while President Obama heads to Massachusetts to remind the public that implementing health-reform there didn’t go smoothly at first, either. Given these two events -- as well as the partisan back-and-forth over the law -- it’s worth emphasizing that this health-care war has now lasted four-plus years. There was the drafting of the law during 2009-2010. The 2010 midterms. The 2012 Supreme Court fight. The 2012 presidential race. Now the implementation battle of 2013. And it’s worth noting that this “Four Years War” hasn’t been good for either side. For the White House and Democrats, it has distracted from other second-term priorities they’d rather talk about (like the economy or immigration reform). Does anyone think Obama would be in Boston today if implementation was going swimmingly? What’s more, the rocky rollout has only helped to reinforce the idea that government isn’t very efficient and can sometimes be incompetent. For Republicans, the current story has been a blessing (masking the party’s ideological struggles), and they would like nothing more than for the 2014 midterms to be about health care. But what they are doing is litigating the past rather than telling Americans where they would like to take the country. Remember, the GOP’s low poll numbers were coming out well before the government shutdown. The party is simply being defined by what it is NOT for; it is very hard to explain to the average American what the Republican Party stands for these days.

Health and Human Services Secretary Kathleen Sebelius arrives in the Rose Garden of the White House in Washington, Monday, Oct. 21, 2013, for and event with President Barack Obama on the initial rollout of the health care overhaul. Evan Vucci / AP

*** Sebelius on the hot seat: As mentioned above, HHS Secretary Sebelius testifies before the House Energy and Commerce Committee beginning at 9:00 am ET. As NBC’s Daniel Arkin notes, Sebelius will acknowledge the problems with the federal health-care website and pledge to fix them, according to her advance testimony. "The initial consumer experience of HealthCare.gov has not lived up to the expectations of the American people and is not acceptable," she is expected to say. "We are committed to fixing these problems as soon as possible." More from the secretary: "By enlisting additional technical help, aggressively monitoring errors, testing to prevent new issues from cropping up, and regularly deploying fixes to the site, we are working to ensure consumers' interaction with HealthCare.gov is a positive one, and that the Affordable Care Act fully delivers on its promise." Essentially, Sebelius will be saying much of the same thing the head of CMS said yesterday, except today the questions will be even more pointed and Sebelius’ answers will be even more scrutinized. This is a big credibility test for the secretary, who needs a good performance if simply to restore confidence about her abilities inside the West Wing, let alone for the public.

*** Obama: Remember Romneycare? Meanwhile, President Obama delivers remarks at 3:55 pm ET from Faneuil Hall in Boston, where the Massachusetts health-reform was signed into law in 2006. He is expected to make two arguments: 1) implementation got off to a slow start there, too (with just 123individuals signing up for coverage in the first month of enrollment); and 2) that the experience there shows that health-care reform can work. But as NBC’s Ali Weinberg notes, there was ONE BIG difference between what Massachusetts passed and what Obama signed into law: The Massachusetts law was a bipartisan effort, and both Democrats and Republicans worked to ensure it was implemented well. "I think part of the reason it went well here in Massachusetts is because we had such wide agreement that it was a good idea," said Jonathan Gruber, professor of economics at MIT and a key adviser for both the Romney and Obama health-care plans. Gruber said he still has confidence that the tide of public opinion will turn in favor of the national health law. "I believe enough in the laboratories of democracy in America that the fact that it's going to go well in some states is going to put pressure on these other states to realize they're denying their citizens the fundamental value of the Affordable Care Act," he said. That said, don’t miss this Boston Globe headline greeting Obama today: “Beseiged President Obama heads to Boston.”

*** Misleading health-care rhetoric all around: As we wrote yesterday, President Obama put himself into a corner when he declared, “If you like your health-care plan, you’ll be able to keep your health-care plan, period.” It was a promise, as we’ve discovered, that was impossible to keep, particularly given the small fraction of Americans who buy their insurance on the individual market. And then there was promise the administration made regarding the website; in fact, during briefings with reporters and lawmakers, they were almost bragging about how good the website was going to be. But let’s not forget all of the misleading and dishonest rhetoric in this entire health-care debate. “Socialism!” (when it turns out that private insurance companies are the ones providing the coverage). “Death panels!” (when that was never true). “Obama is cutting your Medicare” (when the cuts were to providers rather than beneficiaries and when House Budget Committee Chairman Paul Ryan adopted those same cuts to help balance his budget). There’s no doubt that the president’s promise deserves scrutiny -- even three or four years later – but let’s not pretend they occurred in a vacuum, either. It’s a reminder that the health-care debate over the last four years has usually focused more on side issues than the heart of the actual law. And too many times, over-the-top things were said in order to deal with the politics of the moment rather than actually debate the law itself.

*** NBC/WSJ poll day! What are Americans’ impressions of the health-care rollout? What are their attitudes about Obama and Republicans two weeks after the government shutdown? Tune in beginning at 6:30 pm ET for answers from our brand-new NBC/WSJ poll.

*** National Review vs. Erick Erickson…: The intense scrutiny over the health-care website and law has obscured another political story over the last few days: The ideological civil war inside the Republican Party is well underway. In addition to the Senate Conservative Fund airing a new TV ad against Mitch McConnell in Kentucky, National Review is now battling with prominent conservative blogger Erick Erickson. In National Review, editors Ramesh Ponnuru and Rich Lowry penned a long piece arguing that in order to enact change, conservatives need to win elections – and thus broaden their appeal. “There aren’t enough conservative voters to elect enough officials to enact a conservative agenda in Washington, D.C. — or to sustain them in that project even if they were elected. The challenge, fundamentally, isn’t a redoubling of ideological commitment, but more success at persuasion and at winning elections.” That prompted a response from Erickson, who charged that National Review is choosing to sit either with the establishment or on the sidelines. “Like much of the Republican Leadership, National Review wants to win majorities before unleashing hell, but history shows us repeatedly that Republicans never unleash hell once they have the majority. They become well-fed denizens of power, using it to reward friends and influence people, instead of willingly surrendering it to shrink the leviathan.”

*** … and how it illustrates the divide inside the GOP: The divide here between National Review and Erickson perfectly illustrates the real fight inside the GOP and conservative movement. Half believe what National Review believes -- that conservative change will have to be incremental and will have to be achieved by winning elections. But the other half believe Erickson’s point -- that every time Republicans win the White House (whether it’s Reagan or Bush), they expand the size of government.

*** New poll shows McAuliffe up by just four points: Lastly, the final Quinnipiac poll in the Virginia gubernatorial race has brightened the mood at Cuccinelli headquarters. The poll shows Terry McAuliffe (D) leading Ken Cuccinelli (R) by just four points among likely voters, 45%-41%, with Libertarian Robert Sarvis getting 9%. That four-point spread is smaller than the 12-point advantage McAuliffe had in the Washington Post poll, or the eight-point edge he had in the NBC4/NBC/Marist poll. That said, when you’re highlighting a poll showing you down by four points, you aren’t in the driver’s seat.

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